Medicare Plan Options

You’ll have a variety of choices when it’s time to select a Medicare plan. Those who don’t need much health care coverage may be fine with Original Medicare. If you need more coverage, Vermont’s Medicare Advantage program may be a better fit for your needs. Medicare Advantage Plans often include additional benefits, such as vision, hearing, and dental, and some plans also offer prescription drug coverage.

Original Medicare

The basic Medicare plan consists of two parts. Medicare Part A covers home health care, hospitalization, hospice, and nursing home care, while Medicare Part B includes doctor’s visits, mental health, ambulance services, some preventative screenings, and durable medical equipment. With Original Medicare, after your deductible is met, you’ll normally pay about 20% of the Medicaid-approved amount for most doctor services. There is no limit on out-of-pocket expenses under Original Medicare.

Medicare Advantage Plans

There are four types of Medicare Advantage Plans in Vermont: HMOs, PPOs, PFFSs, and SNPs. You can only select Medicare Advantage Plans that are available in your county. All Medicare Advantage Plans include Original Medicare Parts A and B, as well as additional coverage for vision, dental, hearing, and some fitness programs. Some, but not all, Medicare Advantage Plans may also include prescription drug coverage. Premiums, copays, and access to health care providers vary, depending on the plan type you choose.

Medicare Prescription Drug Coverage Plans

With Original Medicare, if you want prescription drug coverage you need to select a Part D plan. This cost depends on several factors, including the pharmacy you use, the drug’s tier, and whether a drug company offers financial assistance to help pay for the prescription. Many Medicare Advantage Plans include prescription drug coverage. If you don’t select a Part D plan during your initial enrollment period or obtain coverage through a Medicare Advantage Plan, you may have to pay a penalty if you want to enroll later.

Medicare Supplement Insurance Plans

If you’re enrolled in Original Medicare and you’re concerned about excess fees, you may want to consider a Medicare Supplement Insurance Plan, also known as Medigap. These plans cover copays for Parts A and B, as well as coinsurance and many deductibles. However, these plans don’t cover long-term care, vision, dental, hearing, or Part B premiums. Many Medicare Supplement Insurance Plans also provide coverage if you need to travel outside the country. Medigap does not work with any Medicare Advantage Plan.

Medicare in Vermont by the Numbers

People enrolled in Original Medicare Average plan cost Annual state spending per beneficiary Spending per beneficiary compared to the national average
129,593 Plan A: $0 to $471 per month*
Plan B: $148.50 per month**
$7,727 -23%

*Most people pay no premium, but this can vary depending on how long they paid Medicare taxes.
**This is the average number, but it can vary based on income.

Medicare resources in Vermont

Choosing a Medicare plan can often feel confusing. Fortunately, several resources and agencies in Vermont provide free, unbiased counseling to help you select the best plan for your health care needs.

Vermont Area Agencies on Aging (AAA)

Vermont has five Area Agencies on Aging offices that serve seniors across the state. The AAA provides resources and information to seniors, their families, or their caregivers in many important areas. This includes counseling about health care options, such as Medicare or Medicaid, senior nutrition programs, housing alternatives, and support for veterans who wish to age in place. While the AAA operates many programs, it also works with local groups to promote and advance the interests and needs of seniors in their communities.

Contact Information: Website | 800-642-5119

Vermont State Health Insurance Assistance Programs (SHIP)

SHIP is a program that provides information and counseling to seniors eligible for Medicare. Trained counselors can help you find the Medicare plan that best fits your situation. Counseling is free and unbiased, and no counselor will ever try to sell you an insurance program or needlessly promote one program over another. SHIP counselors work through local Area Agencies on Aging offices and are available by phone, or you can arrange an in-person counseling session.

Contact Information: Website |800-642-5119

Vermont Senior Medicaid Patrol (SMP)

The SMP works to educate Vermont seniors, their families, or their caregivers about their Medicare benefits. The organization can teach you how to recognize errors in Medicaid billing and how to detect Medicare fraud or abuse. While the SMP holds community outreach programs, their trained volunteers are also available to work one-on-one with Medicare beneficiaries who may have questions about their Medicaid coverage or who suspect problems.

Contact Information: Website | 802-229-4731

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