Medicare Advantage Plans in Vermont

Medicare beneficiaries in Vermont have the option of Original Medicare, offered through the federal government, or choosing a Medicare Advantage plan, purchased through private insurance companies.

Medicare Advantage is becoming increasingly popular because these programs offer benefits beyond what enrollees get with Original Medicare. A Medicare Advantage plan in Vermont is a replacement for Medicare. You’ll still receive the same benefits; only they’ll be covered by and administered by a private insurance company.

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Top-rated Medicare Advantage Providers in Vermont

  • MVP Health Care: This regional insurance company has signed up 18 percent of all Medicare Part C plan members. This company markets a highly rated PPO that may attract a lot of Vermont seniors. The company also has an HMO-POS plan that may offer an alternative to people who would rather not have an HMO.
  • Aetna: Aetna is active in Vermont with about two percent of current members but may have plans to grow in this state moving into 2019.
  • Humana: Vermont Humana doesn’t seem active now for Medicare Advantage plans.
  • Cigna is another popular option to look for in your area.

Popular Medicare Advantage Plan Types in Vermont

There are many Medicare Advantage plans available to Vermont residents for 2022. Each has different coverage options and can suit different needs.

Best Network Freedom: Medicare Advantage PPO

Medicare Advantage PPO is a good option for those who want to be able to go outside of their network when necessary. With this plan, you’ll pay less if you use an in-network provider.

You can go outside your network, but you’ll usually pay more. Premiums are generally anywhere between $0-100 each month. However, Medicare Advantage networks are typically large, and you don’t need a referral.

Best for Lowest Out-of-Pocket: Medicare Advantage HMO Plan

Health care out-of-pocket costs can be expensive. If you want to save as much as possible, a Medicare Advantage HMO plan is the way. These plans will require you to use network providers except in cases like ER visits, out-of-area urgent care, and out-of-area dialysis for end-stage renal disease.

The premiums are usually $0 per month. The costs are inexpensive because you’re locked into the HMO referral network.

Best for Low Income or Health Conditions: Medicare Advantage D-SNP

You may want the Medicare Advantage D-SNP plan if you’re on a meager income or have a chronic health condition. This special needs plan is designed for eligible people for Medicaid and Medicare. Your costs are for things such as copays, deductibles, coinsurance, and more.

Vermont Enrollment Facts:

Nationwide, 62 million people are enrolled in Medicare, and 42% of that group use a Medicare Advantage plan.

In Vermont, 13,566 people are enrolled in Medicare Advantage, making up 9% of the total Medicare recipients. The number of enrollees by the plan type is as follows:

  • Local HMO: 3,579
  • Local PPO: 3,119
  • Regional PPO: 5,469

How much does Medicare Advantage in Vermont cost?

If you’re planning to get a Vermont Medicare Advantage plan, you’re likely wondering about the monthly premium. If you choose an HMO, you’ll probably be paying $0 monthly.

PPOs will usually have a premium. In Vermont, the average premium is $41.27, but this cost will vary slightly by county.

How much do Advantage Plans cost in Vermont?

PPO Plan $0.00 to $41.27

HMO Plan $0.00

When can I enroll in a Medicare Advantage plan?

There are specific windows during the year when you can enroll in Medicare Part C.

Initial Enrollment Period

This period is when you first become eligible for Medicare. For most, it’s a seven-month window beginning three months before you turn 65, the month of your birthday, and the three months following.

Open Enrollment Period – AKA Annual Election Period

You can enroll between October 15 and December 7. Coverage begins the following January.

Medicare Advantage Open Enrollment Period

You cannot enroll during the Medicare Advantage Open Enrollment Period, which runs from January 1 – March 31. This time is only for those with Medicare or Medicare Part C to make changes.

Special Enrollment Periods – Special Circumstances

You may be able to join during a special enrollment period if you meet one of the special circumstances, including:

  • A move to a different service area.
  • Loss of your current health care coverage.
  • The opportunity to get another plan outside of Medicare.
  • Changes to the plan or the plan losing its contract with Medicare.

5-star Special Enrollment Period

If a 5-star plan becomes available in your area, you can switch once between December 8 and November 30.

Special Enrollment Periods if You Get “Extra Help”

If you’re in a lower income bracket and qualify for the “Extra Help” program, you can sign up for Medicare Advantage between January-March, April-June, and July-September. This program is based on income and helps those pay for their monthly premiums, annual deductibles, and co-payments related to Medicare Part D (prescription drug coverage).

Medicare Advantage Highlights:

Here are a few things to know about a Vermont Medicare Advantage plan:

  • Insurance carriers provide benefits, not the government.
  • Almost all plans and benefits are tied to a network of hospitals, doctors, and clinics.
  • Plans specified as “MAPD” or Medicare Advantage Prescription Drug plans include prescription benefits built into the benefits.
  • It’s common for plans to include various extra benefits like vision, dental, and gym memberships.
  • Plans require paying the Part B premium, while others pay some or all.
  • The standard monthly Medicare Part B premium for 2023 is $164.90.
  • The annual Part B deducible for 2023 is $226.

Ready to Learn More?

We help educate Medicare beneficiaries on their Medicare Advantage options and help them go through the process of reviewing and comparing plans. We work with most of the nation’s top-rated Medicare Advantage carriers. Call us today, or request a quote online to learn more about plan options.

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