Medicare Advantage Plans in Vermont

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. 

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