Introduction to Medicare Part C in Vermont (Medicare Advantage)

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 7% 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

In general, the popularity of one Advantage plan over another is largely determined by cost. In the chart below, you can see that HMO plans are more highly favored than any other type. This is because HMO plans keep their costs low with a restrictive provider network. The other plans on the list, such as PPOs and PFFS plans, tend to be more expensive (and also tend to have larger provider networks).

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.

Doctor/Providers List

Drug, Vision and Dental Coverage

Unlike Medicare or other popular Medicare supplements, you have the option to add ancillary benefits to your policy. These include vision, dental, and/or prescription drug coverage (in the form of an MAPD plan). Many seniors like the convenience of having all of their medical needs covered under one simple policy. However, adding lots of additional benefits will significantly increase your monthly rate.

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?

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