Medicare Advantage Plans in Vermont
Key Takeaways
- All Medicare Advantage (Part C)Medicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). plans in Vermont must offer at least the same coverage as Original Medicare (Parts A and B)Original Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). . Many Part C plans provide additional dental, vision, and hearing benefits.
- Most Medicare Advantage plans also cover prescription drugs.
- Every Medicare beneficiary in Vermont has access to at least one Medicare Advantage Medicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). plan with a $0 monthly premium.
- If you have a disability, you may be eligible for Medicare in Vermont no matter your age.
Medicare popularity, can be confusing. If you’re new to Medicare’s alphabet soup, you may be wondering which is better for you — Original Medicare (Parts A and B) or Medicare Advantage (Part C).
Whether you’re applying for the first time or thinking about changing your current plan, here’s what you need to know about Vermont’s Medicare Advantage options.
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Vermont Medicare Advantage Plan Coverage
Medicare Advantage (Part C) is private insurance that substitutes for Original Medicare. By law, Part C plans must cover everything Original Medicare does, but they can provide additional healthcare coverage that is important to many beneficiaries.
Medicare is a federally funded program designed to make healthcare accessible and affordable for people 65 and older, and those living with disabilities. Original Medicare consists of Part A and Part B:
- Medicare Part A provides coverage for inpatient care received in hospitals, skilled nursing facilities and hospice.
- Medicare Part B provides coverage for outpatient care including doctor’s visits, flu shots, durable medical equipment and other services. Part B also covers emergency room care and ambulance service.
Since it is private insurance, the availability of Medicare Advantage plans, as well as their coverage and costs, vary. There are 24 Part C plans offered in Vermont as of 2024, but which ones you can access depends on your ZIP code.
VT Medicare Advantage Plan Costs
In Vermont, the average Medicare Advantage monthly premium is $18.48. No matter where you live in the state, you have at least one $0 monthly premium Part C plan available to you. Other costs associated with Part C plans include copays, coinsurance, and deductibles, but plans feature out-of-pocket maximums that can limit your annual spending.
The Medicare Part B monthly premium still applies when you enroll in Medicare Advantage. In 2025, this premium is $185 for most people, although some may pay more based on their income history.
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Medicare Advantage Plan Eligibility and Enrollment in Vermont
To be eligible for Medicare Advantage, you must first sign up for Original Medicare. Medicare is available to U.S. citizens and permanent legal residents who have lived in this country for at least five years.
Most people qualify for Medicare when they turn 65. Others may qualify due to a disability or because they have either amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease) or end-stage renal disease (ESRD). If you have a disability, ESRD, or ALS, you can qualify for Medicare while you’re still under 65.
If you qualify for Medicare, you can sign up for Medicare Advantage during these enrollment periods in Vermont:
- Initial Enrollment Period (IEP): Seven-month period that starts three months before the month you turn 65 and ends three months after.
- Medicare Open Enrollment Period: You can join a new Medicare Advantage plan during this enrollment period, also called the Annual Enrollment Period. You can also switch or drop your current plan. It starts October 15 and ends December 7 each year.
- Medicare Advantage Open Enrollment Period: If you already have a Medicare Advantage plan but wish to switch to a different plan, you can make those changes during this time. It starts January 1 and ends March 31 each year.
- Special Enrollment Period: These are triggered by events in your own life that affect insurance availability, including losing coverage through an employer or spouse. A special enrollment period may also be triggered if your current plan is no longer available in your county, or if you move to a new county. Special enrollment period time frames vary, based upon the circumstances causing them.
Are There Vermont Medicare Advantage Plans with Prescription Drug Coverage?
Many Medicare Advantage plans in Vermont bundle in prescription drug (Part D) coverage. Many have a $0 drug deductible.
Unlike Original Medicare, if you have a Medicare Advantage plan that includes coverage for prescription medications, you don’t need to purchase a Part D plan.
The prescription drug coverage included in Medicare Advantage plans is based on a formulary. Formularies are lists of the brand name and generic drugs each plan pays for. If you currently take prescription drugs, you can check to see if they’re included in a plan’s formulary before you commit.
Every Medicare Advantage plan that folds in Part D coverage must include at least two medications prescribed for common conditions. These include diagnoses such as diabetes, high blood pressure, thyroid disease, depression, and much more.
Medicare Learning Guides
Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement
Medicare Plans Guide
Costs, coverage and enrollment details for each Medicare plan
Medicare Beneficiary Guide
For those currently enrolled in Medicare
Low Income and Medicare Guide
For individuals with a qualifying income status
A Caregiver's Guide
For individuals with a qualifying income status
My Medicare coverage doesn’t address all of my needs.
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Sources
- FACT SHEET. CMS.gov.
This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.
Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.