Medicare Advantage Plans in Vermont

Fact Checked
Published: June 18, 2021

Medicare Advantage Plans, also known as Part C, are provided by private health insurance companies that are approved by Medicare. These plans include all the same benefits as Original Medicare Part A and Part B, as well as vision, hearing, and dental care. Many Medicare Advantage Plans also offer prescription drug coverage.





  • In 2019, there were nineMedicare Advantage Plans available in Vermont
  • 9% of the total Medicare population in Vermont is enrolled in Medicare Advantage Plans as of 2018.
  • In 2018, Original Medicare spent an average of $7,727 per beneficiary in Vermont which is 23% lower than the national average.
  • Available Medicare Advantage Plans range from 11 to 13 across Vermont’s 14 counties.

There are four types of Medicare Advantage Plans in Vermont, and each comes with different premiums, deductibles, and copays. These plans also have their own rules regarding in-network and out-of-network health care and whether you need a referral to see a specialist. You can only select a Medicare Advantage Plan that is available in your county in Vermont.

Medicare Advantage Plans in Vermont 

Types of Medicare Advantage Plans 

There are four plan types in Vermont’s Medicare Advantage program, including Home Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-For-Service plans (PFFSs), and Special Needs Plans (SNPs). Although each plan type comes with its limitations and pricing structures, all Medicare Advantage Plans are required to provide at least the same coverage as Original Medicare Parts A and B, and many also include additional benefits.

Health Maintenance Organizations (HMO)

HMO plans are less expensive than other plan types. You must use the health care providers in the HMO’s network, or you’ll pay more for care. You also need to select a primary care physician and obtain a referral to see a specialist. Many of these plans offer prescription drug coverage, but not all of them do. You may need to continue to pay Original Medicare Part B premiums, and if you or your spouse haven’t paid Medicare taxes for at least 10 years, you may also need to pay Part A premiums.

Preferred Provider Organizations (PPO)

While PPO plans also work with a network of health care providers, you can use medical services from outside the network. You don’t need to name a primary care physician, and you can see a specialist without a referral. PPO plans also offer additional benefits, such as vision, hearing, and dental, and many offer prescription drug coverage.

Private Fee-for-Service Plans (PFFS)

With a PFFS plan, the insurance company sets limits on how much it pays for the health care you receive and decides what your share of the cost will be. In some cases, these plans work with a network of providers who only see members of that PFFS plan. However, you can use any health care provider who accepts your plan. While some providers may not accept your plan, all health care professionals must treat you in an emergency. Some of these plans also provide prescription drug coverage.

Special Needs Plans (SNP)

Medicare Advantage SNP Plans provide specific benefits for people who qualify for both Medicare and Medicaid, living in nursing homes, or have specific conditions or diseases, such as AIDS, end-stage renal disease (ESRD), or cancer. You’ll need to select a primary care physician and obtain referrals to see specialists. All SNPs are required to provide prescription drug coverage.

Enrollment and eligibility for Medicare Advantage Plans in Vermont

Eligibility:

  • You must be at least 65 years old or younger with a qualifying disability
  • You must be enrolled in Original Medicare Parts A and B but not enrolled in Medicare Supplement Insurance (Medigap).
  • You must be a U.S. citizen or a permanent resident for longer than five years
  • You must live in the service area of the plan you select

Enrollment:

  • The Initial Enrollment period runs for seven months, including the three months before you turn 65, your birth month, and the three months after your 65th birthday.
  • The Open Enrollment period runs from October 15th to December 7th each year. You can switch from Original Medicare to a Medicare Advantage Plan, return to Original Medicare, or switch between Medicare Advantage Plans.
  • The Medicare Advantage Open Enrollment period runs from January 1st to March 31st. You can enroll in a new Medicare Advantage Plan or return to Original Medicare during this time, but you can’t switch from Original Medicare to a Medicare Advantage Plan. If you selected Medicare Part B for the first time during Open Enrollment, you can select a Medicare Advantage Plan from April 1st to June 30th, and your coverage will start on July 1st.

Under certain circumstances, you may qualify for a Special Enrollment period, such as if you become eligible for an SNP or move to a different county in Vermont.

Prescription drug coverage

Many HMO and PPO plans include prescription drug coverage, but you may need to pay an additional premium. If your HMO or PPO plan doesn’t include prescription drug coverage, you can’t purchase a separate Part D plan or you’ll be removed from your plan and returned to Original Medicare. Many PFFS plans include prescription drug coverage, but if yours doesn’t, you can sign up for a Medicare Part D plan. All SNP plans include description drug coverage. Even if you don’t take prescription medications when you first sign up for Medicare, you may want to enroll in prescription drug coverage. If you enroll later, you could have to pay a late enrollment penalty for as long as you have your policy.

Medicare Advantage Resources in Vermont

Choosing a Medicare Advantage Plan is like selecting a new car. You want a car that suits your needs but still has good gas mileage, just like you want a Medicare Advantage Plan that meets your health care requirements while fitting into your budget. Vermont has several resources that can help you chose the best plan for your needs.

Vermont Senior Medicaid Patrol (SMP)

The SMP works to educate Vermont seniors on recognizing Medicaid billing errors and scams and helps them with all forms of Medicare fraud or abuse. It holds regular community outreach programs, but their trained volunteers are also available to work one-on-one with you, your family members, or your caregiver.

Contact Information: Website | 802-229-4731

Vermont Area Agencies on Aging (AAA)

The five Area Agencies on Aging offices in Vermont, each of which serves a different group of counties in the state, provide resources and information to seniors, their families, or their caregivers. This includes counseling about health care options, such as Medicare or Medicaid, nutrition programs, and support for veterans and seniors who wish to age in place.

Contact Information: Website | 800-642-5119

Vermont State Health Insurance Assistance Programs (SHIP)

SHIP provides information and counseling to Vermont seniors who are eligible for Medicare. Trained counselors work with you to find the best Medicare option for your situation. Counseling is free, unbiased, and confidential. None of the SHIP counselors work for a health insurance company, and they will never try to sell you a plan. SHIP counselors are available by phone, or you can arrange an in-person counseling session.

Contact Information: Website |800-642-5119

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