Understand Medicare in Vermont
Medicare, the United States federal medical insurance program, provides coverage for more than 100,000 people in Vermont who qualify for Medicare. You can get Medicare if you’re 65 or older or have a qualifying disability.
Your disability typically qualifies if you’ve received at least 24 Social Security or Railroad Retirement Board (RRB) disability insurance payments. You can also enroll in Medicare Advantage Plans if you have End-Stage Renal Disease (ESRD) or amyotrophic lateral sclerosis (ALS).
Most people have premium-free Part A but, if you have to buy it, the cost can reach up to $499 per month in 2022. Part B costs $170.10 per month but can be more if you have higher income. There are 26 Medicare Advantage Plans in the state that are an alternative to Original Medicare. Learn more about your Medicare options in Vermont.
Medicare Plans in Vermont
|Compare ratings of Vermont’s Medicare plan providers:|
|Insurance company||Medicare rating||A.M. Best rating||BBB rating||NCQA rating||J.D. Power ranking|
|Blue Cross Blue Shield||4.5 stars||A||A+||Not rated||Sixth out of 10|
|Cigna||4 stars||A-||Not rated||2.5 to 4.5 stars||Seventh out of 10|
|Humana||4 stars||A-||A+||1.5 to 4.5 stars||Third out of ten|
|UnitedHealthcare||3.5 stars||A-||A-||4 stars||Fourth out of 10|
Medicare Plan Options in Vermont
Residents of Vermont have multiple Medicare plans to choose from. Many are tiered to help Vermont seniors find the plan that is best suited to their lifestyle and medical needs. For example, seniors and individuals with disabilities who don’t need much coverage can apply for Original Medicare. Vermont’ Medicare Advantage program might be a better option if you need more comprehensive insurance. Some Medicare policies offer additional prescription drug add-ons or supplementary coverage.
|Original Medicare (Parts A and B)||Original Medicare is the basic Medicare plan, which is a fee-for-service form of insurance. It has two parts: Part A hospital insurance and Part B medical insurance. Part A covers hospital stays and periods spent at skilled nursing facilities, lab tests an individual has performed, and hospice care. Part B covers doctor’s office visits and home health care services. It may also cover some preventive care, such as screenings for cancers and mental illnesses, including depression. With Original Medicare, you’ll pay a deductible along with your share of the fees incurred during an inpatient or outpatient visit:
|Medicare Advantage Plans (Part C)||Medicare Advantage plans, also known as Part C, are an alternative to Original Medicare offered by private insurance companies. These plans include both Part A and Part B coverage, except for hospice care. Most services are provided by network providers, and you may need primary care physicians, referrals for specialists, and prior authorizations for treatment and medications. Medicare Advantage offers additional coverage for essential needs, such as prescription drugs, dental and vision care. Some Medicare Advantage Plans also cover gym memberships and transportation to and from medical appointments. Part C may also pay for adult day care services:
|Medicare Prescription Drug Coverage Plans (Part D)||Many Medicare Advantage policies add Part D drug coverage automatically to their package, but you can also add Medicare prescription drug coverage to Original Medicare. Medicare prescription drug coverage is offered to all Medicare enrollees, but you may have to pay a penalty if you wait to enroll after being initially eligible. Medicare Part D plans may not all cover the same drugs or have the same costs as Medicare Advantage policies. Standalone Part D coverage is provided by Medicare-approved private insurers. Most plans require a deductible and a copay for each prescription drug:
|Medicare Supplement Insurance Plans (Medigap)||Some West Virginia seniors purchase a Medicare Supplement Insurance policy, also known as Medigap. These plans are intended to fill in the gaps Original Medicare doesn’t cover. Some of these gaps include medical coverage while overseas, Part A and Part B copays, and excess Part B charges. Medigap doesn’t pay for anything related to Medicare Advantage. You cannot have a Medigap plan and a Medicare Advantage Plan at the same time.
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|
|127,593||Plan A: $0 to $499 per month*
Plan B: $170.10 per month**
*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
Medicare decisions should be made carefully since they can impact both health care choices and finances. Vermont has many organizations and agencies that provide support and help guide and educate seniors about the enrollment process, as well as other related services. For older residents or their caregivers who have questions, reaching out to Area Agencies on Aging (AAAs), state and local public health agencies, or nonprofit groups can make a world of difference. These are a couple of resources to get you started.
Vermont Department of Disabilities, Aging and Independent Living
The Vermont Department of Disabilities, Aging, and Independent Living provides a number of services and programs geared toward those who are 60 years of age or more. The Department also supports adults living with disabilities.
Contact information: Website | (802) 241-2401
Age Well Vermont
Age Well Vermont is an advocacy group working to support seniors in Northwestern Vermont. Among its services is a free hotline for residents to ask questions about aging topics, a program that provides in-home visits to coordinate care, Meals on Wheels, and more.
Contact information: Website | (802) 865-0360