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Medicare in Vermont

GoHealth’s guide feeds your need for the latest information about Medicare in Vermont

Reviewed by: Cassandra Parker, Licensed Insurance Agent. Written by: Bryan Strickland.

Key Takeaways

  • If you’re 65 or older, Medicare in Vermont offers an affordable option for your healthcare needs.

  • Original MedicareOriginal Medicare (Parts A and B) is fee-for-service health insurance available to all Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). offers hospital (Part A) and medical insurance (Part B), with the option of adding drug and supplemental coverage.

  • Medicare AdvantageMedicare Advantage is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). in Vermont replaces Original Medicare and includes the benefits of Parts A and B while bundling drug and supplemental coverage and coverages like dental and vision.

 

As the epicenter of maple syrup production and the home of Ben & Jerry’s ice cream empire, Vermont offers a pretty sweet life.

A healthy helping of Medicare, however, can be bittersweet. Sweet because of the health insurance savings that Medicare can offer; bitter because of how overwhelming Medicare can be.

If you’re starving for answers about Medicare in Vermont, GoHealth is here to make the process palatable.

How do I Sign Up for Medicare in Vermont?

If you are a U.S. citizen age 65 or older, you qualify to sign up for Medicare in VT.

Your choices for applying include:

  • Enrolling online with the Social Security Administration. [1]
  • Visiting a local Social Security office. [2]
  • Enrolling over the phone at 1-800-772-1213 (TTY: 1-800-325-0778).

Medicare is a federal program that provides affordable health insurance to older Americans nearing retirement. At age 65, you can enroll in Part A (known as “hospital insurance”), Part B (“medical insurance”), or both — collectively known as Original Medicare. If you enroll in Part A or Part B, you have the option to add Part D to help with drug costs and Medigap (supplemental insurance) to help cover out-of-pocket expenses.

Private insurance companies manage part D and Medigap plans with guidance from the federal government. That’s also the case with Medicare Advantage in Vermont.

Suppose you enroll in both Parts A and B. In that case, you have the option of switching to a Medicare Advantage plan that replaces Original Medicare and includes the benefits of Parts A and B while bundling drug and supplemental coverage and offering additional coverages like dental and vision.

Does Vermont Have Free Health Insurance?

Part A of Original Medicare provides hospital coverage without a monthly premium to most Vermonters. Medicare Advantage offers both Part A coverage and the medical coverage offered by Part B — as well as additional coverages — and in 2020, the average Medicare Advantage monthly premium was $23.63. [3]

But despite the affordability of the plans, no health insurance can fairly be called “free.” In addition to monthly premiums, Medicare in Vermont typically includes expenses like copays and coinsurance.

The closest thing to an exception is Medicaid.

Who Qualifies for Medicaid in Vermont?

Some Vermont residents facing severe needs may qualify for Medicaid, a federal/state program founded alongside Medicare in 1965 that helps those facing a financial need or a disability — regardless of age. When you turn 65, it is possible to be eligible for both Medicare and Medicaid (called dual eligibility).

Each state formulates its plan for Medicaid and can set its qualifications. Vermont’s Health Connect program offers programs geared toward adults and children in need, all with a specific set of qualification rules. [4]

Does Medicare Pay the Same in Every State?

In the case of Original Medicare, what you pay and what percentages of your medical bills are paid by Medicare are consistent regardless of your location. You pay premiums for Part B (and in some instances Part A) based on your current income and work history, and Part A and B both have universal deductibles and coinsurance.

If, however, you add Part D or Medigap to Original Medicare, or if you have Medicare Advantage, your costs and benefits will vary from state-to-state. In those cases, however, location is only part of the equation. The reality is that all Medicare-related products outside of Parts A and B vary in cost because they also vary in what they offer. A Medicare Advantage plan that offers dental and vision coverage naturally isn’t going to cost the same as one that doesn’t — regardless of location.

Can you use Medicare Advantage out of state?

Original Medicare is accepted nationwide by the large majority of providers. Medicare Advantage plans feature regional networks and generally aren’t accepted outside of your area (at least not at as affordable a rate). However, the in-network concept is one of the top reasons that Medicare Advantage may be more affordable.

What is the Best Medicare Plan for Seniors?

When it comes to comparing different Medicare plans in Vermont, here are some things to consider:

  • Some Medicare Advantage plans mirror Original Medicare but are more affordable.
  • Some Medicare Advantage plans include options for dental, vision and hearing coverage.
  • Some Medicare Advantage plans offer assistance with transportation costs or over-the-counter needs.
  • Some offer all of the above.

Original Medicare is simple. Medicare Advantage offers a variety that can be overwhelming. Still, it’s simple for a dedicated GoHealth licensed insurance agent to review your situation and figure out what plan is the right fit for your specific situation.

Who has the Best Medicare Advantage Program?

The Centers for Medicare & Medicaid Services has a Medicare Star Rating system that assigns one to five stars (five being the highest-rated) to individual Medicare Advantage plans. If you’re already on a Medicare Advantage plan and it’s not five-star, you are offered the opportunity to switch to a five-star plan each year. [5]

While the premiums and rating systems can shed light on various Medicare Advantage plans’ value, there’s more to navigating Medicare in Vermont. A dedicated GoHealth licensed insurance agent can review your situation and figure out what plan is the right fit for you.

Medicare in Vermont by the Numbers

Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 134,786 people are enrolled in Medicare in Vermont. The total number of beneficiaries enrolled in Medicare Advantage in Vermont is 15,791. The previous year, 13,496 enrolled in Medicare Advantage. Medicare Advantage participation in Vermont went from 10.29% to 11.72% year over year. If you’d like to dive deeper into how Medicare in Vermont breaks down across the state, we provide a glance at who is using Medicare, and how.

Outline of Vermont
134,786
Beneficiaries with Part A & Part B
15,791
Medicare Advantage Beneficiaries
11.72%
Medicare Advantage Participation Rate
54.10%
% Female
45.90%
% Male
0.83
Average HCC Score
$9,061.85
Actual Per Capita Costs
24.12%
% Eligible for Medicaid
31.63%
% of Beneficiaries with an Emergency Department Visit
15.99%
Hospital Readmission Rate
94.39%
% Non-Hispanic White
0.44%
% African American
0.67%
% Hispanic
4.49%
% Other/Unknown

Table reflects the latest Beneficiary Demographics data: 2018, All Beneficiaries by State, Centers of Medicare & Medicaid Services (CMS)

Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.

Vermont Medicare Resources & Contacts

Beneficiaries spend an average of $9,061.85 each year on Medicare in Vermont. To be certain you are not leaving anything on the table, let us help. A GoHealth licensed insurance agent can assess your coverage or explain which Vermont-based resources, like these, may be able to help:

Vermont SHIP - Medicare Counseling

1-800-642-5119

https://asd.vermont.gov/services/ship

What should I know about SHIP?

The State Health Insurance Program offers free, unbiased Medicare advice to Vermont residents via your Area Agency on Aging.

Disabilities, Aging and Independent Living

1-802-241-2401

https://dail.vermont.gov/

What should I know about the Disabilities, Aging and Independent Living?

The government department’s mission is to “Make Vermont the best state in which to grow old or live with a disability — with dignity, respect and independence.”

Department of Financial Regulation

1-800-964-1784

https://dfr.vermont.gov/consumers/file-complaint/insurance

What should I know about the Department of Financial Regulation?

The place to turn if you are a Vermonters with a health insurance complaint.

Department of Vermont Health Access - Medicaid

1-800-250-8447

https://dvha.vermont.gov/about-us

What should I know about Vermont Health Access?

This department administers all aspects of the state’s Medicaid program.

Nationwide Resources

Speak with an insurance agent that is licensed in Vermont about your Medicare questions.

1-855-792-0088 TTY: 711

Monday - Friday, 8 AM - 9 PM CT

Medicare & Medicaid

If you have general questions about Medicare in VT, or need help with current Medicare benefits.

1-800-MEDICARE (1-800-633-4227)

Social Security Administration

You can reach the SSA by phone for general questions. Not all questions can be answered over the phone.

Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online

Speak to SSA Representative, Monday - Friday, 8 AM - 7 PM ET

Medicare Learning Guides

Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.

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New to Medicare Guide

Helpful information to get you started with enrolling in Medicare.

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Costs, coverage and enrollment details for each Medicare plan.

Low Income & Medicare Guide

For individuals with a qualifying income status.

A Caregiver’s Guide

For those helping a loved one with Medicare.