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Guide to Medicare in Vermont

October 9, 2023

Guide to Medicare in Vermont

Are you nearing the age of 65? If so, you probably wonder how Medicare works in Vermont. 

Does Vermont have Medicare plans? How do you look for the right plan for your needs? Do you get enrolled automatically or do you have to sign up?

These are all great questions, and this guide will help you answer them. If you have additional questions about Medicare and Medicare Advantage in Vermont, we’re here for you. Just reach out!

Does Vermont have Medicare?

Most health insurance plans aren’t available in every state, so you might wonder if Vermont has Medicare. However, Medicare is a federal program designed to help certain groups of people get health coverage when they might not have access otherwise. That means it’s available in all 50 states.  
There are more than one million people enrolled in Medicare in Vermont, including:

  • Almost nine hundred thousand people enrolled in a Prescription Drug plan
  • Almost three hundred thousand people with a Medicare Advantage plan

How do you qualify for Medicare? You need to be a U.S. citizen or permanent resident that has been in the U.S. for at least five years. 

Also, at least one of the following must apply:

  • You’re age 65 or older
  • You’re under 65 but disabled and receiving disability benefits from Social Security or the Railroad Retirement Board
  • You have end-stage renal disease (ESRD)
  • You have Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease

Often, you’ll automatically be enrolled in Original Medicare as soon as you qualify. Original Medicare includes Medicare Part A, for inpatient hospital care, and Medicare Part B, for doctor’s visits, medical equipment, and outpatient care. 

However, that might not always be the best Medicare plan for your needs. For example, you might decide you need to add a Medicare drug plan (Part D), or that an Advantage plan (Part C) is better for you. It’s important to review all of your options before your initial enrollment period ends.

How Much Does Medicare Cost in Vermont?

How much will you pay for Medicare in Vermont? The answer depends on what Medicare plan you have. Keep in mind that you’ll need to choose a provider that participates in Medicare. 

If you have Original Medicare, you’ll generally get Medicare Part A premium free. 

  • If you have an inpatient hospital stay, you’ll be responsible for a deductible of $1,556 per year in 2022. 
  • After that, you’ll pay a $0 coinsurance per day for days 1-60 within a year. 
  • Days 61-90 in a year are $389 per day coinsurance. After 90 days in a year, you either pay the full cost or use your lifetime days. 

Keep in mind that you only get 60 lifetime days to use throughout your life. Lifetime days have a coinsurance of $778. 
Medicare Part B costs $170.10 per month in 2022. After your deductible is met, you’ll pay 20% of the Medicare-approved cost and Medicare will cover the rest. 

If you need coverage for prescription drugs, you can also sign up for a Medicare Part D plan. This will have a separate monthly premium and a copayment for each prescription you need. 

Wondering how to cover those out-of-pocket costs? You might want to look into getting a Medigap plan or see if you qualify for a Medicare Savings Program. You only have guaranteed acceptance for Medigap during your initial enrollment period. 

Another option is to get a Medicare Advantage plan. Medicare Advantage is a full replacement for Original Medicare and often includes additional benefits. We’ll look at this option in the next section.

Does Vermont have Medicare Advantage Plans?

Is there Medicare Advantage in Vermont? Medicare Advantage is offered by private insurance companies and is focused on providing you with care in your local area. Exactly which plans are available and the benefits you get may vary.

Medicare Advantage replaces Original Medicare and often includes additional benefits. For example, you’ll still get hospital coverage and coverage for doctor’s visits, but you may also get prescription drug, vision, and dental coverage.  Learn more about the differences between Original Medicare and Medicare Advantage.

The important thing to keep in mind is that you’ll generally need to stay within the provider network of the plan, which is usually within your local area. If you travel often or spend periods of time in other states, Medicare Advantage plans may not be the right fit for you. 

Medicare Advantage may not have any cost beyond the normal Part B premium, or you may have an additional premium as well. You’ll want to compare the available plans in your area to choose the one that’s best for your needs.

Contact Us to Learn More About Medicare in Vermont

The page answered the questions we most commonly hear about Medicare in Vermont. If you have questions specific to your situation, or if you’d like to compare Medicare Advantage plans or talk to a licensed agent, feel free to contact us today!

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