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Medicare Advantage Plans in Vermont

Discover popular companies, plan type comparisons, average costs, and when to enroll in a Medicare Advantage Plan in Vermont.

Medicare beneficiaries in Vermont have the option of Original Medicare, which is offered through the federal government, or choosing a Medicare Advantage plan, purchased through private insurance companies.

A Medicare Advantage plan in Vermont is a replacement for Medicare. You’ll still receive all of the same benefits, only they’ll be covered by and administered by a private insurance company. Medicare Advantage is becoming increasingly popular because these programs offer benefits beyond what enrollees get with Original Medicare.

Top rated Medicare Advantage providers in Vermont

  • MVP Health Care: This regional insurance company has signed up 18 percent of all Medicare Part C plan members. This company markets a highly rated PPO that may attract a lot of Vermont seniors. The company also has an HMO-POS plan that may offer an alternative to people who would rather not have an HMO.
  • Aetna: Aetna is active in Vermont with about two percent of current members but may have plans to grow in this state moving into 2019.
  • Humana: Vermont Humana doesn’t seem to be active at this time for Medicare Advantage plans.
  • Cigna is another popular option to look for in your area.

Popular Medicare Advantage plan types in Vermont

There are many Medicare Advantage plans available to Vermont residents for 2022. Each has different coverage options and can suit different needs.

Best Network Freedom: Medicare Advantage PPO

Medicare Advantage PPO is a good option for those who want to be able to go outside of their network when necessary. With this plan, you’ll pay less if you use an in-network provider.

You’re allowed to go outside of your network, but you’ll usually pay more. However, Medicare Advantage networks are typically large and you don’t need a referral. Premiums are usually anywhere between $0-100 each month.

Best for Lowest Out-of-Pocket: Medicare Advantage HMO Plan

Health care out-of-pocket costs can be expensive. If you want to save as much as possible, a Medicare Advantage HMO plan is the way to go. These plans will require you to use network providers except in cases like ER visits, out-of-area urgent care and out-of-area dialysis for end-stage renal disease.

The premiums are usually $0 per month. The costs are inexpensive because you’ll be locked into the HMO referral network.

Best for Low Income or Health Conditions: Medicare Advantage D-SNP

If you’re on a very low income or have a chronic health condition, you may want the Medicare Advantage D-SNP plan. This special needs plan is designed for people who are eligible for Medicaid and Medicare. Your costs on things such as copays, deductibles, coinsurance and more.

Vermont Enrollment Facts:

Nationwide,  62 million people are enrolled in Medicare and of those, 42% use a Medicare Advantage plan.

In Vermont, a total of 13,566 people are enrolled in Medicare Advantage, making up 9% of the total Medicare recipients. The number of enrollees by plan are as follows:

  • Local HMO: 3,579
  • Local PPO: 3,119
  • Regional PPO: 5,469

How much does Medicare Advantage in Vermont cost?

If you’re planning to get a Vermont Medicare Advantage plan, you’re likely wondering about the monthly premium. If you choose an HMO, you’ll likely be paying $0 each month.

PPOs will usually have a premium. In Vermont, the average premium is $41.27, but this cost will vary slightly by county.

How much do Advantage Plans cost in Vermont?
Plan Type Premium Range
PPO Plan$0.00 to $41.27
HMO Plan$0.00

When can I enroll in a Medicare Advantage plan?

There are certain windows during the year when you can enroll in Medicare Part C.

Initial Enrollment Period

This period is when you first become eligible for Medicare. For most, it’s a 7 month window beginning 3 months prior to the month you turn 65, the month of your birthday and the 3 months following.

Open Enrollment Period – AKA Annual Election Period

You can enroll between October 15 and December 7. Coverage begins the following January.

Medicare Advantage Open Enrollment Period

You cannot enroll during the Medicare Advantage Open Enrollment Period, which runs from January 1 – March 31. This time is only for those who already have Medicare or Medicare Part C to make changes.

Special Enrollment Periods – Special Circumstances

You may be able to join during a special enrollment period if you meet one of the special circumstances, including:

  • A move to a different service area.
  • Loss of your current health care coverage.
  • The opportunity to get another plan outside of Medicare.
  • Changes to the plan or the plan losing its contract with Medicare.

5-star Special Enrollment Period

If a 5-star plan becomes available in your area, you can switch once between December 8 and November 30.

Special Enrollment Periods if You Get “Extra Help”

If you’re in a lower income bracket and qualify for the “Extra Help” program,  you can sign up for Medicare Advantage between January-March, April-June and July-September. This program is based on income and helps those pay for their monthly premiums, annual deductibles and co-payments related to Medicare Part D (prescription drug coverage).

Medicare Advantage Highlights:

Here are a few things to know about a Vermont Medicare Advantage plan:

  • Insurance carries provide benefits, not the government.
  • Almost all plans and benefits are tied to a network of hospitals, doctors and clinics.
  • Plans specified as “MAPD” or Medicare Advantage Prescription Drug plans include prescription benefits built into the benefits.
  • It’s common for plans to include a wide variety of extra benefits like vision, dental, gym memberships, over-the-counter prescriptions, transportation to and from medical appointments, meal delivery services and more.
  • Plans require you to pay the Part B premium, while others pay some or all of it.
  • The standard monthly Medicare Part B premium for 2022 is $170.10.
  • The annual Part B deducible for 2022 is $233.

Vermont State Links

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Ready to Learn More?

We help educate Medicare beneficiaries on their Medicare Advantage options and help them go through the process of reviewing and comparing plans. We work with most of the nation’s top-rated Medicare Advantage carriers. Give us a call today, or request a quote online to learn more about plan options.