If you live in Vermont and are eligible to enroll in Medicare, or if you soon will become eligible, taking time to fully understand your coverage options can help you to pick the best coverage for your needs.
Medicare is a government-sponsored health insurance plan for people age 65 or older and those with certain disabilities. There are components of Medicare you can get directly from the government and also parts you can purchase from private insurance companies to add to or replace that coverage.
Read on to learn more about Medicare and your coverage options.
Medicare is made up of different parts. Parts A and B are the parts you can get from the government. Together, they make up what’s known as original Medicare:
- Part A is hospital insurance. It helps pay the costs of inpatient care you get in a hospital, hospice care, limited care at aa skilled nursing facility, and some limited home health services.
- Part B helps pay for outpatient health care, such as the services and supplies you get when you go to a doctor’s office, including preventive care.
If you or your spouse worked for at least 10 years, you likely won’t need to pay a premium for part A. This is because you probably already paid for it through a payroll tax. The premium you pay for part B depends on factors such as your income.
Original Medicare pays for a lot, but there are gaps in coverage. You still have to pay out-of-pocket costs when you go to the hospital or see a doctor. And there’s no coverage at all for things like dental, vision, long-term care, or prescription drugs. If you need additional coverage, you can purchase plans from private insurers that can substantially enhance your coverage.
Medicare supplement plans are plans you can purchase to help cover the gaps in coverage. These are sometimes called Medigap plans. They can help ease the cost of copays and coinsurance, and may also offer coverage for dental, vision, or long-term care services.
Part D plans specifically help pay the costs of prescription drugs.
Medicare Advantage (Part C) plans offer an “all-in-one” alternative to getting parts A and B from the government, plus supplemental coverage through private insurers.
Medicare Advantage plans are a full replacement for original Medicare. Federal law requires that they cover all the same services as original Medicare. They also have supplemental coverage, such as what you might get from supplements and Part D plans, built into different plans. Medicare Advantage plans often also offer extras such as health and wellness programs, and member discounts.
If a Medicare Advantage plan seems like it might be a good fit for you, the following private insurance companies offers these plans in Vermont:
- MVP Health Care
- Vermont Blue Advantage
Medicare Advantage plan offerings vary by county, so enter your specific ZIP code when searching for plans where you live.
You’re eligible to enroll if you are:
If your Medicare eligibility is reliant on age, your initial enrollment period begins 3 months before you turn age 65 and continues for 3 months after. During this period, it generally makes sense to enroll in at least Part A.
If you or your spouse continues to qualify for employer-sponsored health coverage, you may choose to keep that coverage and not enroll in Part B or any Medicare supplement coverage just yet. If so, you’ll qualify for a special enrollment period later on.
There’s also an open enrollment period every year, during which time you can enroll for the first time or switch plans. The annual enrollment period for original Medicare is October 1 through December 7, and the open enrollment period for Medicare Advantage plans is January 1 through March 31.
When it comes to enrolling in Medicare plans in Vermont, you’ll want to carefully consider a lot of the same factors you’d ask when enrolling in any health plan:
- What is the cost structure? How high are the premiums? And what is your cost share when you see a doctor or fill a prescription?
- What type of plan is it? Medicare Advantage plans are required to cover all the same benefits as original Medicare but have flexibility in plan design. Some plans may be Health Maintenance Organization (HMO) plans that require you to choose a primary care provider and get referrals for specialty care. Others may be Preferred Provider Organization (PPO) plans that give you access to network specialists without a referral.
- Does the provider network suit your needs? Does it include doctors and hospitals convenient to you? What about care providers you already have a relationship with and may want to keep seeing for care?
The following resources can be useful if you’d like to learn more about your Medicare options in Vermont:
When you’re ready to move forward with enrolling in Medicare in Vermont, consider these steps:
- Do some more research into your individual plan options. The list above is a great place to start researching Medicare plans in Vermont. You can also call the Vermont Council on Aging’s Senior Helpline at 800-624-5119 for individual consultation on your Medicare plan options.
- You might consider working with an agent who has expertise in selling Medicare plans in Vermont and can advise you on your specific coverage options.
- If you’re currently in an enrollment period, fill out the online Medicare application on the Social Security Administration website. The application takes as little as 10 minutes and doesn’t require any documentation to complete.
This article was updated on November 13, 2020, to reflect 2021 Medicare information.
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