If you’re 65 or older, Medicare in Vermont offers an affordable option for your healthcare needs.
Original Medicare offers hospital (Part A) and medical insurance (Part B), with the option of adding drug and supplemental coverage.
Medicare Advantage 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.
Find a local Medicare plan that fits your needs
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.
- Visiting a local Social Security office.
- 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 (Medicare Supplement Insurance) to help cover out-of-pocket expenses.
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 2022, the average Medicare Advantage monthly premium is $22.58.
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.
Are you eligible for cost-saving Medicare subsidies?
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.
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 extra benefits and savings do you qualify for?
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 (CMS) 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.
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.
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Table reflects the latest Beneficiary Demographics Data: Medicare Geographic Variation – by National, State & County
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.
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.
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.”
What should I know about the Department of Financial Regulation?
The place to turn if you are a Vermonters with a health insurance complaint.
What should I know about Vermont Health Access?
This department administers all aspects of the state’s Medicaid program.
Speak with an insurance agent that is licensed in Vermont about your Medicare questions.
Mon-Fri, 7am-6pm CT
Centers for Medicare and Medicaid Services
If you have general questions about Medicare in VT, or need help with current Medicare benefits.
Social Security Administration
You can reach the SSA by phone for general questions. Not all questions can be answered over the phone.
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement
Medicare Plans Guide
Costs, coverage and enrollment details for each Medicare plan
Medicare Beneficiary Guide
For those currently enrolled in Medicare
Low Income and Medicare Guide
For individuals with a qualifying income status
A Caregiver’s Guide
For individuals with a qualifying income status