Vermont has an older-than-average population, so Medicare plays a key role in providing health and financial security to beneficiaries. With more than 149,900 Vermont beneficiaries enrolled in Medicare, we’ll cover some important information below about Medicare in Vermont. We want to help you better understand your options and make the decision-process as seamless as possible once you’re ready to enroll in Medicare or discover different coverage options.

Who Qualifies for Medicare in Vermont?

Medicare covers most Vermont residents who are 65 or older, and it also covers disabled Vermont residents. In general, Medicare enrollment in Vermont works the same way as it does in the rest of the country. If you qualify for Original Medicare, also known as Part A and Part B, it will help cover 80% of your health care costs.

When you’re first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B. If you’re eligible for Medicare when you turn 65, you can sign up during the 7-month period that:

  • Begins 3 months before the month you turn 65
  • Includes the month you turn 65
  • Ends 3 months after the month you turn 65

In most cases, if you don’t sign up for Part B when you’re first eligible, you’ll have to pay a late enrollment penalty. You’ll be responsible for paying this penalty for as long as you have Part B, and you could have a gap in your health coverage.

Once you reach Medicare eligibility, you can begin choosing additional coverage options to help pay for the remaining 20% of your medical expenses through Medicare Advantage (Part C), Medigap, and/or a Medicare Prescription Drug (Part D) plan.

Who Qualifies for Medicare

Vermont Medicare Enrollments

128,585

Original Medicare Plans
(Part A and B)

21,354

Medicare Advantage & Other Health Plans

94,076

Stand-alone Medicare
Part D (Drug plans)

149,939

Total Medicare Beneficiaries
in Vermont

Vermont Medicare Advantage Plans (Part C)

Only 12% of Vermont Medicare beneficiaries select Medicare Advantage plans.

Medicare Advantage plans are private, Medicare-approved insurance companies. They provide all of your Original Medicare benefits and often include extra benefits such as drug, dental, and vision coverage.

The Medicare Advantage Open Enrollment Period runs from January 1 to March 31. During this period, Medicare beneficiaries in Vermont who already enrolled in a Medicare Advantage plan can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare.

According to the Centers for Medicare and Medicaid Services (CMS), as of May 2020, there are 21,354 beneficiaries enrolled in Medicare Advantage and other plans in Vermont. Only 12% of Vermont Medicare beneficiaries were enrolled in a private Medicare Advantage plan in 2019. 100% of people with Medicare have access to a Medicare Advantage plan.

As of 2020, 13 Medicare Advantage plans are available in Vermont. The average monthly Medicare Advantage premium changed from $36.23 in 2019 to $33.85 in 2020. $0 is the lowest monthly premium for a Medicare Advantage plan in Vermont. In 2020, all of Vermont’s 14 counties have either 11 or 13 Medicare Advantage plans for purchase.

Vermont Medicare Supplement (Medigap) Insurance Plans

Vermont has rules in place to ensure at least some access to Medigap plans for beneficiaries who are under age 65.

Medigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that beneficiaries would otherwise incur if they only had Original Medicare on its own. Typically, Medigap plans are popular for those who want little to no copay when they access healthcare services.

Vermont Medigap insurance is available to everyone with Medicare in the state, including those who are under 65 and are enrolled in Medicare. Often, Medigap plans in Vermont can be more expensive if you don’t enroll during your Initial Enrollment Period and wait for an Annual Open Enrollment Period. 

There are two initial times to enroll in a Medigap plan before and after you turn 65:

  • 6 months prior to turning 65
  • Once you turn 65, your 6 month period begins the month you enroll in Part B.

During this period, an insurance company can’t use medical underwriting. 

There are currently 12 insurers licensed to sell Medigap plans throughout Vermont. Although most states allow Medigap plans to be priced using attained-age rating, issue-age rating, or community rating, Vermont doesn’t allow Medigap insurers to use attained-age rating. Also, Vermont Medigap insurers are required to use community rating as long as the beneficiary is at least 65 years old. Vermont is one of only two states that require insurers offering non-Medicare individual market coverage must charge the same price regardless of how old the beneficiary is. Vermont also has rules in place to ensure at least some access to Medigap plans for beneficiaries who are under age 65. All Medigap insurers in Vermont are required to make all their plans available to all Medicaid beneficiaries, regardless of age, during the first six months after the person is enrolled in Medicare Part B.

Vermont Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t cover outpatient prescription drugs. However, Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Part D plan. Medigap plans don’t cover prescription drugs unless they’re covered under Part B.

As of May 2020, There are 94,076 Medicare beneficiaries in Vermont enrolled in stand-alone Part D prescription drug plans and 19,052 enrolled in Medicare Advantage Prescription Drug plans. For 2020 coverage, there are 25 stand-alone Part D plans available in Vermont, with premiums ranging from about $13 to $128 per month. About 29% of people with a stand-alone Medicare prescription drug plan get Extra Help (also called the low-income subsidy, or LIS).

When deciding on a Part D plan, it’s important to evaluate several factors such as each plan’s premium, formulary, and copays since every plan is different. Learn how you can save money on your out-of-pocket costs with a Medicare Advantage, Part D, or Medigap plan, fill out this form or give us a call.

Local Medicare Health Plan Resources in Vermont

  • Vermont’s State Health Insurance Program is a free counseling service that provides information, assistance, and support to Medicare beneficiaries who need help selecting or managing public and/or private health insurance benefits. 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.
    Contact: Call 800-642-5119 or through any local branch of Vermont’s Area Agencies on Aging

  • Vermont Health Connect is Vermont’s health insurance marketplace, serving all qualified individuals as well as seniors in need of Medicare or Medicaid support. The Senior HelpLine can answer your questions, including how to enroll in Medicare. They can also help you choose a Medicare Part D prescription drug plan that works best for you.
    Contact: Call 1-855-899-9600

  • 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.
    Contact: Call 1-800-917-7787 or through the organization’s online Help Request Form.

  • Green Mountain Care is a division of Health Access Member Services of the Department of Vermont Health Access. Green Mountain Care provides information on low-cost and free health coverage programs offered by the state of Vermont and its partners. Green Mountain Care programs include Medicaid for the Aged, Blind or Disabled (MABD), Medicaid for Children and Adults (includes Dr. Dynasaur), Choices for Care, Long-Term Care, and Prescription Assistance.
    Contact: Call 1-800-250-8427 or online using the help request form.

  • 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. Central Vermont Council on Aging provides information, counseling, and assistance to all Medicare-eligible persons under the auspices of the State Health Insurance & Assistance Program or “SHIP”.

    The staff counsels individuals and provides workshops to the public on Medicare. They can answer your questions about Medicare, private insurance plans, supplemental insurance plans, and Vermont State insurance programs. They also offer regularly scheduled “Medicare & You” workshops to the public in locations convenient to you.
    Contact: Call 802-479-0531 to schedule Zoom workshop meetings and Medicare Part D counseling sessions. The Council also provides a website help form. The senior helpline number is 1-800-642-5119.

  • Senior Solutions is the Area Agency on Aging designated to serve older adults in the southeastern region of Vermont. The agency provides a wide variety of services to older adults within the 46-town service area, giving priority to those with the greatest social and economic needs. This is attained through a comprehensive and coordinated system of information and referral, home-based assistance, case management, nutrition services, and many community partners.
    Contact: Call 802-885-2669, toll-free 1-866-673-8376, 802-885-2655, or email [email protected]

The licensed agents that are partnered with Timefor65 can help you compare the availability, benefits, and costs of Medicare plans in your specific region of Vermont. Our process makes it easier for you to access your Medicare eligibility in Vermont so that you receive personalized, affordable, and easy-to-use coverage options and solutions. Fill out the form or give us a call at (866) 382-1192 anytime to get a free quote or to ask any questions.

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