Do you enjoy the quiet and tranquility of Vermont’s mountain landscapes? Having a great Medicare plan can help you keep your peace of mind. Here’s all the info you need to choose the best Vermont Medicare plan.
- What is Medicare?
- Original Medicare
- Medicare Plans
- See All 12 Items
What is Medicare?
Medicare is a federal health insurance program. It insures:
- People who are 65 or older
- People of any age with end-stage renal disease
- People of any age who are on Social Security disability
Medicare has a few parts. Each part covers a different area of care.
Original Medicare
Also known as Original Medicare, Parts A and B cover essential healthcare services.
Part A: Part A covers hospital care. It covers inpatient care in a hospital or a skilled nursing facility. It also covers hospice care, some home healthcare and inpatient care in a religious nonmedical health care institution. Nonmedical health care institutions serve people who don’t receive medical treatment due to religious beliefs.
Part B: Part B covers medical care. This includes doctor services, some home healthcare, medical equipment, mental health services and outpatient care.
Medicare Plans
Medicare plans help with the out-of-pocket costs associated with Original Medicare. These plans include:
Part C: Medicare Advantage plans are Part C of Medicare. With a Medicare Advantage plan, you receive your Part A and Part B services through the plan. When you see a doctor or go to a hospital, you present your Part C card instead of your Medicare card. These plans often include prescription coverage. They also may cover services Medicare doesn’t, like dental care.
Medicare Supplemental Insurance: Medicare Supplemental Insurance works with Original Medicare. It helps cover the copays and other out-of-pocket costs associated with Parts A and B. When you go to a doctor, you present both your Medicare card and your Medicare Supplement card.
Prescription Coverage
Part D of Medicare is prescription drug coverage. If you have Original Medicare or Original Medicare with a Medicare Supplement, you can choose one of the standalone Medicare Part D plans. You can also get Part D coverage by purchasing a Medicare Advantage plan that includes prescription benefits.
Each plan has its own formulary, which is a list of covered prescriptions. If you take prescription medications, check each plan’s coverage to make sure the medications you take are covered.
What’s Not Covered by Medicare?
Medicare doesn’t cover every type of care. Medicare Advantage plans may help cover some of these services. Medicare doesn’t typically cover:
- Dental care
- Dentures
- Routine eye exams
- Elective cosmetic surgery
- Hearing aids and related exams
- Massage therapy
- Acupuncture
- Long-term care (also known as nursing home or custodial care)
If you’re concerned about paying for long-term care, longtermcare.gov provides information and resources for planning.
Legalities of Medicare in Vermont
The federal Department of Health and Human Services oversees the Centers for Medicare and Medicaid Services (CMS). CMS oversees Medicare. Medicare offers rights and protections to its beneficiaries. These rights include:
- The right to be protected from discrimination
- The right to be treated with respect
- The right to keep your personal information private
- The right to understand what Medicare covers and how it works
- The right to get answers to your Medicare questions
- The right to file a complaint
You can file a complaint about Medicare on its website. Vermont oversees insurance companies that operate in the state. You can contact Vermont’s insurance department to file a complaint about a Medicare supplement. If you need help with filing a Medicare complaint, contact the Senior HelpLife for assistance at 800-642-5119.
Types of Medicare Advantage Plans
As you consider your Medicare Advantage plan options, it’s important to keep the type of plan in mind. Here are the most common types of plans:
HMO: HMOs have a provider network. HMO plans expect you to see providers from within the network. You may not be able to see out-of-network providers. If a plan allows you to go out-of-network, you may have to pay significantly more. With an HMO, you choose a primary care provider. Your primary care provider refers you to specialists.
PPO: PPOs also have a provider network. With a PPO, you can see providers outside the network, but you pay more when you do. You don’t have to choose a primary care doctor or get referrals to see a specialist.
SNP: SNPs are special needs plans. These plans serve a specific group of people, like those who have Medicaid and Medicare or those who have diabetes.
How to Sign Up for Medicare in Vermont
Social Security handles the administrative aspects of Medicare. In other words, if you need to sign up, contact Social Security. You might not have to enroll, though. Social Security enrolls many people automatically. Here’s an overview of signing up for Medicare:
- If you are receiving Social Security when you turn 65, Social Security will enroll you automatically.
- If you are not receiving Social Security when you turn 65, contact Social Security to enroll.
- If you receive Social Security due to a disability and are younger than 65, Social Security will enroll you automatically after you receive benefits for 24 months.
- If you receive Social Security disability benefits due to ALS, Social Security will enroll you in Medicare as soon as your disability benefits start.
- If you have end-stage renal disease, you will need to contact Social Security to enroll.
Enrollment Periods
You can’t enroll in Medicare any time. Medicare has enrollment periods. Here’s what you need to know:
Initial enrollment: Unless you’re enrolling in Medicare due to a disability, your initial enrollment period will start 3 months before the month you turn age 65. It will end 3 months after the month you turn 65. (If you turn 65 in May, your open enrollment will start February 1 and end August 31.)
Special enrollment: Some people don’t enroll in Part A or Part B of Medicare when they turn 65 because they have other health insurance. If that other health insurance ends coverage, you receive a special enrollment. This enrollment period ends 8 months after the month your coverage ends. If your coverage ends in May, you have until January 31 to enroll in Medicare Part A and/or Part B. If you have group coverage and you’re not sure whether to enroll in Medicare Parts A or B, contact your human resources department.
General enrollment: If you didn’t sign up for Part A or Part B during your initial or special enrollment, Medicare offers a general enrollment each year. You can sign up from January 1 to March 31 each year. Your coverage won’t start until July 1. Keep in mind that if you enroll late, you may have to pay a penalty.
Average Cost of Medicare Advantage Plans in Vermont
How much should you expect to spend with a Medicare Advantage plan? Let’s look at a few of Vermont’s plans:
| Plan Name | Company | Plan Type | Health Care Deductible | Drug Deductible |
|---|---|---|---|---|
| MVP WellSelect with Part D | MVP Health Care | PPO | $0 | $325 |
| AARP Medicare Advantage Plan 3 | UnitedHealthcare | HMO | $1,000 | $0 |
| AARP Medicare Advantage Plan 1 | UnitedHealthcare | HMO | $0 | $250 |
| UnitedHealthcare Medicare Advantage Assure | UnitedHealthcare | PPO | $198 | $435 |
| MVP GoldValue with Part D | MVP Health Care | HMO | $0 | $0 |
Best Medicare Insurance Providers in Vermont
Ready to find Vermont’s best Medicare options? Here are our top 5 picks:
1. Best Overall in Vermont: MVP Health Plan
MVP Health Plan offers several Medicare Advantage plans to Vermont residents. Its plans are available at different price points so you can choose one that fits your budget.
MVP offers rewards for engaging in health and wellness activities. It offers free meal delivery after inpatient hospital stays so you can focus on recovery. It includes dental coverage with all its plans and an eyewear allowance with most of its plans.
- Same day coverage available
2. Most Affordable in Vermont: UnitedHealthcare
UnitedHealthcare offers multiple plans with no or low monthly premiums. AARP has endorsed UnitedHealthcare for its members. It offers low copays for doctor visits. It covers routine eye exams and eyewear, some dental care, routine foot care and benefits for hearing aids and hearing exams.
UnitedHealthcare also offers virtual medical visits, which means you can talk to a doctor without dealing with long lines or harsh winter weather.
- Medicare Advantage Plans
3. Best for Medicare Supplements With Extras: Humana
Humana offers Medicare Supplement and Part D plans in Vermont. Many of its Medicare Supplement plans are “Healthy Living” plans. These plans include additional benefits for members that go beyond the standard requirements.
These plans include vision and dental benefits, a fitness club membership and a 24-hour nurse line.
- Medicare Prescription Drug Plans
4. Best for Part D Plans: WellCare
WellCare offers standalone Part D plans in Vermont. You can use these plans with Original Medicare or with a Medicare Supplement. Its plans have a range of monthly premiums and deductibles.
This allows you to choose a plan that fits your budget and prescription needs.
- Medigap
5. Best for Personal Service: Mutual of Omaha
Mutual of Omaha offers Medicare Supplement plans in Vermont. These plans minimize your out-of-pocket costs. If you want assistance choosing a Medicare Supplement, Mutual of Omaha has agents who can help.
Your agent can also help you if you have questions about your coverage or if you need help with filing a claim.
Which Medicare Plan is Right for Me?
You have several options to choose from when it comes to Medicare coverage. Which is right for you? It depends on your budget and your health needs. Look at the premiums, deductibles and copays to get a sense of your out-of-pocket costs. Consider whether you have strong preferences when it comes to the doctors you see. If you prefer a specific doctor, look for a plan that has that doctor as an in-network provider.
If you need help choosing a plan, contact 855-971-2115 for assistance.
Frequently Asked Questions
1) Q: What are the different parts of Medicare?
Medicare has 4 parts named Parts A, B, C, and D. Part A provides hospitalization coverage while Part B provides outpatient coverage, like doctor visits. Parts A and B make up Medicare’s core coverages. Part C is provides private-market Medicare plans, called Medicare Advantage Plans. Part C coverage often includes additional benefits. Medicare Part D provides coverage for prescription drugs. Get a Medicare Insurance Quote through the top providers here.
2) Q: Is Medicare free?
Because there are 4 parts to Medicare, there can be different cost structures. Most people won’t have to pay for Medicare Part A (hospitalization). Eligibility for premium-free Part A is based on your work history during which you paid Medicare taxes. Many people do pay a monthly premium for Medicare Part B, however, which covers outpatient medical services, like doctor visits. Deductibles also apply to services covered under Medicare Parts A and B, so you’ll pay a part of the annual cost.
Medicare Parts C and D are optional coverages and have premium costs of their own. Medicare Part C refers to Medicare Advantage Plans that offer additional coverage in exchange for a monthly premium. Part D, the prescription plan, reduces the cost of medications but also requires a monthly premium. Subsidies may be available for low income households to help reduce overall Medicare costs.
3) Q: Do I need to sign up for Medicare?
If you signed up for Social Security before age 65, you were enrolled in Medicare automatically but benefits will begin at age 65. In most cases, there are penalties for not enrolling at age 65, so it pays to sign up on time. Click here to get a medicare quote in minutes from the best providers.
If you have employer coverage, you may be able to delay Medicare coverage while your work plan is still in force. However, the size of the employer determines whether you’ll pay a penalty for not enrolling at age 65. Employees (and their spouses) of companies that offer group health insurance to 20 or more people are usually exempt from late sign-up penalties if they are covered by the employer’s plan.
