Educational Center
Understanding Your Coverage Options
We believe an informed client makes the best decisions. Browse the basics below before your consultation.
New Delaware Law — Effective 2026
Delaware Birthday Rule for Medicare Supplement (Medigap)
Under Senate Bill 71 (signed September 3, 2025; effective January 1, 2026), Delaware Medigap policyholders now have an annual Special Enrollment Period tied to their birthday — the power to shop for better rates or coverage without being denied for pre-existing conditions.
Your Birthday Window
Starts 30 days before your birthday, includes your birthday, and stays open 30 days after — a 61-day window each year.
What You Can Do
Switch to a different Medigap policy with the same or lesser benefits — guaranteed issue, no medical underwriting, regardless of health.
Who It Applies To
Delaware residents who bought their Medigap in Delaware, or who moved to DE with an out-of-state policy once insurers are notified of DE residency.
Important exceptions: it does not apply if you have moved out of Delaware, or to Medicare-eligible State of Delaware retirees managed by the State Employee Benefits Committee. Also new under SB 71: when switching from Medicare Advantage back to Original Medicare during federal enrollment periods, insurers cannot deny your Medigap application, though they may individually rate your premium.
Medicare & ACA Basics
What is Medicare?
Medicare is federal health insurance for people 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease. It has four parts — A, B, C, and D — each covering different services.
Medicare Part A vs Part B
Part A covers hospital stays, skilled nursing, and some home health care. Part B covers doctor visits, outpatient care, preventive services, and medical equipment. Together they form Original Medicare.
Medicare Advantage vs Supplement
Medicare Advantage replaces Original Medicare with an all-in-one private plan. A Supplement works alongside Original Medicare to cover out-of-pocket costs. Which is better depends on your health, budget, and preferences.
When Can I Enroll?
Key periods include your Initial Enrollment Period (around your 65th birthday), the Annual Enrollment Period (Oct 15 – Dec 7), and Special Enrollment Periods triggered by qualifying life events like losing employer coverage.
What is the ACA / Marketplace?
The Affordable Care Act created Marketplaces where individuals and families shop for coverage. Many people qualify for premium tax credits that significantly lower monthly premiums — sometimes to very little.
What is a DSNP?
A Dual Special Needs Plan is a type of Medicare Advantage plan for people who have both Medicare and Medicaid. These plans coordinate benefits and often include extra perks at little to no cost.
What is a Scope of Appointment?
CMS requires that before any Medicare consultation you complete a Scope of Appointment (SOA) form documenting which plan types you want to discuss — a federal consumer protection requirement.
Do I Need a Part D Drug Plan?
If you do not have creditable prescription drug coverage when first eligible, you may face a late enrollment penalty. We compare drug plans against your specific medications to find your best match.
Veterans: VA, TRICARE & Medicare
VA benefits and TRICARE work alongside Medicare, not instead of it. TRICARE for Life acts as a Medicare wraparound for eligible retirees, while VA benefits cover care at VA facilities. Coordination matters — contact us for a personalized review.
Is Working with a Broker at No Cost?
Yes — completely. As an independent broker, we are compensated by the insurance carriers. You pay the same premium whether you enroll directly or through us, but with us you get expert guidance.
Have Questions? Let Us Walk You Through It
Book a no-cost consultation and we will explain your options in plain English.