In Burlington, Vermont, there are 26,478 Medicare Part C beneficiaries. The number of Part A and Part B beneficiaries in this area is 134,274, which means the Medicare Advantage participation rate is 19.72%.
This article discusses Vermont Medicare Advantage coverage and the various plans available to help you make informed health insurance decisions.
Medicare Advantage plans in Vermont
Medicare Advantage provides all-in-one healthcare coverage through private carriers. With this alternative to Original Medicare, you’re leaving the federal government program and signing up with a personal plan instead. Most Medicare Advantage plans cover benefits that Original Medicare doesn’t, such as hearing, vision, and dental. Some plans, but not all, provide prescription drug coverage.
Each carrier offers unique plans, and a thorough understanding of each plan’s coverage before enrollment is critical. Looking closely at the summary of benefits can give you the insights to choose the plan that fits your needs. In recent years, the number of available Medicare Advantage plans has doubled. Today, Medicare beneficiaries in Vermont can choose from 22 to 29 Medicare Advantage plans, depending on the county where they reside.
Unlike Medigap plans, the federal government doesn’t standardize Medicare Advantage plans. The information below is relevant to one Vermont zip code, and the information in your zip code might vary slightly. The sections below discuss Vermont Medicare Advantage plans according to their stand-out features. These categories include zero-dollar premiums and zero-dollar drug deductibles. We will also discuss two plans offering Part B reductions.
Medicare Advantage plans with a zero-dollar premium
Your premium is the amount you pay monthly to receive health coverage. You don’t need to make this monthly payment with a zero-dollar premium plan. However, these plans have relatively high out-of-pocket costs when using the benefits.
The local preferred provider organization (PPO) plan from Wellcare has the lowest maximum out-of-pocket (MOOP) limit of $6,000. This plan offers Part D coverage, which means it covers prescription drugs. It also provides coverage for vision, hearing, and dental services.
You can also consider the health maintenance organization (HMO) plan from Vermont Blue, with a MOOP limit of $6,660. This plan comes with a $0 medical deductible. It offers copays as low as $0 on many prescription drugs.
If you need four-star coverage, the HMO plan from with a $6,700 MOOP is a viable option. This plan offers comprehensive dental coverage, not just basic cleaning coverage. It even provides a level of coverage for stays in nursing facilities.
| PLAN | PREMIUM | MOOP | PLAN TYPE | STAR RATINGS |
| Vermont Blue | $0 | $6,900 | LOCAL PPO | N/A |
| Wellcare | $0 | $6,000 | LOCAL PPO | N/A |
| MVP Health | $0 | $6,700 | LOCAL PPO | 4 |
| $0 | $6,700 | HMO | 4 | |
| Vermont Blue | $0 | $6,660 | HMO | N/A |
Medicare Advantage Plans with a Zero-Dollar Drug Deductible
With a zero-dollar drug deductible, you immediately receive the full cost-sharing benefit when your plan starts. This option is ideal if you expect significant future medical expenses.
In Vermont, two Medicare Part C plans are available with a zero-dollar drug deductible: one Local PPO and one HMO. These plans from Wellcare have a zero-dollar premium with a $6,000 MOOP.
The HMO plan from also has a zero-dollar premium. While this plan comes with a MOOP limit of $6,700, it has a four-star rating.
| PLAN | PREMIUM | MOOP | PLAN TYPE | STAR RATINGS |
| Wellcare | $0 | $6,000 | LOCAL PPO | N/A |
| Wellcare | $0 | $6,000 | HMO | N/A |
| $0 | $6,900 | LOCAL PPO | 3 | |
| $0 | $6,700 | HMO | 4 | |
| MVP Health | $90.00 | $7,550 | HMO-POS | 4 |
Medicare Advantage plans with a Part B reduction
A Part B reduction is a give-back benefit that helps beneficiaries reduce their healthcare costs. The carrier can fully or partially pay the Part B premium of your outpatient coverage with this benefit. These plans vary by zip code and might not be available in your area.
Two Vermont Medicare Advantage plans are available with Part B reductions. The Wellcare plan offers a $54 Part B reduction with a zero-dollar premium and a $7,550 MOOP limit.
If the Wellcare MOOP limit is too high for you, consider the zero-premium plan. This plan has a three-star rating and offers a Part B reduction of $40. The MOOP limit of this plan is significantly lower at $4,500.
| PLAN | PREMIUM | MOOP | PART B REDUCTION | STAR RATINGS |
| Wellcare | $0 | $7,550 | $54.00 | N/A |
| $0 | $4,500 | $40.00 | 3 |
Ancillary/DVH
Vermont Medicare Advantage plans allow you to access additional benefits that Original Medicare and Medicare Supplement plans don’t cover. Depending on the Medicare Advantage plan, these benefits can include routine examinations, hearing, vision, dental, and more.
Some Medicare Advantage plans also include drug coverage (Part D). In these cases, joining a different Medicare drug plan is not necessary.
Estimated premiums for Medicare Advantage plans in cities across Vermont
For the cities listed below, the estimated premiums for Medicare Advantage coverage can be found by accessing the charts linked:
FAQs
Does getting a Medicare Advantage plan make you lose your Original Medicare in Vermont?
When joining a Medicare Advantage plan, you will not lose your Original Medicare. However, your Medicare Advantage plan will provide most of your Part A and B coverage through a private insurance company.
In Vermont, Medicare Advantage plans must cover all the benefits of Original Medicare except for hospice treatment.
Is Medicare Advantage based on your income in Vermont?
Your income can determine your premium for outpatient care (Part B) and drug coverage (Part D) under a Medicare Advantage plan. If you’re a high-income beneficiary, you can expect to pay a higher percentage for the total cost of your Part B coverage.
If you have prescription drug coverage, you might also pay an additional amount according to the income you report to the IRS.
What is the average cost for Medicare Advantage plans in Vermont?
This year, the average Medicare Advantage premium in Vermont is $22.58. This amount is around $1.50 per month.
All Medicare enrollees have access to zero-dollar premium Medicare Advantage plans.
Which Medicare Advantage plan is rated the best in Vermont?
The Medicare plans from are among the best in Vermont. This company has a 3.5-star Medicare rating and offers plans with zero-dollar premiums and drug deductibles.
You can also find a plan with a Part B reduction to save on your healthcare costs.
What is the most used Medicare Advantage plan in Vermont?
Vermont’s Medicare Advantage plans with the most enrollees are Local PPOs and HMOs. However, Special Needs Plans (SNPs) or Medicare Private Fee for Service (PFFS) plans can also be found. The latter pays for medical benefits, such as hospital stays and doctor’s appointments.
How to get help enrolling in a Vermont Medicare Advantage plan
At Medigap, we can compare the different plans available and help you find a Vermont Medicare plan that fits your needs. Our agents work with all carriers, and our services are free, making choosing the best possible plan easy. Call or complete our online rate form to receive the best rates in your area.
