Medicare in Vermont
- Discover more about Medicare in Vermont in our guide on the topic. It covers all the plans you can choose from, who is eligible and when you can enroll.
What Vermont Medicare Plans Are Available?
The federal government's Medicare program helps pay for medically necessary services for Vermont seniors and those with disabilities. To provide competition and broader coverage options, private insurance companies also offer Medicare plans. You have two options for coverage:
- Basic health insurance through Original Medicare, with prescription drug and Medigap insurance plans added on if you wish. Original Medicare is delivered by the federal government.
- Extended benefits through Medicare Advantage, providing health insurance through a single policy. Medicare Advantage is delivered through private insurance companies.
Here's a closer look at your Medicare options in Vermont.
When you first sign up for Medicare, you’re enrolled in the federal government's Original Medicare program. You receive two types of coverage, Part A and Part B.
- Part A health insurance helps cover hospital, skilled nursing and hospice care. It also helps pay for some home health care.
- Part B medical insurance covers physician services, lab tests, treatments and preventive screenings.
Original Medicare lets you see any health care provider in the United States that accepts Medicare as payment. Part A premiums are based on how much you've paid in Medicare taxes while working. Part B premiums are based on income. You must also pay deductibles and co-insurance when you receive services.
More than 130,400 people were enrolled in Original Medicare in Vermont in 2020.
Medicare Advantage plans are sold by private insurance companies. Also known as Medicare Part C, these plans cover the same hospital and medical insurance as Original Medicare. The difference is that Medicare Advantage offers a mix of benefits not included in the federal government's health plan, such as vision, hearing, dental, fitness and prescription drugs.
There are four main types of Medicare Advantage plans:
- Health Maintenance Organizations
- Preferred Provider Organizations
- Private Fee-for-Service
- Special Needs Plans
Each type of plan has different rules. Some may limit the health care providers you can use depending on whether the plan has a network. Monthly premiums, deductibles, copays and co-insurance vary, but annual out-of-pocket costs are capped.
About 19,800 Vermont residents are enrolled in Medicare Advantage.
Part D Prescription Drug Coverage
For assistance in paying for medication your doctor prescribes, you can join a prescription drug plan.
- If you're in Original Medicare, you can buy a standalone Part D plan from a private insurer to add onto your Part A and B coverage.
- If you're in Medicare Advantage, you can choose a plan that has prescription drug coverage as part of its benefits. Standalone drug plans can't be added to a Medicare Advantage plan except some PFFS plans.
While prescription drug coverage is optional when you first join Medicare, you can incur a late enrollment penalty if you wait to sign up.
Medicare Supplement Insurance
Medicare makes health care more affordable, but you must still pay coinsurance, copayments and deductibles. Vermont residents who are enrolled in Original Medicare have the choice of adding Medicare Supplement Insurance to their coverage. Sold by private insurance companies, these plans — also called Medigap — pay for costs such as Part A hospital coinsurance, Part B coinsurance and copayments, and Part A and B deductibles. Some Medigap plans cover out-of-country medical emergencies or excess fees charged by physicians.
In Vermont, Medigap is standardized by letter category: A to D, F, G, and K to N. Plans within each letter category cover the same types of benefits.
Who Is Eligible for Vermont Medicare?
Most people are automatically enrolled in Part A and B when they turn 65 if they've been receiving Social Security benefits for at least 4 months. If your benefits are automatic, you can expect a Medicare package in the mail 3 months before your 65th birthday.
If you aren't automatically enrolled by Social Security, you can join Medicare during the following windows:
- Initial Enrollment Period: You can sign up for Medicare starting 3 months before the month you turn 65 and ending 7 months later.
- General Enrollment Period: If you miss your initial enrollment period for Medicare Part A and B, there's a General Enrollment Period each year between January 1 and March 31. Late enrollment fees may apply unless you qualify for a Special Enrollment Period.
- Special Enrollment Periods: In certain situations, you may qualify for a Special Enrollment Period at other times of the year. These special circumstances include moving back to the United States after living in another country, no longer qualifying for Medicaid or losing health insurance coverage from an employer or union.
- Open Enrollment Period: If your existing Medicare coverage is no longer meeting your needs, you can change plans between October 15 and December 7 of each year. During Open Enrollment, you can change between Original Medicare and Medicare Advantage. You can also switch between Medicare Advantage plans if you're enrolled in Part C, or between drug plans if you're enrolled in Part D.
How Do I Enroll in Medicare in Vermont?
Enrollment in Original Medicare (Part A and B) is handled by the Social Security Administration. To sign up, you may:
- Submit an application on the Social Security website
- Visit your local Social Security office
- Call Social Security at 1-800-772-1213
Contact Information for Vermont Medicare, Medicaid and Insurance Help
Here are additional resources to help you find the right health insurance for your needs.
Vermont residents having trouble affording Medicare because of limited income may be eligible for state assistance through Medicaid.
Vermont State Health Insurance Program (SHIP)
SHIP's trained counselors provide private, one-on-one counseling to help those eligible for Medicare to compare and enroll in plans. You can also receive assistance with Medicare claims and appeals. SHIP is delivered through Vermont's five Area Agencies on Aging.
VPharm helps Vermont residents pay for prescription medication. You must be enrolled in a Part D drug plan and meet income requirements to qualify.
Medicare Savings Programs (MSPs)
MSPs help low-income Vermonters pay for out-of-pocket Medicare costs. Vermont Legal Aid and Legal Services Vermont has an excellent resource on their website summarizing eligibility and how to apply.