Unfortunately, most seniors are unaware of the potentially disastrous coverage gaps inherent in Medicare Parts A and B. Things like extended hospital stays, hospice care, and Part B excess charges are not covered by Medicare. Therefore, the responsibility is on you to pay those bills. Thankfully, you can lessen this burden on yourself by purchasing Medicare supplement insurance. One of these supplements, known as Medicare Advantage, helps you do much more than just cover the gaps in Medicare Coverage. We’ll discuss all the different aspects of Medicare Advantage here in this article.

Federal Regulations for Medicare Advantage

Medicare Advantage plans are provided by private insurance companies, and not the federal government. Therefore, purchasing an Advantage plan means that your claims will be paid out by that private company (and not the government) for as long as you maintain the policy. Federal regulations guarantee that your plan will give you the same benefits as Medicare Parts A and B. In fact, many plans provide much more coverage than that.

Medicare Advantage Enrollment In Vermont

Vermont seniors don’t often resort to Medicare Advantage as a means to supplement the gaps in their Medicare coverage benefits. Only 8% of active Medicare recipients are subscribed to a Medicare Advantage plan. Of those, the enrollment amongst the different types of Medicare Advantage plans is as follows:

Plan Type Enrollment Percentage
HMO Plans 59%
Local PPO Plans 13%
Special Needs Plans 11%
Regional PPO Plans 9%
Private Fee-For-Service Plans 5%
Other (Cost Plans, MSA’s, etc.) 3%

Plan Coverage & Cost

Living in Vermont, as opposed to any other state, will influence your monthly premium. Other personal factors, such as your age and overall health, will also augment your costs. Below is a sample list of plans for sale in your area:

Most Popular Medicare Advantage Plans in Vermont

Are you familiar with how five star reviews work? Then you’ll find our Medicare Advantage reviews rating system very easy to navigate. Companies who earn the most stars out of a total of 5 are ranked that way because they are affordable, provide good customer service, are offered by financially stable companies, and excel at long-term care management. The better their rating, the better the care you can expect at an affordable price.

Helpful Medicare Advantage Tips & Tricks

Doctor/Provider Network Restrictions

Unlike Medicare or other Medicare supplement plans, you must get your treatment from doctors and facilities which are a part of your provider network. On less expensive plans, such as HMOs, you cannot get medical care from a non-network provider unless it is a medical emergency, or you are willing to pay 100% out of pocket. Other plans, such as PPOs or PFFS, have more choice and flexibility. However, they will have a higher monthly premium.

  • HMO Plans – In a regular, private health insurance plan, a Health Management Organization network either assigns you or lets you choose a primary care doctor. You will go to that doctor for the majority of your care, and they will give you referrals based on what they think will best suit your medical needs. You cannot get care outside of your insurance company’s health provider network unless it is an emergency. Going out-of-network may result in substantially higher or 100% out-of-pocket costs.
  • PPO Plans – Preferred Provider Organization plans are private health insurance plans which gives you more choice. These are better for people who have a little extra money to spend on their medical care, require more frequent care, and want to have a little more control over the doctors and facilities they get that care from. They tend to be pricier as far as monthly premiums and cost-sharing goes, but most people consider this a fair trade-off in exchange for better health.
  • PFFS Plans – Private Fee-For-Service plans don’t work with networks the way HMO and PPO plans do. You can see any doctor you want. But before you get care, your insurance company and the healthcare provider must agree to payment terms first. And they must make a new agreement every single time you schedule an appointment with that care provider. The terms and agreement status can change at anytime, so you’ll have to stay on your toes. If they don’t come to an agreement, you’ll either have to pay for your costs out-of-pocket or get care from somewhere else.
  • Special Needs Plans – Special needs plans are almost identical to an HMO, but they are exclusively reserved for people who have exceptionally expensive medical needs due to chronic illness. Your network of doctors and facilities to choose from is very limited, and the majority of your healthcare will be managed through a primary care physician. Specialized, out-of-network care is negotiable but difficult to get without paying out-of-pocket. There are also exceptions for out-of-network care in the event of a medical emergency.

Doctor/Providers List

  • HMO Plans – Despite their strict rules, HMO plans are typically more affordable than most insurance policies. And when you combine that with financial assistance via the federal Medicare program, you get a highly affordable Medicare Advantage HMO plan. All you have to do is stick to the referrals you get from your primary care doctor and do your best to stay healthy as you age. It’s as simple as that.
  • PPO Plans – As you get older and prepare for retirement, signing up for a Medicare Advantage PPO plan can get you better healthcare at a more affordable price. You won’t have the restrictions you would have with an HMO, so you’ll have more doctors to choose from and more of your costs covered thanks to financial Medicare assistance.
  • PFFS Plans – Sometimes payment terms can be difficult to negotiate under a Private Fee-For-Service plan. But with a Medicare Advantage PFFS plan, this makes it a little easier. Medicare is more widely accepted than most other forms of insurance coverage, and the payment terms tend to be a little bit more flexible. so you may not have to stress out and go back and forth between different doctors with a Medicare Advantage PFFS plan.
  • Special Needs Plans – Qualifying for a special needs plan can help you get more affordable healthcare and give you access to doctors and Facilities which specialize in your conditions. And if you can qualify for one through Medicare Advantage, that’s even better. Not only will the Medicare Advantage financial assistance help lower your costs and keep more of your savings in your bank where it belongs, but Medicare is more universally accepted than most health insurance plans – so this could allow you access to specialists and other doctors which you might not have been able to see before.

Using the Medicare website Physician Search Tool is one of the quickest and easiest ways to make sure that your doctor will be available on the Medicare Advantage plan you choose. Believe it or not, not all doctors are available on all networks. But clicking that link will give you the opportunity to search for them and double check before you make a final decision.

Drug, Vision and Dental Coverage

One of the big differences between Medicare Advantage and other Medicare plans is that you have the option to add vision coverage to your policy. This makes it easier and sometimes more affordable to keep your eyes (as well as the rest of your body) healthy. It’s also more convenient because you manage all of your needs on the same policy instead of going through multiple providers.

You can also add dental coverage to a Medicare Advantage plan. But you cannot add it to Original Medicare (parts A, B, or D) and you cannot add it to a Medicare supplement insurance policy. You can always purchase dental coverage (or vision coverage, for that matter) from an independent insurance company and use it in tandem with whatever Medicare or Medicare supplement insurance you purchase; but you won’t have the added convenience of having all of your care managed under the same policy by the same company.

Enrollment Options & Best Time To Enroll

If you are newly 65 and already enrolled in Medicare, you are in a great position to find affordable coverage with an uncomplicated approval process. Those who wait, however, will have more difficulty. Also, regardless of age, serious pre-existing conditions such as End Stage Renal Disease will make it that much harder to find the coverage you need. Thankfully, there are options for you. Your state department of insurance will have more information on those options, as well as your local insurance agent. And be sure to visit our Medicare Advantage Enrollment Options page when you get a chance.

  • Initial Enrollment Period: 6-month timeframe when you first enroll in Medicare to purchase a Medicare Advantage plan.
  • Annual Enrollment Period (AEP): This timeframe runs from October 15th through December 7th every year, and during this time you can change or cancel your Medicare Advantage and part D drug plan.
  • Special Enrollment Period (SEP): During special circumstances, you may be eligible to purchase/change a plan outside of the Annual Enrollment Period. Things such as moving out of the plans’ service area, losing group health or employer coverage, a company no longer offering plans in the area, etc. are all events that could trigger a SEP.

What Medicare Advantage Plan Is Best For Me?

The Medicare supplement you choose now will likely be the one that helps you cover the costs of your medical care for the rest of your life. So you can’t afford to make a mistake. If you choose wrong, it could increase your medical costs for years to come.

We know that you have a lot of pressure on you because you’re enrollment period isn’t going to be open forever. But we have the expertise necessary to help you make a smart decision quickly. We can refer you to the best providers in your area and we can help you shop among them to find the most affordable quotes. Just answer a few questions for us, and we can connect you with the right Medicare supplement insurance plan today!

by Lindsay Malzone, Lindsay Malzone is the Medicare expert for Medigap.com. She's been contributing to many well-known publications as an industry expert since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.