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Medicare Advantage Plans in Vermont


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If you live in Vermont, you may enjoy maple syrup. If you live in Vermont, you may also be one of over 141,000 people enrolled in Medicare in 2018 according to the Centers for Medicare and Medicaid Services (CMS). When you enrolled in Medicare Part A and Part B (Original Medicare) you might have been surprised to discover what it generally doesn’t cover, including:

  • Prescription drugs
  • Routine dental
  • Routine vision
  • Routine hearing

With a Medicare Advantage plan in Vermont, you can get coverage for all of the above and more.

What is Medicare Advantage in Vermont?

Medicare Advantage is alternative way to get your Part A and Part B benefits through a private insurance company contracted with Medicare. Medicare Advantage plans in Vermont must cover everything that Original Medicare covers, with the exception of hospice care, which is still covered by Part A. Medicare Advantage plans are free to offer additional benefits that Original Medicare usually doesn’t cover. Another benefit of Medicare Advantage plans are they have out-of-pocket maximums, unlike Original Medicare which has no out-of-pocket maximum. According to CMS, over 14,000 people are enrolled in Medicare Advantage plans in Vermont in 2018.

What types of Medicare Advantage plans are there in Vermont?

The types of Medicare Advantage plans available may be the same types of plans you had when receiving employer-sponsored health insurance. Medicare Advantage plans are usually managed-care plans such as:

  • Health Maintenance Organizations (HMOs): HMOs in Vermont typically have a provider network of hospitals and doctors you must use to get coverage. These plans require a referral from your primary care doctor to see a specialist.
  • Preferred Provider Organizations (PPOs*): PPOs in Vermont have more provider flexibility; you have the option to use doctors in the plan’s preferred provider network, or you can use out-of-network providers and pay higher costs. These plans don’t require primary care doctors, and you don’t need a referral before seeing a specialist.
  • Private Fee-for-Service plans (PFFSs**): PFFS in Vermont do not have provider networks. Instead, you can use any doctor or hospital that agrees to the plan’s terms and conditions, on a case-by-case basis.

Only 8 Medicare Advantage plans are available in Vermont in 2018, according to the Centers for Medicare and Medicaid Services, but 100% of Medicare beneficiaries in Vermont have access to a Medicare Advantage plan.

What are the costs of a Medicare Advantage plan in Vermont?

Cost of Medicare Advantage plans in Vermont include premiums, copayments, and deductibles. One or more of these costs may be $0 depending on your plan.

  • A premium is an amount you pay monthly to have your plan, whether you use medical services or not. You may pay a premium as low as $0 for your Medicare Advantage plan, but you must continue to pay your Medicare Part B premium.
  • A deductible is the amount you pay before you plan begins to pay
  • Coinsurance or copayment is amount you pay when you use a service. For example, if you pick up a prescription drug that retails for $500, and you have a $10 copayment, you only pay $10. If you have 10% coinsurance, you pay $50.

Keep in mind that plans with lower premiums may charge higher deductibles and copayments/coinsurance.

To learn more about Medicare Advantage in Vermont, enter your zip code into the “zip code” box on this page.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/co-insurance] may change on January 1 of each year.

The Formulary and/or provider network may change at any time. You will receive notice when necessary.
*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

**A Private Fee-for-Service plan is not Medicare supplement insurance. Providers who do not contract with our plan are not required to see you except in an emergency.

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