Medicare Advantage Plans in Vermont

Vermont is one of the most beautiful places on earth. From rustic, rural areas to cozy cities, Vermonters are surrounded by nature. Living in Vermont means benefiting from clean mountain air and easy access to outdoor sports and activities.

And yet, even in the land of apples and maple syrup, people get sick and require healthcare.

Medicare, despite its popularity, can be confusing. If you’re new to Medicare’s alphabet soup, you may be wondering which is better for you —  Original Medicare (Parts A and B) or Medicare Advantage (Part C).

Whether you’re applying for the first time or thinking about changing your current plan, here’s what you need to know about Vermont’s plethora of Medicare Advantage options.

Medicare Advantage (Part C) plans in Vermont are a private insurance option to Original Medicare. Part C plans are sold by Medicare-approved insurers. By law, Medicare Advantage plans must cover everything Original Medicare does. They provide an alternative way to get all the benefits and coverage of Original Medicare, plus additional healthcare coverage that is important to many beneficiaries.

Medicare is a federally funded program designed to make healthcare accessible and affordable for people 65 and older, and those living with disabilities. Original Medicare consists of Part A and Part B. Medicare Part A provides coverage for inpatient care received in hospitals, skilled nursing facilities and hospice. Medicare Part B provides coverage for outpatient care including doctor’s visits, flu shots, durable medical equipment and other services. Part B also covers emergency room care and ambulance service.

For all that it covers, Original Medicare has some significant coverage gaps. These include prescription drug (Part D) coverage, which needs to be purchased separately. It also doesn’t include healthcare services that many people find essential, such as dental, vision and hearing care. That’s where Medicare Advantage (Part C) comes in.

Since it is private insurance, the availability of Medicare Advantage plans, as well as their coverage and costs, vary.

While not every plan is available in every county, there are 26 Part C plans being offered in the state in 2023. And no matter where you live in Vermont, you will have at least one $0 monthly premium Part C plan available to you.

In Vermont, the average Medicare Advantage premium, or monthly cost, is $18.43 Other costs associated with Part C plans include copays, coinsurance and deductibles.

Even though Part C is an alternative way to get Medicare, the Medicare Part B monthly premium still applies. In 2023, the Part B monthly premium is $164.90. This is what most Vermonters pay for Part B, although some may pay more, based on income history.

To be eligible for Medicare Advantage in Vermont, you must first sign up for Original Medicare. Medicare is available to U.S. citizens and permanent legal residents who have lived in this country for at least five years.

Eligibility for Medicare is determined by age, disability, or by living with certain diseases. In Vermont, most people who qualify for Medicare are 65 or older.

Others qualify for Medicare due to a disability or because they have either amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease) or end-stage renal disease (ESRD). If you have a disability, ESRD or ALS, you qualify for Medicare if you’re under 65.

People with disabilities become eligible for Medicare Advantage on the first day of the 25th month they receive Social Security disability benefits.

Disabilities which may make you eligible for Medicare Advantage in Vermont include:

• Multiple sclerosis
• Parkinson’s disease
• Alzheimer’s disease
• Fibromyalgia
• Post-traumatic stress disorder (PTSD)
• Autism
• Schizophrenia
• Depression
• Blindness

If you qualify for Medicare, you can sign up for Medicare Advantage during these enrollment periods in Vermont:

• Initial Enrollment Period (IEP): Seven-month period that starts three months before the month you turn 65 and ends three months after.
• Medicare Open Enrollment Period: You can join a new Medicare Advantage plan during this enrollment period, also called the Annual Enrollment Period. You can also switch or drop your current plan. It starts October 15 and ends December 7 each year.
• Medicare Advantage Open Enrollment Period: If you already have a Medicare Advantage plan but wish to switch to a different plan, you can make those changes during this time. It starts January 1 and ends March 31 each year.
• Special Enrollment Period: These are triggered by events in your own life that affect insurance availability, including losing coverage through an employer or spouse. A special enrollment period may also be triggered if your current plan is no longer available in your county, or if you move to a new county. Special enrollment period time frames vary, based upon the circumstances causing them.

Many Medicare Advantage plans in Vermont bundle in prescription drug (Part D) coverage. Many have a $0 drug deductible.

Unlike Original Medicare, if you have a Medicare Advantage plan that includes coverage for prescription medications, you don’t need to purchase a Part D plan.

The prescription drug coverage included in Medicare Advantage plans is based on a formulary. Formularies consist of the brand name and generic drugs the plan pays for. If you currently take prescription drugs, you can check to see if they’re included in a plan’s formulary before you commit to buying it.

Every Medicare Advantage plan that folds in Part D coverage must include at least two medications prescribed for common conditions. These include diagnoses such as diabetes, high blood pressure, thyroid disease, depression and much more. Some Medicare Advantage plans in Vermont offer lower out-of-pocket insulin costs.