Vermont Medicare Supplement Plans cover out-of-pocket costs that Original Medicare doesn’t.
In Vermont, there are 10 Medigap plans that newly eligible Medicare beneficiaries may buy.
Medicare Supplement Plans in Vermont don’t cover prescription drugs.
Medigap plans are most affordable when you first become eligible for Medicare.
If you’ll be going on Medicare soon, you may be looking for ways to save money on expenses that Medicare doesn’t cover. Vermont Medicare Supplement Plans — also known as Medigap — are insurance policies that provide richer coverage, and less costs, for people on Medicare.
Vermonters on Medicare can use Medigap to cover out-of-pocket expenses such as copays, coinsurance, deductibles and more.
Medigap policies fill in the “gap” left by Original Medicare (Part A and Part B). That gap can get pretty big, especially if you are living with a chronic health problem such as cancer, diabetes or heart disease. And even the healthiest person can get into an accident. Medigap also covers out-of-pocket costs for emergency medical care, including car accidents and falls.
If you’re new to Medicare, you may confuse Medigap plans with Medicare’s parts:
- Medicare Part A – covers inpatient care
- Medicare Part B – covers outpatient care
- Medicare Part C (Medicare Advantage) – an alternative way to get Part A and Part B coverage, plus extras that vary by plan
- Medicare Part D – prescription drug coverage
Medigap is identified by alphabetical plan names — like Plan A and Plan G — not parts. In Vermont, there are 12 Medigap plans which may be available for you, although not every plan can be purchased in every county. By law, Medigap plans must have standardized coverage. Every plan that is identified by the same letter offers the same benefits as every other plan that has that letter, no matter which insurance company provides it. Their costs may differ, however, so it makes sense to compare Medigap plans in this side-by-side chart.
If you became eligible for Medicare before January 1, 2020, you may be able to get a Medigap plan that covers the annual Part B deductible. In 2022, the Part B deductible is $233. The plans that include this coverage are Plan C and Plan F. These plans are no longer available to new beneficiaries.
Medigap plans cover one beneficiary only. If you’re married, and both you and your spouse want Medigap, you’ll have to apply separately for your own individual plans.
Find a local Medicare plan that fits your needs
The Vermont Department of Financial Regulation reviews and approves the rates (premiums) required by insurers for the Medigap plans they sell. Medigap plans in Vermont are community rated. If you’re 65 or older and buy a Medigap plan when you first become eligible, your rate will be the same as everyone else 65 or over who buys that plan. Your gender, age, tobacco use and preexisting health conditions will not influence your rate.
Medigap is more expensive for people under 65. However, community rating also applies to this group. If you’re under 65 and have Medicare due to a disability or illness, your rate will be identical to the rate given to all beneficiaries under 65.
Community rating only remains in effect during initial enrollment. Initial enrollment is a six-month period that starts on the first day of the first month you have Medicare Part B. After this timeframe, insurers are free to use medical underwriting to determine your premium cost. Habits like cigarette smoking will influence your rate. So will your age, gender and health. Insurers can also refuse to sell you a policy after your initial enrollment period has passed. For these reasons, it makes sense to buy Medigap when you’re first eligible, rather than delaying.
To be eligible for a Medicare supplement plan, you must already be enrolled in Medicare Part A and Part B. Medigap plans do not work with Medicare Part C, or Medicare Advantage plans.
If having Medigap is important to you, make sure you enroll during your initial enrollment period. This six-month time frame is the only time you can’t be turned down for Medigap. It is also the best time to get the best rates. In Vermont, people under 65 may be turned down for Medigap after initial enrollment. This age group may also pay extremely high rates for a plan, if they can get one.
Once you know you want Medigap, consider reaching out to a GoHealth licensed insurance agent to learn more about plans in your area. A knowledgeable insurance agent can also help you compare Medigap to Medicare Advantage plans so you can best determine which will give you the coverage you need.
Vermont’s Medigap plans are also listed alphabetically by zip code in Medicare’s find a plan tool. If you already know the plan type you want, this tool may also be helpful for comparing costs.
Are you eligible for cost-saving Medicare subsidies?
There are no Medigap plans available in Vermont or in other states that include coverage for prescription drugs.
Prescription drug coverage is included in many Medicare Advantage (Part C) plans. It is also available as stand-alone coverage. You can buy a prescription drug (Part D) plan if you have Original Medicare and Medigap.
Medicare Advantage (Part C) is an alternative way to get all the coverage provided by Original Medicare, plus some additional benefits that Original Medicare does not cover. These vary from plan to plan but often include:
- Prescription medications
- Hearing aids
- Gym memberships (Silver Sneakers)
Based on the plan you choose, Medicare Advantage may or may not have monthly premiums and deductibles. In Vermont, the average monthly premium cost for a Medicare Advantage plan is $22.58 in 2022.
Many Part C plans have copays for specialists, and hospital coinsurance costs you’re responsible for. Some require a copay when you see your general practitioner, but others don’t.
With Part C, you may also be required to use doctors and healthcare providers within a network. These networks may be located solely in Vermont. In contrast, Medigap is usually accepted by healthcare providers nationwide.
Even though Part C plans have some out-of-pocket costs, you can’t have Medigap and Medicare Part C.
What extra benefits and savings do you qualify for?
Guaranteed issue means you can enroll in any insurance plan, no matter what your health predictors are. These include pre-existing conditions, age and gender. In Vermont, guaranteed issue is assured for Medigap only during your initial enrollment period.
No. Medigap only pays your out-of-pocket cost for healthcare that Original Medicare covers. Since Original Medicare doesn’t pay for hearing aids, neither will Medigap.
No. Medicaid pays for most of the costs that Medigap covers.
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement