By January 2022, 165,205 Vermont residents were receiving Medicare benefits. Given that Vermont has the second-highest median age in the country, it is not surprising that a larger-than-usual proportion of its residents apply for Medicare.
Most Vermont residents become eligible for Medicare when they turn 65, but almost 10 million Americans under the age of 65 are also enrolled in Medicare and receive benefits due to a disability or chronic illness. Around 16% of Medicare recipients are younger than 65 in Vermont, compared to 16% across the US.
Whether you are under the eligibility age, just turned 65, or need help with your medical expenses, you should familiarize yourself with the different Medicare insurance plans in the state. It’s always good to consult with a qualified Medicare insurance agent in Vermont who can help you compare different plans based on your health needs and budget.
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Medicare Options in Vermont
Original Medicare
An individual is automatically enrolled in the original Medicare program once they reach the Medicare eligibility age of 65. Original Medicare, which consists of Parts A and B, is a government-sponsored health insurance program for the elderly and the disabled Vermont residents. This program covers all your basic medical expenses.
Part A deals with care received at a hospital or medical facility. This includes inpatient care, outpatient care, and some forms of home healthcare. Part B covers care received outside a hospital, like examinations, vaccinations, X-rays, lab tests, oxygen tanks, ambulance transportation, and other emergency services.
Medicare Supplement (Medigap) Plans in Vermont
There is no limit on out-of-pocket payments (co-insurance and deductibles) in Original Medicare. Beneficiaries with chronic diseases may end up paying a disproportionate share of their medical bills from their own pockets if they are on Original Medicare only.
Over half of all Medicare recipients in the US have supplemental coverage through employer-sponsored plans or Medicaid. However, for Vermont beneficiaries without access to such plans, Medigap policies fill a critical gap in coverage. Medigap plans are supplementary insurance that complement Original Medicare by paying part of the costs that beneficiaries on Medicare would have to pay on their own.
Medigap plans in most states can be priced using either attained-age rating (where premiums rise with the policyholder’s age) or issue-age rating (where premiums are calculated using the policyholder’s age at the time of enrollment), or community-rated pricing (rates are not based on age). If the enrollee is at least 65 years old, Vermont mandates community rating for Medigap policies rather than attained-age rating.
However, age is the only factor used to determine premium differences between enrollees aged 65+ or younger than 65 in Vermont. Vermont is one of two states where providers who do not participate in Medicare are required to offer the same premium to all customers, regardless of age.
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Medigap for Beneficiaries Under 65
Medigap plans in most states can be priced using either attained-age rating (where premiums rise with the policyholder’s age) or issue-age rating (where premiums are calculated using the policyholder’s age at the time of enrollment), or community-rated pricing (rates are not based on age). If the enrollee is at least 65 years old, Vermont mandates community rating for Medigap policies rather than attained-age rating.
However, age is the only factor used to determine premium differences between enrollees aged 65+ or younger than 65 in Vermont. Vermont is one of two states where providers who do not participate in Medicare are required to offer the same premium to all customers, regardless of age.
According to federal regulations, Medicare Supplement (Medigap) enrollment is open to everyone, regardless of health status, for a period of six months. This period begins when they enroll in Medicare Part B and are at least 65 years old. However, if you are under 65 and eligible for Medicare due to a disability, you are not guaranteed access to a Medigap plan under federal regulations.
Vermont has enacted regulations to ensure that individuals under the age of 65 have some access to Medigap policies. In Vermont, Medigap insurers are required to make sure their plans are available to Medicare enrollees of any age for the initial six months following Medicare Part B enrollment.
Insurers are allowed to set higher prices for persons under the age of 65, even though Medigap policies are guaranteed-issue for individuals younger than 65 during the six-month enrollment period.
Medicare Advantage Plans in Vermont
A rising number of seniors in Vermont and across the country are opting for Medicare Advantage plans. Vermont’s private Medicare plan enrollment was still far lower than the national average in 2020, but it has climbed since 2017 and now accounts for about 15% of the state’s Medicare population.
Most Medicare Advantage plans include coverage for prescription drugs (Part D) and other perks such as dental and vision care, gym subscriptions, and a nurse helpline, in addition to the basic benefits of Medicare Parts A and B. However, the amount you pay out of pocket varies depending on which Advantage plan you have. The costs will not be the same as combining a Medigap policy with an Original Medicare plan.
As of 2022, Vermont residents can choose from 26 different Medicare Advantage plans. These plans can be of four types:
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Health Maintenance Organization (HMO)
Most HMOs mandate that you use only in-network providers for all healthcare services:
- A PCP (primary care physician), specialist referrals, and prior approvals for certain procedures and prescriptions are required.
- Plans typically provide drug coverage.
- You can’t purchase separate drug coverage.
- Staying within your network keeps costs low.
Preferred Provider Organization (PPO)
Medicare PPO plans in Vermont have a recommended network of providers. However, you can choose doctors or hospitals outside the network for a higher price.
- You don’t need to have a PCP or specialist referrals.
- Most plans provide drug coverage.
- Drug coverage cannot be purchased separately.
- Higher out-of-network charges and premiums.
Private Fee-For-Service (PFFS)
PCPs and specialist referrals aren’t necessary under PFFS programs:
- You can consult any Medicare-approved doctor or healthcare facility, provided that they agree to the plan’s terms.
- Drug coverage may be included, or you can purchase a separate drug plan.
- You’ll pay more if you go with a provider who doesn’t agree with the rules of your insurance plan.
Special Needs Plan (SNP)
SNPs are only available to people with certain medical conditions, and they feature care coordination and benefits that are specifically designed to match their specific needs:
- You require a PCP and recommendations for specialists.
- Plans always include prescription coverage.
- SNPs are open to everyone who meets the eligibility criteria at any point in time.
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Comparing Medicare Advantage Plans in Vermont
The availability of Medicare Advantage plans varies by region because they are offered by independent insurance companies. Medicare Advantage Plans vary across counties in Vermont. There are 14 counties in Vermont, and the number of Medicare Advantage plans available ranges from 15 to 23 in 2021.
Given the variety of choices available, it’s crucial that you settle on a plan that works for your specific needs and financial constraints. Consider the following elements while assessing your options:
Provider Network
Since each Medicare Advantage plan has its own set of providers, you might have to stick to a Depending on your Medicare Advantage plan, the network of doctors and hospitals you can visit may be limited to a certain area. Consider enrolling in Original Medicare with a Medigap plan and Part D coverage if the size of the provider network is an issue or if you plan on traveling within the US.
Even if you have a specific insurer in mind, it’s still a good idea to compare your choices before committing to a plan. Many medical professionals treat Medicare Advantage patients but may not be in the regular Medicare provider network.
Amount of Coverage Required
You might be interested in plans with extra benefits like health care, retirement plans, and gym memberships. Unlike Medigap plans, many Medicare Advantage plans carry these benefits. Discuss your required benefits with a licensed Medicare insurance agent to find a plan that has everything you need.
Check Plan Ratings
Visit the CMS website to evaluate different Part c and Part plans before enrollment begins. These plans are ranked from 1 to 5, with 5 being the highest ranking.
Out-of-Pocket Expenses
This includes all the expenses you pay out of your pocket, like deductibles, co-pays, and co-insurance. Staying within a provider network will help you keep these expenses low. You can compare the costs of various plans with our convenient plan finder tool.
Monthly Premium
You have to pay monthly premiums even if you don’t utilize your benefits, so these costs add to your monthly cash flow. If you want to keep your expenses down, you should look for at least one zero-premium plan that provides adequate prescription coverage in your area.
Drug Coverage
You may want to look into Medicare Part C plans if you need help paying for your prescriptions. Prescription drug coverage, known as Medicare Part D, is typically bundled into Medicare Advantage plans. If you decide to go with Original Medicare plus Medigap coverage, you’ll still need to sign up for a Medicare Part D plan to manage your prescription drug expenditures.
Deductibles, Co-insurance & Copays
You start paying these costs once your Medicare insurance coverage comes into effect. Hence, it’s important that you understand the extent of your plan’s inpatient and outpatient coverage. All medical costs, including hospitalization and prescribed medications, are included in your co-pays and deductibles.
Freedom to Travel
Original Medicare offers very limited travel coverage, unlike Medigap and Medicare plans. Medicare Advantage plans are more flexible than Medigap policies and offer more extensive coverage for international travel than Original Medicare. Make sure you learn about how different plans handle overseas travel before enrolling.
Medicare Eligibility in Vermont
Medicare enrollment is open to Vermont residents, regardless of age, as long as they meet the eligibility requirements. Enrollment is open year-round for patients of chronic or incurable conditions, such as end-stage renal disease (ESRD) and amyotrophic lateral sclerosis (ALS).
Medicare Enrollment in Vermont
If you are at least 65 years old or have received at least four payments from Social Security or the Railroad Retirement Board before your 65th birthday, Medicare will enroll you automatically. You can enroll in Medicare by applying online, or you can contact your local Social Security Administration office.
Medicare enrollment is available during the following timeframes:
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Initial Enrollment
Those eligible can sign up for Medicare beginning three months before their 65th birthday and during the three months that follow. Anyone who has never received Medicare before should enroll during this time. You can change or upgrade your current Medicare plan, even if you started receiving benefits at a younger age, during the IEP.
General Enrollment
If you missed the initial enrollment period, you get another chance between January 1 and March 31 during general enrollment. You can enroll in Medicare Part D, Medicare Advantage (Part C), Medigap coverage, or Original Medicare (Parts A and B) during this period.
Open Enrollment
You can make changes to your Medicare Part C plan over the three months spanning from October 15 to December 7.
Special Enrollment
If you lose your insurance coverage or become ineligible for it for some other reason, such as changing jobs or moving to a different state, you may be given a special timeframe to enroll.
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Why Should You Choose Medicare Hope Insurance Agents?
The Medicare insurance agents at Integrity Now Insurance Brokers are AHIP-accredited and required to renew their license every year. So, you can trust us to have the latest knowledge and expertise in the health insurance industry. We help individuals of all ages, including elderly and disabled youth, who are struggling to keep up with medical expenses.
The Medicare insurance market is dynamic, and keeping track of new development can get overwhelming. Even the plans you’re already enrolled in can see changes or become inactive altogether. When you work with our Medicare insurance agents in Vermont, you don’t need to worry about keeping track of these changes. Leave that to us.
Achieving your goals and satisfaction is our core mission. Whether you need a Medigap policy or want to bundle policies together, we’ll tell you how to pick the most affordable and appropriate option. Our Medicare insurance agents in Vermont will help you to compare your plan options after assessing your financial and individual requirements.
Call us to speak with a licensed Medicare insurance agent in Vermont and get started right away!
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