Medicare in Delaware & Washington, D.C. (2026): Plans, Costs & How to Choose

If you are turning 65 in Delaware or the District of Columbia - or you have retired to Wilmington, Dover, the Sussex County beaches or a rowhouse on Capitol Hill - Medicare can feel like a wall of mailers and acronyms. Parts A, B, C and D. Advantage versus supplement. Networks, formularies and enrollment windows that each seem to have their own rules. It is a lot, and most of it lands in your mailbox at once.

Here is the reassuring truth up front: Medicare works exactly the same way in Delaware and Washington, D.C. as it does everywhere else in the country, because it is a federal program. What differs is the local plan menu - which private plans are sold where you live, at what price, and with which doctors and hospitals in network - and, for anyone under 65, how each place runs its Affordable Care Act (ACA) marketplace. On that last point the two markets go in opposite directions, and we will explain exactly how.

We wrote this as a single guide because Delaware and the District are both small, licensed markets we serve, and they are neighbors in the same Mid-Atlantic region - yet they are structured differently enough that comparing them side by side makes each one clearer. This article is the narrative companion to our data pages for Medicare & health insurance in Delaware and Medicare & health insurance in Washington, D.C., which keep the plan-by-plan numbers in one place. Read this to understand the concepts; use those pages when you want the hard figures.

Medicare basics for both markets

Medicare is the federal health insurance program for people 65 and older, and for some younger people with disabilities or specific conditions. It is not small even in small places: about 245,324 Delawareans were enrolled in Medicare as of the latest CMS count, roughly 78,252 of them in Medicare Advantage or other private plans; the District of Columbia had about 97,234 Medicare beneficiaries. Wherever you live, the program is built from four "parts," and understanding them is the foundation for every decision that follows.

The four parts, in plain English

• Part A (hospital insurance) covers inpatient hospital stays, skilled nursing care after a hospital stay, hospice and some home health care. Most people pay no premium for Part A because they or a spouse paid Medicare taxes while working.
• Part B (medical insurance) covers doctor visits, outpatient care, preventive services, lab tests and durable medical equipment. Nearly everyone pays a monthly premium for Part B - $202.90 in 2026, per the Centers for Medicare & Medicaid Services (CMS). Higher earners pay more through an income-related adjustment, which we explain in our guide to Medicare IRMAA for 2026.
• Part C (Medicare Advantage) is private insurance that bundles Parts A and B - and usually Part D drugs - into a single plan, often with extras like dental and vision.
• Part D (prescription drugs) covers outpatient medications, either as a stand-alone plan paired with Original Medicare or built into a Medicare Advantage plan.

Together, Parts A and B are called Original Medicare - the traditional, government-run program. From there, you build the rest of your coverage in one of two directions, which we compare in detail below. If you would like our own plain-language overview of all of this, see our Medicare coverage page.

Who qualifies, and signing up

You are generally eligible for Medicare if you are age 65 or older and a U.S. citizen or lawful permanent resident, if you are under 65 and have received Social Security Disability Insurance for 24 months, or if you have End-Stage Renal Disease or ALS. If you already receive Social Security benefits before 65, you are typically enrolled in Parts A and B automatically, and your red-white-and-blue Medicare card arrives in the mail. If you are not yet drawing Social Security - increasingly common as more people delay claiming - you must actively enroll through the Social Security Administration during your Initial Enrollment Period. We break the timing down in the enrollment section below.

The two paths: Original Medicare + Medigap vs. Medicare Advantage

Every beneficiary in Delaware or the District ultimately picks one of two structures. There is no universally "best" answer - each distributes cost, freedom and risk differently. We cover this trade-off in national depth in our guide to Medicare Advantage vs. Original Medicare in 2026; here is how it plays out in these two markets.

Path 1: Original Medicare + Medigap + Part D

With this route you keep government-run Original Medicare and add a Medigap (Medicare Supplement) policy to pay much of the deductibles, copays and coinsurance Original Medicare leaves behind. Because Medigap plans are standardized and lettered A through N, a Plan G from one insurer covers exactly the same benefits as a Plan G from another - only the price and the company's service differ. You then add a stand-alone Part D plan for drugs. We explain the letters in our guide to Medicare Supplement plans for 2026.

The appeal is freedom and predictability. You can see any doctor or hospital in the country that accepts Medicare - the overwhelming majority do - with no networks and no referrals. That matters more than you might think in this corner of the country, because Delaware and the District sit inside a tightly packed tri-state region. A Delawarean may see specialists at hospitals in Philadelphia or Maryland; a District resident routinely crosses into suburban Maryland or Northern Virginia for care. Original Medicare plus Medigap follows you across every one of those state lines. The trade-off is a higher, steady monthly premium.

Path 2: Medicare Advantage (Part C)

With Medicare Advantage, a private insurer delivers your Part A and B benefits, usually with Part D drugs and extras like dental, vision and hearing bundled in, for a low or $0 plan premium. As the county data below shows, both markets offer a solid slate of these plans. The appeal is low cost and rich extras, plus a yearly cap on your out-of-pocket costs that Original Medicare alone does not have. The trade-off is that plans use networks and prior authorization to manage costs, and your routine care is generally tied to a local service area - a real consideration for anyone who regularly crosses into a neighboring state for a preferred specialist.

Side-by-side, whichever market you are in

Cost figures from CMS (2026) and the CY2026 plan landscape described below. General education, not a recommendation.

Delaware: all three counties

Delaware is unusually simple to map, because the entire state is only three counties: New Castle in the north (anchored by Wilmington and Newark), Kent in the middle (Dover), and Sussex in the south (Georgetown, plus the fast-growing beach towns of Lewes, Rehoboth and Millsboro). Medicare Advantage availability is set county by county, so those three counties are the whole picture. We pulled the CMS 2026 plan landscape for a representative ZIP in each - New Castle 19801, Kent 19901 and Sussex 19947 - and counted the individual MA-PD plans, how many carry a $0 plan premium, their average premium, their average in-network out-of-pocket maximum, their average Part D deductible, and how many are rated four stars or higher.

Individual MA-PD figures exclude Special Needs Plans (SNPs). MOOP = maximum out-of-pocket. Averages are enrollment-unweighted plan averages computed across the MA-PD plans listed for each county. Some newer plans are not yet star-rated, so the star column counts only rated plans. Source: CMS CY2026 Medicare Advantage / Part D Landscape, accessed via The Brain (Ambrose) platform on July 31, 2026. General education, not a recommendation for any specific plan.

A few things stand out. First, the north-south split: New Castle County has the most plans (18) and the cheapest average premium ($18.59), while smaller Kent County has fewer plans (12) at a higher average ($30.31). That is a common pattern - denser, more competitive markets often push plan premiums down. Second, roughly two-thirds of Delaware's plans carry a $0 plan premium: 27 of the 45 county plans across the three counties. Third, the average in-network out-of-pocket maximum sits around $6,900 to $7,200, which is the ceiling that separates a good fit from an expensive surprise in a heavy-care year.

Delaware's ACA marketplace: the federal HealthCare.gov

If you are 65 or older, Medicare is almost always your path and this part is not for you. But for Delawareans under 65 - early retirees, spouses not yet Medicare-eligible, or a younger family member - the key fact is that Delaware uses the federal HealthCare.gov Marketplace. The state is a single statewide rating area, so the same set of plans applies in all three counties: 39 individual plans for 2026, offered by three issuers (AmeriHealth Caritas Next, Ambetter Health of Delaware and Highmark Blue Cross Blue Shield Delaware). Many households qualify for a premium tax credit; as one illustration, a single 40-year-old with a $30,000 income could see an estimated credit of about $536 a month for 2026, though your own amount depends on income and household size. Our 2026 ACA Open Enrollment guide and the Delaware insurance page go deeper.

Washington, D.C.: a single district

The District of Columbia is even simpler to map than Delaware, because it is a single jurisdiction - one county-equivalent, no counties to compare. For 2026, CMS lists 11 individual Medicare Advantage drug plans (MA-PD) in the District, from 6 carriers: Aetna, CareFirst BlueCross BlueShield, Humana, HealthSpring, Kaiser Permanente and UnitedHealthcare. Three of the 11 carry a $0 monthly plan premium, the average in-network out-of-pocket maximum is about $6,714, the average annual Part D deductible is about $334, and 5 of the 11 hold a CMS Overall Star Rating of four stars or higher. The District's average MA-PD premium runs about $36 a month.

Because the District is one small market, it is genuinely practical to look at every plan at once - something you cannot do in a big state. Here is the full 2026 MA-PD slate, ordered by monthly premium.

All 11 non-SNP MA-PD plans listed for the District of Columbia (county-equivalent, ZIP anchor 20001). The monthly premium is the consolidated Part C + Part D plan premium. Source: CMS CY2026 Medicare Advantage / Part D Landscape, accessed via The Brain (Ambrose) platform, July 31, 2026, and confirmed against the live landscape file. General education, not a recommendation.

What the full list makes visible is a real spread of philosophies inside a tiny market. The three $0-premium plans keep monthly cost to just your Part B premium, but you accept the network and cost-sharing terms. At the other end, a plan like Kaiser's MA High DC charges $105 a month but carries the lowest out-of-pocket maximum on the board ($5,700) - you pay more each month in exchange for a lower worst-case year. And the star ratings matter: several District plans, including all three Kaiser options and Aetna Medicare Premier, sit at 4.5 stars, a strong quality signal - though a high star rating is a starting point, not a substitute for checking your own doctors and drugs.

The District's ACA marketplace: DC Health Link, not HealthCare.gov

Here is the single most important structural difference between the two markets. Washington, D.C. does not use the federal HealthCare.gov Marketplace. The District runs its own state-based exchange, DC Health Link (dchealthlink.com), where residents and small businesses shop for and enroll in individual, family and small-group (SHOP) plans, and where income-based premium tax credits are applied. If you are a District resident under 65 who needs an ACA plan, you will not find your options on HealthCare.gov - you start at DC Health Link. The District also sets its own Open Enrollment dates through that exchange, which can differ from the federal calendar.

Delaware vs. D.C. side by side

Putting the two markets in one table makes the similarities and the one big divergence obvious. Notice that the Medicare figures are simply "how many plans and at what price," while the real structural difference is in how each place handles the ACA marketplace and which free counseling program serves it.

Sources: CMS CY2026 Medicare Advantage / Part D Landscape (plan counts, premiums, MOOP); CMS Medicare Monthly Enrollment (beneficiary totals); HealthCare.gov Marketplace (Delaware plan count). Accessed via The Brain (Ambrose) platform, July 31, 2026.

Part D drug coverage in both places

Prescription coverage is where many retirees feel the most anxiety, and 2026 brings genuinely good news everywhere. Whether your Part D comes bundled inside a Medicare Advantage plan or as a stand-alone plan alongside Original Medicare, every Part D plan now includes a $2,000 annual cap on out-of-pocket prescription drug costs. Once your covered drug spending hits that ceiling, you pay nothing more for covered medications for the rest of the year - a major protection for anyone on expensive specialty drugs. We explain the mechanics in our guide to Medicare Part D for 2026.

Residents who keep Original Medicare choose from a set of stand-alone Part D (PDP) plans sold in their area - CMS lists 10 for Delaware and 10 for the District in 2026. The catch with Part D is that plans are not interchangeable. Each has its own formulary - the list of drugs it covers and the tier (and therefore the cost) of each one. A plan that is cheap for your neighbor may be expensive for you if it places one of your medications on a high tier or requires prior authorization. Comparing plans against your actual medication list, using the official Medicare Plan Finder, is the single most valuable hour you can spend each fall.

Enrollment periods and deadlines

Medicare runs on a calendar, and missing a window can cost you money or coverage. These dates are federal, so they are the same in Delaware and the District. Our full 2026 enrollment periods guide walks through each scenario in detail.

Source: Medicare.gov, accessed July 31, 2026.

Two coordination notes are worth flagging. First, the ACA marketplace calendars are not the same as Medicare's, and they are not the same as each other: Delaware follows HealthCare.gov's Open Enrollment (November 1 through January 15 for 2026 coverage), while the District sets its own dates through DC Health Link, generally beginning November 1. Second, if you are still working past 65 with employer coverage - common for the District's large federal workforce and for cross-border commuters - talk with an advisor before you delay Part B, so you use the right Special Enrollment Period and avoid a penalty. We cover those triggers in our guide to Medicare Special Enrollment Periods.

How to choose

With a slate of plans in front of you - whether it is Delaware's county menus or the District's 11-plan list - the way to avoid overwhelm is to stop shopping by premium and start shopping by your life. Work through these questions in order.

1. Start with your doctors

List the doctors and hospitals you want to keep - your primary care physician, any specialists, and your preferred hospital system. In this region that list often crosses a state line: a Delawarean may rely on ChristianaCare or a Philadelphia specialist; a District resident may see doctors at MedStar, George Washington or Johns Hopkins in nearby Maryland. If keeping specific providers matters more than anything, either confirm they are in a particular Medicare Advantage plan's network for the coming year, or choose Original Medicare plus Medigap, which lets you see any Medicare-accepting provider anywhere. Networks reset every January 1, so last year's answer does not guarantee this year's.

2. Then your prescriptions

Write down every medication and dose. Run that exact list through the Medicare Plan Finder to see which plans cover your drugs at the lowest total cost, including premiums, deductibles and copays. Two plans with identical premiums can differ by hundreds or thousands of dollars a year once your specific drugs are priced.

3. Then your geography and travel

Both Delaware and the District are compact and provider-rich, so Advantage networks are generally workable close to home. The question is how far and how often you leave. If you split time between a Sussex County beach house and elsewhere, snowbird to a warmer state each winter, or routinely cross into Maryland, Pennsylvania, Virginia or New Jersey for care, weigh that carefully. Original Medicare plus a Medigap policy carries no network at all, so it works with any provider nationwide that accepts Medicare - portability that can matter more than a low monthly premium for frequent travelers and border-crossers.

4. Then your budget and risk tolerance

Finally, weigh predictability against monthly cost. Medicare Advantage keeps monthly costs low but exposes you to copays up to the plan's out-of-pocket maximum in a heavy-care year - and in these markets that ceiling averaged around $6,700 to $7,200. Original Medicare plus Medigap costs more each month but makes a bad health year financially uneventful. Neither is "smarter" - they simply distribute cost and risk differently.

The best Medicare decision in Delaware or the District is not the cheapest plan or the one with the most extras - it is the one that keeps your doctors, covers your drugs, and reaches the places you actually live and travel. That is a personal fit, not a ranking.

DMAB, HICP and other official help

You do not have to sort this out alone, and you do not have to rely only on people who sell insurance. Both markets offer genuinely excellent free resources built for exactly this purpose.

• Delaware Medicare Assistance Bureau (DMAB) - Delaware's State Health Insurance Assistance Program (SHIP), housed in the Delaware Department of Insurance. Free, unbiased Medicare counseling from staff and volunteers who do not sell insurance.
• Health Insurance Counseling Project (HICP) - the District of Columbia's SHIP, providing free, unbiased one-on-one Medicare counseling to D.C. residents.
• Delaware Department of Insurance and the District's Department of Insurance, Securities and Banking (DISB) - the state and District regulators that license carriers and agents, oversee Medigap, and handle complaints.
• Medicare.gov and the official Plan Finder - compare every plan in your area against your drug list, or call 1-800-MEDICARE (1-800-633-4227).
• Social Security Administration at ssa.gov or 1-800-772-1213 - enroll in Parts A and B and handle premium questions.
• HealthCare.gov (Delaware, under 65) and DC Health Link (District, under 65) - the two ACA marketplaces described above.

A licensed independent agent adds value on top of these resources by knowing the local plans, running the comparisons for you, and staying with you year after year as plans change. The two work well together: use DMAB, HICP and Medicare.gov to verify, and an agent to save you time and translate the fine print. When you are ready for a neutral second opinion, our team is glad to help - see how we approach Medicare guidance, or explore the full data on our Delaware and Washington, D.C. pages.

Frequently asked questions

Written by

Keith McLiverty

Keith is the Founder & COO of TSM Life & Health, with more than 30 years in finance, taxes, medical insurance and retirement planning. He believes in educating first and planning second, so every client understands their options before making a decision. TSM Life & Health is an independent agency and is not affiliated with or endorsed by the federal government, Medicare, CMS or the SSA.

Related reading