Assisted living facilities primarily help residents with non-medical needs. Although minor and infrequent medical services, such as first-aid for a wound, can sometimes be met on-site by nurses. These communities may sometimes also be called ALFs, residential care facilities, retirement homes, or long-term care facilities.
The financial options available to help pay for senior care is dependent on, among other things, the type of care that is required. If you are just beginning the research process on how to pay for long-term care, it is helpful to have an idea about the type of care you or your loved one currently requires, as well as to anticipate future needs. In addition, it is important to be familiar with the associated eldercare terminology.
Can using home care technology help your family save money caring for an aging loved one? The answer is most certainly “Yes”. Our goal is not to provide a comprehensive list, but rather to make sense of those that are available on the market today and can reduce the care hours required by elderly persons. As such, they can reduce a family’s out-of-pocket care costs or reduce the hours they spend providing care themselves.
Medicare Advantage (Part C), a privately offered alternative to Original Medicare (Parts A and B), has grown in popularity over the years. Despite the growing popularity of Medicare Advantage, some seniors face obstacles that prevent them from truly understanding how it works and who it benefits. Common mistakes about Medicare Advantage include misunderstanding its differences from Original Medicare, getting it confused with other forms of private Medicare insurance (like Medigap or Part D), or not understanding how to look up or evaluate plans.
Medicare Advantage is a type of health insurance policy that provides the same benefits as Original Medicare, but private insurance companies operate them. These plans, also referred to as Part C, resemble private insurance plans sold on the health care marketplace, but the Centers for Medicare & Medicaid Services subsidizes them. To qualify as a Medicare Advantage provider, the private insurance company must offer the benefits available in Medicare Parts A and B. The plans can also include additional coverage options, such as vision, dental and prescription drugs.
In Vermont, 41,910 adults are enrolled in Medicare Advantage plans in 2020, less than 20% of all Medicare enrollment in the state. This is one of the lowest Part C participation rates in the entire country, which the significant rural population partly explains. The national rate is 42%. Despite the relatively low enrollment, Vermont seniors have many Medicare Advantage plans available to them, including Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Special Needs Plans (SNPs) and Private Fee-for-Service (PFFS). The vast majority of seniors have plans they obtain individually on the open market, but there is a significant number who get their benefits through their employer or union-sponsored group.
Seniors can use this guide to learn more about the Medicare Advantage plans available to them in Vermont. It includes eligibility requirements, coverage options, enrollment periods and how to find the right policy.
The Top 10 Medicare Advantage Plans in Vermont
The table below lists the 10 most popular Medicare Advantage plans available to seniors in Vermont. The table bases ranking on total provider enrollment as of April 2022. It presents cost information in a range since many of the providers have more than one plan. The table also includes a Medicare quality rating, which is between one and five stars. It bases this rating on satisfaction surveys, updated every year to give seniors an idea about each provider’s quality before the open enrollment period. For up-to-date information about Medicare Advantage plans available in Vermont, residents can visit the Medicare.gov website.
Name
Total Enrollment
Star Rating
Min Cost
Max Cost
Plan Types
UnitedHealthcare
20,207
3.5
$0
$62
HMO, PPO
Vermont Blue Advantage
10,921
0
$0
$59
HMO, PPO
MVP HEALTH CARE
5,058
4.5
$50
$130
HMO, PPO
Wellcare
3,156
0
$0
$25
HMO, PPO
Aetna Medicare
1,070
0
$0
$0
PPO
Cigna
667
0
$0
$0
PPO
Humana
401
4
$60
$60
PPO
Anthem Blue Cross and Blue Shield
57
0
$0
$0
PPO
Highmark Inc.
31
0
$0
$0
PPO
How Medicare Advantage Plans Work in Vermont
Before switching to or enrolling in a Medicare Advantage Plan, it’s helpful for seniors to know how Part C works in Vermont. First, they should decide which of the main coverage categories are right for their needs: Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Special Needs Plans (SNPs) or Private Fee-for-Service (PFFS). The graphic below lists details about how much these plans cost and what they cover.
What Medicare Advantage Plans Cover in Vermont
Medicare requires private insurance companies offering Medicare Advantage plans to cover the same service offered by Original Medicare like hospital care, preventative screenings and durable medical equipment. One exception is hospice care, which is not covered by Medicare Advantage, but by Medicare Part A. In addition to the benefits included in Original Medicare Parts A and B, these plans can also cover dental, vision, hearing aids, prescription drugs and other health care products and services seniors commonly need. Some plans may even cover fitness club memberships and other health and wellness programs.
Coverage Available With Medicare Parts A & B?
Coverage Available With Medicare Advantage?
Preventive Screenings
Yes
Yes
Hospital Care
Yes
Yes
Durable Medical Equipment
Yes
Yes
Prescription Drugs
No
Yes**
Vision Care
No
Yes*
Dental Care
No
Yes*
Hearing Aids
No
Yes*
*Select plans offer this coverage
** Most plans offer this coverage
Eligibility for Medicare Advantage in Vermont
Medicare Advantage has many of the same eligibility requirements as Original Medicare. To start, the applicant must already have Medicare Parts A and B. This requirement means they must be aged 65 and older or have a qualifying disability or end-stage renal disease. In addition, they must be a Vermont resident living in a community where Medicare Advantage providers offer coverage. Seniors are automatically eligible for Medicare Advantage if they are already receiving Social Security benefits or Railroad Retirement benefits. To sign up for a plan, residents must enroll during specific times of the year, which are listed below.
Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.
Start Date
End Date
Initial Coverage Election Period
3 Months Before One’s 65th Birth Month
3 Months After One’s 65th Birth Month
Annual Election Period (AEP)
October 15th
December 7th
Medicare Advantage Open Enrollment Period
January 1st
March 31st
Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.
How to Find & Choose a Medicare Advantage Plan in Vermont
Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.
First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.
Vermont’s State Health Insurance Program is a free counseling service available to provide information, support and assistance to eligible seniors seeking Medicare coverage. Seniors can call with questions and concerns about choosing a Medicare plan and receive confidential and unbiased information and resources. Counseling extends to both private and public insurance options, as well as supplemental policies and long-term care insurance. SHIP can also help those using Medicaid or VPharm to coordinate coverage. This service is organized through Vermont’s Area Agencies on Aging and is available to all seniors eligible for Medicare, as well as their family members and caregivers.
Vermont Health Connect is Vermont’s health insurance marketplace, serving all qualified individuals as well as seniors in need of Medicare or Medicaid support. Seniors can browse their options using the plan comparison tools or call to find out about plans and benefits. Vermont Health Connect’s services are free to use and are available on a daily basis to answer insurance questions and help Vermont residents enroll in insurance plans. Those who want who meet with someone from VHC in person can do so in locations situated regionally throughout the state.
Vermont Legal Aid is a nonprofit organization that provides fair and unbiased legal support for low-income citizens of the state of Vermont. In addition to more standard civil legal services, Vermont Legal Aid also offers Medicare support, including a comprehensive FAQ page on its website and access to a help line. Seniors with questions about Medicare, those who would like to connect to additional Medicare resources or those who have other general legal questions about Medicare coverage can call to receive custom support from a legal perspective.
Green Mountain Careis a division of Health Access Member Services of the Department of Vermont Health Access. Its focus is on connecting low-income individuals with cost-saving opportunities. For seniors on Medicare who are having trouble affording benefits or who need other forms of financial assistance, Green Mountain Care can provide information about options such as Medicaid and prescription drug cost aid. In addition, the organization can connect seniors with other financial assistance programs, such as meal assistance, live-in caregiver resources and access to basic health screening to make getting health care with Medicare more affordable. Green Mountain Care is available to anyone who qualifies for Medicaid, including seniors on Medicare looking for additional resources.
The Central Vermont Council on Aging is one of Vermont’s Area Agencies on Aging serving the Central Vermont region, including the capital of Montpelier. For people living in this area, numerous Medicare counseling resources are available. In addition to offering support through the State Health Insurance Program, CVOCA also hosts in-person Medicare & You information sessions on a regular basis at locations throughout Central Vermont. Currently, sessions are also being held over the Zoom video call platform, allowing seniors from all over the state to participate. In addition, CVOCA offers Part D prescription drug counseling services from October to December each year. The Central Vermont Council on Aging is available for all seniors living in the Central Vermont region as well as those living throughout the state for virtual information sessions.
Seniors can contact the Central Vermont Council on Aging by phone at 802-479-0531 to schedule Zoom workshop meetings and Medicare Part D counseling sessions. The Council also provides a website help form. The senior help line number is 1-800-642-5119.
An invaluable resource for seniors in Southeastern Vermont, including Windham and Windsor counties, Senior Solutions is one of Vermont’s Area Agencies on Aging. Offering extensive options for seniors, Senior Solution’s main benefit is its comprehensive help line service. Using a thorough Medicare planning option, the representatives at Senior Solutions can offer free and unbiased counseling services to empower seniors making Medicare decisions. Counseling includes private and public plan options, like Medicare Advantage and Original Medicare. Senior Solutions can also connect seniors with other necessary resources, including Medicaid, day programs, home health resources, transportation options, Meals on Wheels, prescription assistance programs and Social Security. Senior Solutions is available to all seniors living in the Southern Vermont area.
Seniors can reach the Senior Solutions help line at 802-885-2669 or toll-free at 1-866-673-8376. General contact with the organization is available at 802-885-2655 or via email at [email protected].