Vermont Medicare Guide

Get free, personalized Medicare advice from an unbiased advisor! Schedule a consultation with one of our licensed Vermont Medicare Advisors or give us a call at (888) 604-0055 to get your questions answered.

Read this Vermont Medicare guide to learn when and how to enroll in Medicare and how to make sure you get the most out of your Medicare.

Use this table of contents to jump to specific sections:

A Snapshot of Medicare in Vermont

Vermont has 155,000 Medicare beneficiaries, making up 24% of the state’s total population. The majority of Vermont beneficiaries are on Medicare due to age, but about 13% are on Medicare due to disability. 18% of Vermont’s Medicare enrollees also receive Medicaid benefits.

When it comes to Original Medicare vs. Medicare Advantage, 80% of Medicare beneficiaries choose to remain on Original Medicare and 20% choose to move to a Medicare Advantage plan.

Vermont Medicare Eligibility and Enrollment Steps

Eligibility is the same for all US citizens. You’re eligible for Medicare if you’re 65 or older or have certain disabilities like ALS or End-Stage Kidney Disease.

Vermont Medicare Enrollment Steps

1. Enroll in Original Medicare (Part A & Part B)

When you first get Medicare, you’ll sign up for Original Medicare, which consists of Part A and Part B. The majority of people age into Medicare, and if you’re already drawing from Social Security, you’ll be automatically enrolled as soon as you’re eligible. If you aren’t automatically enrolled, you’ll sign up during your Initial Enrollment Period (IEP). Your Initial Enrollment Period is a 7-month window that starts three months before the month you turn 65 and ends three months after it.

Some people who are still working may choose to delay their Part B enrollment in favor of their employer linked coverage. Before you make this decision, you should:

Make sure you’ll be eligible for the Part B Special Enrollment Period once you stop working, so you don’t have to pay the Part B late enrollment penalty.
Compare your employer insurance with Medicare to see if you’d be better off moving to Medicare. We often find that Medicare is better!

2. Compare additional coverage options

Once you’ve enrolled in Original Medicare, you have options. You can choose to stay on Original Medicare, in which case you can also enroll in a Medicare Supplement plan and/or Part D (prescription drug) plan. You could also choose to move to a Medicare Advantage plan. These plans provide alternatives to Original Medicare, bundling together Part A, Part B, and usually Part D benefits. They also tend to come with additional benefits not provided by Original Medicare. We’ll explain the pros and cons of both staying on Original Medicare and switching to Medicare Advantage later on in this guide. Our licensed Advisors are also on-hand to help you make a decision regarding Original Medicare vs. Medicare Advantage.

3. Get the best value from Medicare

Enrolling in the best Medicare coverage option(s) for your specific health and financial needs is step one to getting more out of Medicare. We recommend doing the following two things to ensure you continue to get the best value from your Medicare insurance:

Make sure you use all of your Medicare benefits, including preventive care services and any extra perks that come with Medicare Advantage plans.
Review your coverage each year during the Medicare Open Enrollment Period (Oct 15 - Dec 7) to ensure your coverage is still the best fit for you. We recommend doing this because Medicare plans and your healthcare needs can both change each year!

Vermont Medicare Advantage Plans

There are 24 Medicare Advantage (MA) plans available in Vermont. Plan pricing, benefits, and availability will vary from one county to the next. For example, Chittenden County has 16 Medicare Advantage plans available from MVP Health Care, United Healthcare, and Vermont Blue Advantage. Rutland County has 21 plans available from the same carriers, plus Wellcare.

Because Medicare Advantage plans replace Original Medicare, they must legally provide at least the same coverage. One of the reasons these plans are popular is because they generally offer more coverage and benefits. Some of the additional benefits include:

Dental, vision, and hearing services
Prescription coverage
Flex cards
Fitness perks
Transportation services

Medicare Advantage plans provide the additional benefits, often with low or no additional premium (note: you still need to pay your Original Medicare premiums).

Extra coverage with no (or a low) additional premium sounds great—so, what’s the catch? Medicare Advantage plans often also come with:

Limited provider networks
Preauthorization requirements
High out-of-pocket costs

Because Original Medicare doesn’t cover about 20% of costs and comes with no out-of-pocket spending limit, we always recommend that everyone gets some form of additional Medicare insurance coverage. In that case, the choice becomes Medicare Advantage vs. Original Medicare paired with a Medicare Supplement plan.

Vermont Medicare Supplement Plans

Medicare Supplement (also known as Medigap) plans pair with Original Medicare to cover the costs it doesn’t. These plans don’t provide coverage for additional healthcare services, but they significantly reduce your out-of-pocket costs! For example, with a Plan G, you don’t owe anything for Medicare-covered services once you’ve met your annual Part B deductible. There are ten types of Medicare Supplement plans in Vermont, each labeled by a letter from A through N.

Medigap plans have important benefits that Medicare Advantage plans don’t, including:

No restrictive networks
No need for prior authorizations
Low out-of-pocket costs

The Medigap Open Enrollment Period occurs during the first six months that you have Part B coverage. This is the best time to enroll in a Medigap plan because you have a guaranteed issue right. This means that insurance companies are legally obligated to accept your application without asking questions about your health history. Outside of this period and a handful of other guaranteed issue periods, insurance companies are allowed to ask you questions about your health history. If they don’t like your answers, they can reject your application.

Vermont Part D Plans

Original Medicare does not cover prescriptions. Medicare beneficiaries can receive Part D (prescription) coverage, either through a Medicare Advantage plan that includes it or through a stand-alone Part D plan. There are 24 stand-alone Part D plans available in Vermont, with an average premium of $40.58. Like with Medicare Advantage plans, plan availability and pricing varies by county.

Even if you don’t need prescription coverage when you first enroll in Medicare, you should consider enrolling in a low-cost plan. This will help you avoid the Part D enrollment penalty later on, if you do need prescription coverage.

If you have questions about your Medicare options or want to compare plan benefits and pricing, schedule a free consultation with one of our licensed Vermont Medicare Advisors or give us a call at (888) 604-0055.

Get help paying for Medicare in Vermont

Healthcare costs can be overwhelming for many Americans. These three government programs that can help low-income Vermonters pay for Medicare-related expenses.

Vermont Medicaid for Medicare Beneficiaries

Vermont Medicaid has two primary programs for Medicare beneficiaries: Medicaid for Aged, Blind, and Disabled residents (commonly called ABD Medicaid) and Medicare Savings Programs.

Medicaid for the Aged, Blind, and Disabled (MABD) Medicaid in Vermont

When you apply for MABD, you’ll be considered for a variety of programs:

VPharm: a pharmacy program to help Medicare beneficiaries pay for prescriptions
Medicare Savings Programs: outlined below
Healthy Vermonters Program (HVP): provides prescription discounts for Vermonters without prescription drug coverage

You can apply for Vermont MABD online, in person, or over the phone. Learn more about how to apply, and reach out to one of our licensed Vermont Medicare Advisors if you need assistance! Our support is always free.

Vermont Medicare Savings Program

Vermonters can get help from these three Medicare Savings Programs to pay for Medicare-related expenses.

Qualified Medicare Beneficiary (QMB) Program

The QMB Program pays for Medicare Part A & B premiums, deductibles, and coinsurance. The 2023 maximum monthly income level to qualify for the QMB Program is $1,215 for individuals and $1,644 for couples.

Specified Low-Income Medicare Beneficiary (SLMB) Program

The SLMB Program pays for Medicare B premiums. The 2023 maximum monthly income level to qualify for the SLMB Program is $1,458 for individuals and $1,972 for couples.

Qualified Individual-1 (QI-1) Program

The QI-1 Program pays for Medicare B premiums. The 2023 maximum monthly income level to qualify for the QI-1 Program is $1,641 for individuals and $2,219 for couples.

Medicare Extra Help

Extra Help is a federal program that helps pay for costs associated with prescription drug coverage. It’s also commonly referred to as the Part D Low-Income Subsidy (or LIS).

You automatically qualify for Extra Help if you:

Receive full Medicaid coverage from Vermont
Vermont pays your Part B premium
Are eligible for Supplemental Security Income (SSI)

If you don’t automatically qualify for Extra Help, you can learn more about the program here or talk to one of our licensed Vermont Medicare Advisors to get free support with your application.

Supplemental Security Income (SSI) Benefits

Eligible US citizens receive monthly payments from the SSI program. You’re considered eligible if you meet the following criteria:

You are 65 and older, blind, or have a disability
You have limited income and limited resources

You can apply for SSI Benefits online or by calling 1-800-772-1213 / TTY 1-800-325-0778.

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