Medicare Advantage in Vermont

Medicare Advantage, or Medicare Part C, is a type of health insurance plan offered by private companies as an alternative to the Original Medicare program, also known as Medicare Parts A and B. Although technically a private option, Medicare Advantage plans are available at subsidized prices and must adhere to federal guidelines. They also cover the same services as Original Medicare, including hospital stays and outpatient care, but generally offer additional benefits, such as vision, hearing and dental coverage, wellness programs and support with prescription drug costs.

Medicare Advantage Plans often operate under a network-based structure, offering beneficiaries the choice between Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs) and other plan types. Those enrolled in HMOs choose a primary care physician and have access to lower costs within a network of doctors and hospitals. PPOs offer more flexibility to see out-of-network providers, but at the expense of higher costs. Less popular options include Medical Savings Account (MSA) plans, which combine a health insurance policy with high deductibles and a savings account with tax advantages, and Special Needs Medicare (SNP) plans, designed to provide specialized health care coverage for individuals with specific conditions, such as diabetes and certain types of cancer.

As of 2023, about 49,190 adults in Vermont have enrolled in Medicare Advantage Plans, which amounts to only 31% of residents who are eligible for Medicare coverage, well below the average national enrollment rate of 48%. This is rapidly changing, however; compared to 2022, 14% more residents enrolled in Medicare Advantage in the state during 2023, which is higher than the U.S. increase of 7%.

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 practical advice to find the right policy for their needs.

The Top Medicare Advantage Plans in Vermont

The table below lists the top six Medicare Advantage providers available to Vermont residents. Companies are ranked based on the total number of enrolled beneficiaries as of 2023.

To help retirees choose a high-quality provider which caters to their needs, the table assigns each company a quality star rating between one and five, which is based on annually updated satisfaction surveys. It also provides a price range, so seniors know in advance which plans best fit their budget.

For up-to-date information about Medicare Advantage options in Vermont, residents can use Medicare’s plan comparison tool.

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. 

*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.

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.

State-Wide Medicare Advantage Resources

Local Medicare Advantage Resources