Delaware residents enrolled in Medicare Advantage in 2026 have 37 plans to choose from statewide, up from 35 plans in 2025, according to the CMS Medicare Open Enrollment fact sheet for Delaware. Of the state's 249,786 Medicare beneficiaries, an estimated 82,000 (about 33%) are enrolled in a Medicare Advantage plan rather than Original Medicare, a penetration rate well below the national 2026 average of 55%. The statewide average monthly premium is $17.11 in 2026, higher than the roughly $14 national MA average.
Delaware stands out for two reasons. First, the state has one of the highest shares of residents age 65 and older in the country (about 211,000 people, 21.3% of the population), driven partly by retirees settling in the Rehoboth Beach and Lewes areas of Sussex County. Second, despite that large senior population, Delaware's Medicare Advantage penetration trails the national average, leaving room for continued carrier competition. No single carrier dominates: Highmark Blue Cross Blue Shield Delaware, Humana, UnitedHealthcare, Aetna, Cigna Healthcare, and Wellcare all compete across the state's three counties (New Castle, Kent, and Sussex), and Kaiser Permanente does not operate in Delaware.
Delaware's Medicare Advantage market for 2026 is covered in detail below: how many plans, which carriers, what to look for when shopping, and the key enrollment dates. The Annual Election Period runs October 15 to December 7, 2026, with coverage starting January 1, 2027.
2026 Medicare Advantage Market Overview in Delaware
In 2026, Delaware has 37 Medicare Advantage plans available, with 82,000 beneficiaries enrolled (33% MA penetration). The average monthly premium is $17 and the statewide average Star Rating is 3.8.
Top Medicare Advantage carriers in Delaware (2026)| Carrier | Plans | Avg Star Rating | Avg Premium |
|---|
| Humana | 9 | 4.0 | $18/mo |
| UnitedHealthcare | 8 | 3.5 | $15/mo |
| Aetna | 7 | 4.0 | $12/mo |
| Highmark Blue Cross Blue Shield Delaware | 6 | 4.0 | $22/mo |
| Cigna Healthcare | 4 | 3.5 | $28/mo |
| Wellcare | 3 | 3.0 | $5/mo |
Source: CMS Medicare Open Enrollment Fact Sheet for Delaware 2026, KFF Medicare Advantage 2026 Spotlight
Plan Types in Delaware: HMO vs PPO vs SNP
Medicare Advantage plan-type breakdown in Delaware| Plan Type | Plans Available | Avg Premium | Best For |
|---|
| HMO | 19 | $12/mo | Lower premiums for Delaware residents willing to use in-network providers in New Castle, Kent, or Sussex County |
| PPO | 6 | $28/mo | Flexibility for Delaware residents who split time in another state part of the year |
| Special Needs Plan (SNP) | 12 | $0/mo | Dual-eligible (Diamond State Health Plan + Medicare), chronic conditions, institutional care |
HMO plans make up roughly half of Delaware's 37 Medicare Advantage plans in 2026. Delaware's Special Needs Plan enrollment is unusually concentrated in Chronic Condition SNPs (C-SNPs), which account for more than 40% of statewide SNP enrollment, a higher share than most states.
Source: CMS Medicare Open Enrollment Fact Sheet for Delaware 2026, CMS Medicare Plan Finder
What to Look For in a Medicare Advantage Plan in Delaware
Delaware Medicare Advantage shoppers should look past the premium sticker price in 2026. The following factors matter most when comparing plans:
- Provider network. Confirm your primary care physician, specialists, and preferred hospital (ChristianaCare, Bayhealth, or Nemours) are in-network before enrolling. Delaware's small size means many plans share overlapping hospital systems, but referral rules and copays still vary by plan.
- Prescription drug coverage (formulary). Most Delaware Medicare Advantage plans include Part D. Check that your specific medications are on the plan's formulary at a tier you can afford. The 2026 Part D out-of-pocket cap is $2,100 across all plans.
- Star Ratings. CMS rates Delaware Medicare Advantage plans 1 to 5 stars annually on quality of care, member experience, and customer service. Highmark Blue Cross Blue Shield Delaware and Aetna typically post the state's higher ratings, around 4.0 stars, while smaller low-premium carriers often rate lower.
- Extras (dental, vision, hearing, transportation). Delaware Medicare Advantage plans vary widely on supplemental benefits. Several plans include free rides to medical appointments, useful for Sussex County residents who live far from Wilmington's larger hospitals.
- Maximum out-of-pocket (MOOP). Medicare Advantage plans cap your annual in-network out-of-pocket spending. The 2026 federal MOOP ceiling for in-network MA is $9,250 (down $100 from $9,350 in 2025); Delaware plans commonly set it lower. Original Medicare has no MOOP.
- Prior authorization burden. Delaware Medicare Advantage plans can require prior authorization for surgeries, advanced imaging, and specialist referrals. If you manage a chronic condition, ask each carrier how often it requires prior authorization and review denial rates published by CMS.
Key Medicare Dates in Delaware
Delaware Medicare and Medicare Advantage enrollment follow several federal windows in 2026. Missing them can mean delays or, in some cases, late enrollment penalties.
- Annual Election Period (AEP): October 15 - December 7, 2026 — Switch between Original Medicare and Medicare Advantage, change MA plans, or change Part D plans. Coverage starts January 1, 2027.
- Medicare Advantage Open Enrollment Period (MA OEP): January 1 - March 31, 2026 — If you're already enrolled in a Delaware Medicare Advantage plan, you can switch to a different MA plan or return to Original Medicare. One switch only.
- Initial Enrollment Period (IEP): 7-month window around your 65th birthday — Starts 3 months before your 65th birthday month, includes the birth month, and runs 3 months after. Enroll in Medicare Parts A and B, then choose Medicare Advantage or Original Medicare plus Part D.
- Special Enrollment Periods (SEPs): Varies by qualifying event — Triggered by moving out of your plan's service area, losing employer coverage, qualifying for the Diamond State Health Plan (Delaware Medicaid), or other life events. Typically a 2-3 month window.
Notable Extras in Delaware Plans
Delaware Medicare Advantage plans include several state-specific features worth knowing about in 2026:
- Diamond State Health Plan dual-eligible coverage: Delaware residents who qualify for both the Diamond State Health Plan (Delaware's Medicaid program) and Medicare are dual eligible. Dual-eligible Delawareans can enroll in a Dual Special Needs Plan (D-SNP), which coordinates both programs into one plan and typically carries $0 premiums and $0 copays for primary care. Highmark Health Options, AmeriHealth Caritas, and Delaware First Health manage Diamond State Health Plan Medicaid coverage alongside Medicare D-SNPs.
- Unusually high C-SNP share: Delaware's Special Needs Plan enrollment leans more heavily toward Chronic Condition SNPs (C-SNPs) than most states: more than 40% of Delaware's SNP enrollees are in C-SNPs designed for conditions like diabetes, heart failure, or chronic lung disease, compared with dual-eligible D-SNPs dominating enrollment nationally. If you manage a qualifying chronic condition, ask your carrier whether a C-SNP is available in your county.
- Delaware Medicare Assistance Bureau (DMAB) counseling: Delaware's State Health Insurance Assistance Program is the Delaware Medicare Assistance Bureau (DMAB), housed within the Delaware Department of Insurance. DMAB counselors offer free, one-on-one help comparing Medicare Advantage, Medigap, and Part D options at 1-800-336-9500.
- Small three-county market simplifies comparison: Delaware has only three counties (New Castle, Kent, and Sussex), so residents can review nearly every statewide Medicare Advantage plan with a single ZIP code search at medicare.gov, unlike larger states where plan availability shifts dramatically county to county.
Medicare Advantage vs Original Medicare in Delaware
Delaware residents choosing between Original Medicare and Medicare Advantage in 2026 face a real tradeoff. Original Medicare (Parts A and B) plus a Medigap supplement and a standalone Part D drug plan gives nationwide provider freedom and no prior authorization for most services, but Medigap plus Part D premiums in Delaware commonly run $150 to $350 per month. Medicare Advantage plans bundle hospital, medical, and usually drug coverage into one plan with a statewide average premium of $17.11 per month in 2026, though the tradeoff is a defined provider network and prior authorization requirements for many services.
Delaware residents who winter outside the state, or who need frequent access to specialists in Philadelphia or Baltimore, often find Original Medicare plus Medigap the better fit because Medigap coverage travels nationwide. Residents who stay in Delaware year-round and want lower premiums plus extras like dental, vision, and transportation typically find Medicare Advantage wins on total cost.
One practical note for Delaware: federal rules let you switch from Medicare Advantage back to Original Medicare during AEP or MA OEP, but Medigap insurers are not required to sell you a policy at that point unless you have a guaranteed issue right. Delaware does not have an annual Medigap birthday rule like some states, so once your initial Medigap open enrollment window closes, buying a Medigap policy after leaving Medicare Advantage can require medical underwriting. Plan ahead before you enroll in MA if you might want Medigap later.
How Star Ratings work in Delaware
Delaware Medicare Advantage Star Ratings, like every state's, are published by CMS every October, rating plans 1 to 5 stars based on roughly 40 quality measures covering chronic condition management, member experience, customer service, and Part D drug safety. Plans rated 4 stars or higher receive quality bonus payments from CMS, which often translate into richer benefits the following plan year.
Delaware's statewide weighted-average Star Rating for 2026 is approximately 3.8, close to and slightly above the national average, which CMS reported fell to roughly 3.65 for the 2026 ratings released in October 2025. Highmark Blue Cross Blue Shield Delaware and Aetna post some of the state's stronger ratings, near 4.0 stars, while smaller, low-premium carriers such as Wellcare typically rate closer to 3.0. A 5-star plan, if one becomes available in Delaware, would trigger a Special Enrollment Period letting you switch into it any time of year.
How to enroll in Delaware Medicare Advantage
Delaware residents enrolling in Medicare Advantage in 2026 follow the same federal process as the rest of the country, with a few Delaware-specific resources worth using. Start at medicare.gov/plan-compare, where CMS publishes a personalized plan finder tool keyed to your ZIP code across all three Delaware counties.
Common reasons Delaware Medicare Advantage applications are delayed or denied: late Part B enrollment (no active Part B on file), a home address outside the plan's service area within New Castle, Kent, or Sussex County, missing Diamond State Health Plan eligibility documentation for a D-SNP application, identity verification mismatches, and applying for a plan type you don't qualify for, such as a C-SNP without a documented qualifying chronic condition.
- Step 1: Confirm Medicare Part A and Part B eligibility. You must already be enrolled in both before joining a Delaware Medicare Advantage plan. If you're newly turning 65, your Initial Enrollment Period covers this step.
- Step 2: Gather your documents. You will need your Medicare card (showing your Medicare number and Part A/B effective dates), your ZIP code (for plan availability in New Castle, Kent, or Sussex County), a list of current prescriptions (for formulary lookup), a list of current doctors and hospitals (for network check), and your Diamond State Health Plan card if you are dual-eligible.
- Step 3: Compare plans at medicare.gov/plan-compare. Filter by your ZIP code and sort by Star Rating, monthly premium, total estimated annual cost, or maximum out-of-pocket. Delaware residents can also call the Delaware Medicare Assistance Bureau (DMAB) at 1-800-336-9500 for free, unbiased counseling.
- Step 4: Apply. You can enroll directly through medicare.gov, by calling 1-800-MEDICARE (1-800-633-4227), or through the carrier directly. Most online enrollments take 10 to 15 minutes.
- Step 5: Confirm your coverage start date. AEP enrollments in Delaware start coverage January 1, 2027. SEP enrollments typically start the first of the month after you enroll. You will receive a member ID card and Evidence of Coverage from the carrier within 7 to 10 business days.
$0 premium plans in Delaware for 2026
Delaware has a growing number of $0 monthly premium Medicare Advantage plans in 2026, concentrated among Humana, Aetna, and Wellcare offerings across New Castle, Kent, and Sussex counties. A $0 premium does not mean $0 cost: Delaware enrollees still pay the Part B premium ($202.90 per month in 2026) plus any drug copays, deductibles, and out-of-pocket costs the plan charges.
$0 premium plans in Delaware for 2026 detail| Carrier | Plan Type | Star Rating | Counties Available |
|---|
| Humana Gold Plus HMO | HMO | 4.0 | New Castle, Kent, Sussex |
| UnitedHealthcare AARP Medicare Advantage | HMO | 3.5 | New Castle, Kent, Sussex |
| Aetna Medicare Eagle HMO | HMO | 4.0 | New Castle |
| Wellcare No-Premium HMO | HMO | 3.0 | New Castle, Kent |
| Highmark Blue Cross Blue Shield Delaware D-SNP | SNP | 4.0 | New Castle, Kent, Sussex (dual-eligible only) |
Sample of $0 premium Medicare Advantage plans in Delaware for 2026. Exact plan availability and Star Ratings vary by ZIP code; run a personalized search at medicare.gov to confirm what's offered where you live.
Source: CMS Medicare Plan Finder Q4 2025, Delaware carrier filings
Delaware's Diamond State Health Plan and dual eligibility
Delaware residents who qualify for both the Diamond State Health Plan (Delaware's Medicaid program) and Medicare can enroll in a Dual Special Needs Plan (D-SNP), a type of Medicare Advantage plan built specifically for dual-eligible beneficiaries. D-SNPs coordinate Medicare and Diamond State Health Plan benefits into one plan, typically with $0 premiums, $0 primary care copays, and no out-of-pocket prescription costs for eligible enrollees.
Dual eligibility also unlocks a special enrollment right: dual-eligible Delaware residents can change Medicare Advantage plans, or move between Medicare Advantage and Original Medicare, once per quarter in the first three quarters of the year, plus again during AEP. If your Diamond State Health Plan eligibility status changes, you also qualify for a Special Enrollment Period to adjust your coverage.
Frequently Asked Questions
How many Medicare Advantage plans are available in Delaware in 2026?
Delaware has 37 Medicare Advantage plans available statewide in 2026, according to the CMS Medicare Open Enrollment fact sheet for Delaware, up from 35 plans in 2025. Because Delaware has only three counties (New Castle, Kent, and Sussex), most of these plans are available across a wide area of the state rather than concentrated in a single metro. Run a ZIP-code search at medicare.gov to see your exact 2026 options.
What is the average Medicare Advantage premium in Delaware for 2026?
The statewide average Medicare Advantage premium in Delaware is $17.11 per month in 2026, according to CMS, slightly higher than the roughly $14 national MA average. Several Delaware carriers, including Humana, Aetna, and Wellcare, offer $0 monthly premium HMO plans, though enrollees still pay the Part B premium ($202.90 per month in 2026) and any plan cost-sharing.
When can I sign up for Medicare Advantage in Delaware?
The main enrollment window is the Annual Election Period (AEP) from October 15 to December 7, 2026, for coverage starting January 1, 2027. You can also enroll during your 7-month Initial Enrollment Period around your 65th birthday, or during a Special Enrollment Period triggered by moving, losing employer coverage, or qualifying for the Diamond State Health Plan. Existing Delaware Medicare Advantage enrollees can switch plans during the MA Open Enrollment Period (January 1 to March 31, 2026).
Who has the best Medicare Advantage plans in Delaware?
Highmark Blue Cross Blue Shield Delaware and Aetna typically post Delaware's higher Star Ratings, both close to 4.0 stars for 2026. Humana offers the broadest plan lineup and strong $0-premium HMO options. The best plan for you in Delaware depends on your doctors, your medications, and whether you value a low premium or a wider provider network.
Can I switch from Medicare Advantage back to Original Medicare in Delaware?
Yes. Delaware residents can switch back during the Annual Election Period (October 15 to December 7, 2026) or the Medicare Advantage Open Enrollment Period (January 1 to March 31, 2026). Returning to Original Medicare does not automatically guarantee you can buy a Medigap policy, since Delaware does not have an annual Medigap birthday rule; insurers can require medical underwriting outside your initial Medigap window unless you have a guaranteed issue right. Plan ahead before switching.
What is the difference between an HMO and a PPO in Delaware Medicare Advantage?
HMOs make up about half of Delaware's 37 Medicare Advantage plans in 2026 (19 plans) and require you to use in-network providers, usually with a referral to see a specialist. HMOs offer lower premiums, averaging about $12 per month. PPOs (6 plans) let you see out-of-network providers at a higher cost share and don't require referrals, but charge higher premiums, averaging about $28 per month. Choose HMO for lower in-network cost; choose PPO for flexibility, especially if you split time outside Delaware.
Does Medicare Advantage cover prescription drugs in Delaware?
Most Delaware Medicare Advantage plans bundle Part D prescription drug coverage, making them MA-PD plans. The 2026 Part D annual out-of-pocket maximum is $2,100 across all plans, set by the Inflation Reduction Act. Always check a Delaware plan's formulary before enrolling to confirm your specific medications are covered and at what tier.
Are dental, vision, and hearing covered by Medicare Advantage in Delaware?
Most Delaware Medicare Advantage plans include some dental, vision, and hearing benefits that Original Medicare does not cover. Coverage varies widely by carrier: some Delaware plans cover only routine cleanings and exams, while others cover crowns, hearing aids, and prescription eyewear. Always check the plan's Evidence of Coverage for annual dollar limits and what's actually included.
What is a Special Needs Plan (SNP) and who qualifies in Delaware?
A Special Needs Plan (SNP) is a type of Medicare Advantage plan designed for people with specific needs. Delaware offers 12 SNP plans in 2026 across three categories: Dual Special Needs Plans (D-SNPs) for people who qualify for both Medicare and the Diamond State Health Plan, Chronic Condition SNPs (C-SNPs) for people with qualifying conditions like diabetes or heart failure, and Institutional SNPs (I-SNPs) for people living in a nursing home or similar facility. Delaware is unusual in that more than 40% of its SNP enrollment is in C-SNPs, a higher share than most states, where D-SNPs typically dominate.
