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.
The Centers for Medicare & Medicaid Services (CMS) reported the following information on Medicare trends in Vermont for the 2021 plan year:
- A total of 151,195 residents of Vermont are enrolled in Medicare.
- The average Medicare Advantage monthly premium decreased in Vermont compared to last year — from $29.60 in 2020 to $25.69 in 2021.
- There are 23 Medicare Advantage plans available in Vermont for 2021, compared to 13 plans in 2020.
- All Vermont residents with Medicare have access to buy a Medicare Advantage plan, including plans with $0 premiums.
- There are 12 different Medigap plans offered in Vermont for 2021.
Medicare is made up of different parts. We’ll explain several of them and what they mean for your healthcare.
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 a 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.
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 Advantage in Vermont
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. 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:
Medicare Advantage plan offerings vary by county, so enter your specific ZIP code when searching for plans where you live.
Medicare supplement plans in Vermont
Medicare supplement (Medigap) plans are those you can purchase to help cover the gaps in coverage if you want to stick with original Medicare. They can help ease your out-of-pocket costs like copays and coinsurance.
Many companies offer Medigap plans in Vermont. In 2021, some of the companies offering Medigap plans throughout the state include:
You’re eligible to enroll if you are:
- age 65 or older
- younger than age 65 and have a qualifying disability
- any age and have end stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS)
When can I enroll in Medicare Vermont plans?
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.
Tips for Enrolling in Medicare in Vermont
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:
- More than 150,000 Vermont residents are enrolled in Medicare.
- There are several private insurance companies offering various types of Medicare Advantage and Medigap plans throughout the state.
- Overall, monthly premium costs have decreased for 2021 Medicare Advantage plans in Vermont.
- There are also several Medigap plan options if you live in Vermont and are looking for additional coverage.