Vermonters looking for health insurance that offers comprehensive coverage may want to consider a Medicare Advantage (MA) plan. More than 30 million people had an Advantage plan in 2023. Keep reading to learn more about Medicare Advantage plans in Vermont.
What is Medicare Advantage in Vermont?
Also known as Medicare Part C, Medicare Advantage plans are similar to the group health insurance many people have through their employers.
At a minimum, Advantage plans must provide the same coverage you get with Original Medicare. This includes:
- Medicare Part A, hospital insurance (inpatient services)
- Medicare Part B, medical insurance (outpatient services)
Prescription drug coverage is available via standalone Medicare Part D plans. It is also included with around 90 percent of Advantage plans.
Medicare Advantage plans with prescription drug coverage in Vermont
Medicare Advantage Prescription Drug plans (MA-PD) combine the benefits of Medicare Parts A, B, and D.
Many Advantage plans – with or without prescription drug coverage – also offer additional benefits. Common items include:
- Routine vision care
- Fitness programs
- Hearing aids
- Routine dental care
Private insurance companies provide Medicare Advantage plans, which means that coverage and costs will vary depending on which plan you choose.
Who is eligible for Medicare Advantage in Vermont?
If you have Medicare Parts A and B, you can join a Medicare Advantage plan in Vermont.
American citizens and permanent legal residents aged 65 and older qualify for Medicare. If you start collecting Social Security benefits at least 4 months before your 65th birthday, enrollment in Parts A and B occurs automatically. Everyone else must apply for Medicare.
You're also eligible for Medicare if you collect Railroad Retirement Board (RRB) or Social Security disability benefits for 24 months. Enrollment occurs automatically in month 25.
When can you sign up for a Medicare Advantage plan in Vermont?
You may join a Medicare Advantage plan in Vermont during specific enrollment periods.
Your Initial Enrollment Period (IEP) begins 3 months before your Medicare eligibility month and lasts for a full 7 months. So, if your 65th birthday or 25th month of collecting disability occurs in February, your IEP starts on November 1 and ends on May 31.
If you fail to sign up for Part A and/or Part B during your IEP, you may do so during the General Enrollment Period from January 1 until March 31. You may then join a Medicare Advantage plan from April 1 until June 30.
You can also sign up for an Advantage plan during Medicare's Annual Enrollment Period (AEP), which runs from October 15 through December 7.
People currently enrolled in Part C can take advantage of the Medicare Advantage Open Enrollment Period from January 1 through March 31. Options are limited to joining a different MA plan or returning to Original Medicare. However, if making that change causes you to lose your prescription drug coverage, you may also sign up for a standalone Part D plan.
If you experience certain life changes, you can sign up for Part C during a Special Enrollment Period. Find the full list of qualifying circumstances on Medicare.gov.
Types of Medicare Advantage plans in Vermont
The four main types of Medicare Advantage plans in Vermont are:
- Health maintenance organizations: HMO plans require members to choose a primary care doctor and get a referral to see a specialist. They also have a provider network that may include any entity you rely on for healthcare services. Treatment received from an out-of-network provider is rarely covered by an HMO unless it's an emergency.
- Preferred provider organizations: PPO plans also have provider networks, but members can go outside the network for a higher copay. PPO plan members also don't need a primary doctor or specialist referrals.
- Private fee-for service: PFFS plans establish cost guidelines for covered services, including what plan members pay. Most PFFS plans have a provider network but allow members to use an out-of-network provider for a higher cost. There is no need to choose a primary physician or get a referral to see a specialist.
- Special needs plans (SNPs) are limited to people who meet certain criteria. Guidelines vary by plan. One of the following must apply for you to join an SNP: having a chronic condition, living in an institution or requiring home-based care, or qualifying for both Medicare and Medicaid. If you qualify for an SNP, you may join the plan at any time.
How to choose a Medicare Advantage plan in Vermont
When comparing your Medicare plan options, consider the following:
- Costs: These may include an annual deductible, monthly premiums, and copays or coinsurance.
- Coverage: Benefits vary widely, so compare your options carefully. Don't forget the drug formulary for MA-PD plans.
- Network: If you have complicated medical issues or preexisting conditions, you may want a plan that includes your providers in its network.
- Ratings: Medicare rates plans on a 5-point scale and releases their findings every fall to help beneficiaries during AEP.
It's easy to compare Medicare Advantage plans in Vermont with our Find a Plan tool. Just enter your location information to review the Medicare plan options in your area.
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