Medicare Plans in Vermont – Coverage and Benefits
Medicare Parts A and B, which are the base plan of the federal Medicare program, help provide senior citizens 65 and older with basic health care during their golden years. Part A covers hospital stays and most other procedures performed within hospital walls. Part B, on the other hand, provides benefits for non-hospital services, such as doctor visits and outpatient procedures.
Because most people age 65 and older are retired, and therefore living on a fixed income, the Medicare program is designed with this in mind. To keep the program solvent yet affordable, every single member is required to pay yearly deductibles and monthly premiums for Medicare Part B. There are additional fees for Part A, but only if you have a short work history of less than 10 years cumulative (or 40 quarters).
|Medicare Part A (Hospital Coverage)
||Medicare Part B (Medical Insurance)
|Medicare Part C (Medicare Advantage)
||Medicare Part D (Drug Coverage)
Vermont Supplemental Medicare Plans
Vermont may be a smaller state, but it still has a sizeable population of Medicare beneficiaries (117,393 total residents). Of those, only 7% (8,217 people) are supplementing their Medicare benefits with a Medicare Advantage policy. A much more popular choice, according to 33% of beneficiaries (38,157 recipients) is a Medigap supplemental policy. But the vast majority of seniors, which equates to 60% of beneficiaries (or 70,435 people) are either relying upon some sort of employer benefit, or aren’t supplementing their Medicare coverage at all.
Naturally, you will not be able to purchase a supplement plan unless you are already enrolled in Original Medicare. To enroll, address questions about enrollment, or to learn more information about Medicare enrollment, click here.
Why isn’t Medicare Enough for Vermont Residents?
Parts A and B of Medicare by themselves may be enough – or even more than enough – to take care of your medical needs and expenses. Most people with Medicare plans in Vermont might not require supplemental coverage at all. However, unexpected medical emergencies can happen at any time. And if they sneak up on you, these are just a few of the expenses you can expect:
|Medicare Part A Costs||Medicare Part B Costs|
Fortunately, there are Medicare supplement policies out there which will protect you financially and help you secure the medical services you need to live a long, healthy life. The two major forms of supplement coverage out there are Medicare Advantage, and Medigap. Keep reading to learn more about them.
Medigap Supplement Insurance in Vermont
For simplicity’s sake, each one of the ten available Medigap policies are assigned a letter of the alphabet in order to identify them: Plans A, B, C, D, F, G, K, L, M, and N are currently available for purchase in all 50 states. Plans E, H, N, and I are no longer available due to the Medicare Modernization Act of 2010. Plan A in Iowa offers the exact same coverage and benefits as Plan A in Vermont; however, it will likely be cheaper in your state. You will may also have several different underwriters to choose from.
Here are the coverage and benefits options for each plan:
Top Medicare Supplement Plans in the Area
|Type||Starting From||Part A Deductible||Part B Deductible||Excess||Nursing||Travel|
|F||$141||$0||$0||100% Covered||100% Covered||100% Covered||Request Info|
|C||$131||$0||$0||Not Covered||100% Covered||100% Covered||Request Info|
|G||$169||$0||$147||100% Covered||100% Covered||100% Covered||Request Info|
|B||$118||$0||$147||Not Covered||Not Covered||Not Covered||Request Info|
|N||$96||$0||$147||Not Covered||100% Covered||100% Covered||Request Info|
|D||$120||$0||$147||Not Covered||100% Covered||100% Covered||Request Info|
|A||$92||$1||$147||Not Covered||Not Covered||Not Covered||Request Info|
|L||$104||$304||$147||Not Covered||75% Covered||Not Covered||Request Info|
|K||$63||$608||$147||Not Covered||50% Covered||Not Covered||Request Info|
|M||$147||$608||$147||Not Covered||100% Covered||100% Covered||Request Info|
Medicare Advantage Options in Vermont
Although Medicare Advantage (MA) is technically a form of supplemental insurance, it acts more like a replacement of Traditional Medicare in practice. This is because MA policies are not offered by the federal government. Rather, a private insurance company promises to provide “equal or greater” coverage and benefits than Traditional Medicare as is required by law. In fact, many companies do fulfill the “greater” part of that promise with additional coverage options like prescription drugs or vision. But these extra benefits will cost extra, too.
MA plans offer access to fairly restricted networks. These limited PPO (Preferred Provider Organization) and HMO (Health Maintenance Organization) networks of doctors and physicians do help keep costs low, but switching to a Medicare Advantage plan might make it difficult or impossible for you to keep seeing the same doctor. However, if the price is right and you feel like you may get comparable care from a new physician, you have to sit down and consider what is best for you, your health, and your budget.
Top HMO Plans in the Area
|Cost||Plan Name||Coverage Type||Premium||Deductible||Rating|
|$220||Preferred Gold without Part D (HMO-POS)||Health Only||$18.40||$0|
|$714||GoldValue with Part D (HMO-POS)||Health and Drug||$59.50||$0|
|$1404||Preferred Gold with Part D (HMO-POS)||Health and Drug||$117.00||$0|
Top PPO Plans in the Area
|Cost||Plan Name||Coverage Type||Premium||Deductible||Rating|
|$324||BasiCare with Part D (PPO)||Health and Drug||$27.00||$310|
|$768||GoldAnywhere with Part D - Option 2 (PPO)||Health and Drug||$64.00||$0|
|$2856||GoldAnywhere with Part D - Option 1 (PPO)||Health and Drug||$238.00||$0|
Vermont Medigap vs. Vermont Medicare Advantage
There are many subtle differences between these two forms of Medicare supplemental coverage. It can be difficult to learn exactly how these supplements are different from one another at first. Below, we have set up an informational chart to show you exactly where and how these supplement policies differ:
|Questions||Medicare Advantage||Medicare Supplement|
|How are the plans funded?||Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company.||Your monthly premium takes care of the majority of your expenses.|
|Do I continue paying for Part B?||Yes||Yes|
|What does it cost me?||Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly.||While each plan does require a monthly premium, many of them are affordably priced.|
|What does the plan cover?||Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be.||All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.|
|Can I budget my health care expenses?||It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket.||Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.|
|Can my plan be cancelled?||Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage.||No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.|
|Are pre-approvals or pre-certifications required?||Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care.||No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.|
|Can I use any doctor or hospital?||Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time.||Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.|
|Can drug, vision, or dental coverage be included in the policy?||Yes.||No. These forms of coverage must be purchased separately.|
|Who is this plan type generally best suited for?||If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you.||If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.|
Vermont Medicare Resources
It’s highly likely that you still have questions about Medicare Advantage and Medigap supplement insurance. That is to be expected. For this reason, we’ve included a helpful pool of contact resources for you to draw from. Try contacting representatives from the offices below to learn more about which supplement is best for you.
Choose at least one topic area you are interested in: Select All
Help with my Medicare options & issues
Other insurance programs
Complaints about my care or services
General health & health conditions
Claims & billing
Health care facilities & services in your area
Important Medicare Terms
- HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
- PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
- Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
- Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
- Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.