Original Medicare doesn't have an annual out-of-pocket maximum, meaning you could have substantial medical bills. Medicare Supplement plans in Vermont help pay a variety of medical expenses, such as coinsurance and deductibles. Commonly known as Medigap, the right plan for you depends on your unique needs and budget.
How does Medigap work in Vermont?
Medigap plans help pay your out-of-pocket costs when you have Original Medicare. This includes Part A, inpatient care, and Part B, outpatient medical services.
There are 10 standard Medicare Supplement plans available in Vermont, each represented by a letter: A, B, C, D, F, G, K, L, M, and N. Some plans also have high-deductible versions.
Medicare standardizes Supplement plans, ensuring beneficiaries get the same benefits with Plan A (or D, G, etc.) no matter where they buy it. Premiums, however, are not standardized. Medigap insurers set their own rates, although they must follow state and federal guidelines.
Unlike Original Medicare, Medigap coverage is not guaranteed just because you're 65 years old. Unless you have a guaranteed issue right, your application goes through medical underwriting. If you smoke, have preexisting conditions, or are otherwise considered a high-risk enrollee, Medigap insurers may charge you higher premiums or even refuse to sell you a plan.
Who qualifies for Medicare Supplement Insurance in Vermont?
At the federal level, you qualify for Medicare Supplement Insurance in Vermont once you enroll in Original Medicare and are at least 65 years old. Most states also require Medigap insurers to offer plans to beneficiaries who qualify for Medicare due to a disability and are not yet 65 years old. This includes Vermont.
What does Medigap cover?
Medicare Supplement coverage varies according to the plan you choose. At a minimum, every Medigap plan pays the Medicare Part A coinsurance and gives you 365 additional lifetime reserve days as an inpatient.
Compare Medigap plan benefits with the following table:
Medicare Supplement Insurance does not include prescription drug coverage. You get those benefits with a Medicare Part D prescription drug plan.
Medigap Plan C and Medigap Plan F in Vermont
A new federal law prohibits Medigap plans that cover the Medicare Part B deductible. As a result, Medigap Plan C and Medigap Plan F are no longer available to new Medicare beneficiaries. You can get the same coverage, minus the Part B deductible, with either Medigap Plan D or Medigap Plan G.
When is the best time to join a Medicare Supplement plan in Vermont?
The best time to join a Vermont Medicare Supplement plan is during your 6-month Medigap Open Enrollment Period (OEP), which starts the day you enroll in Original Medicare.
Your OEP is one of the few times you have guaranteed issue rights. If you're at least 65 years old, your application cannot be rejected AND you can't be charged a higher premium.
If you're under age 65, you're guaranteed a Medigap policy during your OEP but you'll most likely be charged a higher premium. Once you turn 65, you get a new Medigap OEP. At this point, your application gets the same protections as someone who is brand-new to Medicare.
Choosing a Medigap plan in Vermont
The first step is deciding how much coverage you want. We recommend choosing a plan with the most comprehensive benefits you can afford. If you don't have a guaranteed issue right, medical underwriting makes upgrading your Medigap plan very difficult (or very expensive).
Pricing comes next. Vermont statute requires Medigap insurers to use community rating. This means your age is not considered when setting your premiums. You'll probably pay more for a community rated plan at first, but over time, these are the cheapest plans available.
Our Find a Plan tool makes it easy to compare Medigap plans in Vermont. Simply enter your location information to review Medicare plan options in your area.
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