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Medicare Part D in Vermont


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Over 105,000 Medicare beneficiaries in Vermont have Medicare Part D Prescription Drug Coverage, according to the Centers for Medicare and Medicaid Services (CMS). This represents about 74% of all Medicare beneficiaries in Vermont. If you have Medicare in Vermont, you might want Medicare Part D coverage because Original Medicare (Part A and Part B) doesn’t cover most prescription drugs you take at home. Without Medicare Part D, you could be paying for all of your prescription drugs out-of-pocket.

What are my options for Medicare Part D in Vermont?

If you want Medicare Part D in Vermont, you have two options: a stand-alone Medicare Part D Prescription Drug Plan and a Medicare Advantage Plan with prescription drug coverage. Both types of plans are offered by private insurance companies regulated by Medicare.

Stand-alone Medicare Part D plans can be used alongside Original Medicare. According to CMS, about 88% of people with Medicare Part D in Vermont have stand-alone Medicare Part D Prescription Drug Plans. There are 22 stand-alone Medicare Part D Prescription Drug Plans available in Vermont in 2018, reports CMS, although not all plans may be available in all areas.

Medicare Advantage plans are an alternative way to get your Medicare Part A and Part B benefits through a private insurance company contracted with Medicare. Medicare Advantage plans often include prescription drug coverage, so you get Medicare Part A, Part B, and Part D all in one plan. Medicare Advantage plans must offer everything that Original Medicare offers with the exception of hospice care, which is still covered by Part A. According to CMS, there are 8 Medicare Advantage plans available in Vermont in 2018. One hundred percent of people with Medicare in Vermont have access to a Medicare Advantage plan.

What are the costs of Medicare Part D in Vermont?

One cost of a Medicare Part D prescription drug plan in Vermont is a monthly premium. A premium is the amount you pay to have the plan, whether or not you fill prescriptions. According to the Centers for Medicare and Medicaid Services, $12.60 was the lowest monthly premium for a Medicare prescription drug plan in Vermont in 2018.

Another cost is a deductible. This is the amount you pay each year for your prescriptions before the plan begins to pay its share. Different plans may have different deductibles, but no deductible can exceed $405 in 2018, as regulated by Medicare. Some Medicare Part D plans in Vermont don’t have a deductible.

Another cost is a copayment, which is a set dollar amount you pay when you fill a prescription. A copayment might be $10, for example. Instead of a copayment, you may pay coinsurance. Coinsurance is usually a percentage, 15%, for example. Medicare Part D plans in Vermont may put prescription drugs on tiers, with lower tier prescription drugs having a smaller copayment or coinsurance than higher tier prescription drugs.

How do I know if my medications are covered by my Medicare Part D plan in Vermont?

To find out if your prescriptions are covered, ask for a copy of the plan’s formulary, or list of covered prescription drugs. The eHealth plan finder tool will also let you enter your Rx drugs and search by plans that cover that specific prescription drug. The formulary may change at any time, but the plan will inform you when necessary.

How do I sign up for Medicare Part D in Vermont?

There are a number of times when beneficiaries may enroll in Medicare Part D coverage in Vermont. The first is the Initial Enrollment Period for Part D, which occurs when a beneficiary first becomes eligible for Medicare. The seven-month Initial Enrollment Period begins three months before the beneficiary becomes eligible for Medicare, includes the month of eligibility, and continues for three months afterward.

Beneficiaries may also enroll in or make changes to their Medicare prescription drug coverage during the Annual Election Period(AEP), also called Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage, which runs from October 15 to December 7 of each year. For beneficiaries who use the Medicare Advantage Open Enrollment Period (OEP) (January 1 to March 31) to disenroll from their Medicare Advantage plan, they will be returned to Original Medicare; they can also use this disenrollment period to enroll in a stand-alone Medicare Prescription Drug Plan.

Beneficiaries may also be able make coverage changes outside of the regular periods with a Special Election Period, provided they have a qualifying situation (such as moving out of a plan’s service area).

To start searching for a prescription drug coverage in Vermont, enter your zip code 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.

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