Vermont has more than 157,000 people enrolled in Medicare – and the number of plan options is also growing. Comparing the different plans is key to finding the best plan for you.

Medicare plan options include:

  • Original Medicare (Part A and Part B)
  • Medicare Advantage
  • Medicare Part D

You may also elect to add a Medicare Supplement Plan (Medigap) to go along with Original Medicare to help with additional out-of-pocket expenses.

Before you pick a plan, learn about your costs, coverage, and choosing the best Medicare plan for your needs.

What You Should Know About Medicare in Vermont
  • Average costs of Medicare in Vermont: In 2023, Medicare Advantage premiums decreased 7.5% from $19.92 to $18.43. The lowest Part D plan in Vermont is $6.80.
  • Average expenditure per enrollee: In Vermont, the average Medicare spending per enrollee is $9,040.
  • Number of enrollees in Vermont: As of 2023, 157,294 individuals are enrolled in Medicare in the state of Vermont. Approximately 27,842 individuals are on a Medicare Advantage Plan.
  • Medicare Advantage availability: Vermont has had a 3.8% decrease in Medicare Advantage Plans since 2022.There are 25 Vermont Medicare Advantage Plans available in 2023, which is an increase from 26 plans in 2022.

Who Qualifies for Medicare in Vermont?

To qualify for Medicare, you must meet certain eligibility requirements. First, you must be a U.S. citizen or permanent resident. You must also be at least 65 years old or have a disability and receive Social Security Disability Insurance (SSDI) benefits for at least 24 months. You may qualify for Medicare at a younger age if you have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease).

How does Vermont Medicare enrollment work?

If you start receiving your Social Security or Railroad Retirement Board (RRB) benefits at least four months before you turn 65, you’ll be enrolled in Medicare automatically. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:

  • Initial enrollment: Your Initial Enrollment Period (IEP) starts three months before your 65th birthday and ends three months after your 65th birthday. If you’ve never had Medicare, you can enroll during this period. If you started receiving Medicare when you were younger, you can also make changes to your plan.
  • General enrollment: Choose this enrollment period if you missed your IEP. The Medicare General Enrollment Period (GEP) is Jan. 1 to March 31. You can choose Original Medicare, Medicare Advantage, Medigap, or Part D.
  • Medicare Advantage open enrollment: You can make changes to your Medicare Part C, also known as Medicare Advantage, from Jan. 1 to March 31.
  • Open enrollment: You can join, switch plans, or drop your coverage from Oct. 15 to Dec. 7 each year.
  • Special Enrollment Periods (SEPs): You may qualify for a SEP if you lose your coverage or have changes to your eligibility outside the regular enrollment periods.

Expert tips for enrolling in Medicare in Vermont

  • Beware of late penalties: You will be penalized if you do not enroll in Medicare A, B, and Part D when you become eligible. To avoid late enrollment penalties, you must have creditable coverage through group health insurance or the U.S. Department of Veterans Affairs (VA). Medicare Part A penalty only applies if you don’t qualify for premium-free coverage, and you don’t enroll for the plan when you first become eligible.
  • Get the right plan: Make sure to consider your coverage area, the doctors you see, and overall health care needs. Check to see if your doctors and medical facilities that you use and prefer are in-network with the plan you choose. If you have a health condition that requires you to travel out of state to specialty clinics, consider if they will be covered. When searching plans only look for those that are specific to your coverage area. If you travel a lot, you may want a plan that has a larger network of coverage and is accepted beyond Vermont.
  • Know your prescription drugs and pharmacy: When considering prescription drug coverage make sure you have a list of what you take and know what pharmacy you will be using. There are tools through or licensed agents that can determine what plan covers your drug cost the best and if your pharmacy will be in-network. You may assume that all prescription drug plans (PDPs) are created equal, but every drug plan has different formularies and network providers.
  • Don’t procrastinate: If you wait until the last minute, you may miss something important. Be familiar with enrollment periods and deadlines. Three months prior to your eligibility month is a good time to start comparing plans, enrolling and preparing.
  • If you don’t know, ask! Don’t be afraid to ask for help. Ask questions. Reach out to the Social Security Administration (SSA) or local licensed insurance agents. Utilize resources provided when you have questions.

Medicare Plans in Vermont

Vermont has several Medicare options available to U.S. citizens or permanent residents at least age 65. You are eligible if under age 65 and you have ESRD, ALS, or have been disabled for at least 24 months and draw SSDI.

  • Original Medicare: Coverage consists of two parts: Part A (hospital insurance) and Part B (medical insurance). Medicare Part A covers benefits such as hospital, home health, hospice, and skilled nursing care facilities. Part B covers doctors’ visits, outpatient services, emergency care, labs, diagnostic testing, preventative, and medical supplies. It can also cover some medications that have to be administered at a clinic or facility and cannot be self-administered.
  • Medicare Advantage (Part C or MA): Medicare Advantage is an alternative to Original Medicare with plans sold by private insurers. Many plans include prescription coverage and may also cover gym memberships, dental, vision, hearing, and transportation to medical appointments, giving you more coverage than Original Medicare.
  • Medigap: Medigap plans are standardized plans sold by private insurance companies. Plans are designed to pick up costs where Original Medicare leaves off in coverage.
  • Medicare Part D: Part D is prescription drug coverage you add to Original Medicare or Medicare Advantage. Plans are offered by private insurance companies but are regulated by Medicare.

Original Medicare

Original Medicare is the standard coverage for Medicare beneficiaries and has two parts: Part A (hospital insurance) and Part B (medical insurance). Here’s a look at the details about Original Medicare:

  • Part A: Medicare Part A covers benefits such as hospital, home health, hospice, and skilled nursing care facilities. Part A covers 80% of your medical costs and you are responsible for the remaining deductibles, copay, coinsurance and remaining out-of-pocket expense. Part A is usually premium free if you or your spouse have paid the required Medicare tax. If you did not meet the required Medicare tax to qualify for a free premium, you could pay up to $506 per month for Part A.
  • Part B: Part B covers doctors’ visits, outpatient services, emergency care, labs, diagnostic testing, preventive and medical supplies. It can also cover some medications that have to be administered at a clinic or facility and cannot be self-administered. Part B premium is based on Income Related Monthly Adjustment Amount (IRMAA) but the average cost is $164.90 per month. You will be responsible for 20% of your medical cost after meeting a yearly deductible of $233 (in 2023).

Who Original Medicare is best for: Original Medicare is a good option if you want more flexibility. It has a broad coverage area throughout the U.S. If you have several health conditions, you may want to pair your Medicare with a Medigap. Because Original Medicare does not cover prescriptions, enrolling in a stand-alone drug plan is important. If not paired with a Medigap, the out-of-pocket cost is a drawback to the plan.

Original Medicare in Vermont:
Part A premium Standard Part B premium
Usually free $164.90 per month
  • Covers 80% of the cost for most medical bills.
  • You pay the remaining 20% of costs, with no yearly limit on what you pay out-of-pocket.
  • You can buy a Medicare Supplement Insurance (Medigap) policy to help pay your share of costs.
  • If you want drug coverage, you can join a separate Drug plan (Part D).
  • Can use any doctor or hospital that takes Medicare, anywhere in the U.S.

Medicare Advantage Plans

An alternative to Original Medicare, Medicare Advantage Plans – also known as Part C – cover everything Part A and Part B do, but typically offer additional coverage.

Vermont Medicare Advantage programs have networks and may only be available in certain areas of Vermont. Plan options are based on ZIP code. These plans usually consist of copayments, deductibles, and out-of-pocket maximums that you are responsible for. However, plans can start at a $0 premium and go up from there. The average monthly premium in Vermont is $18.43 (in 2023).

The Vermont Medicare Advantage Program is made up of four types of plans:

  • Health maintenance organization (HMO): HMO plans generally provide coverage only at in-network providers except in medical emergencies. You usually need to have a primary care physician (PCP), who can give you a referral to see specialists. Most HMO plans include prescription drug coverage.
  • Preferred provider organization (PPO): PPO plans have a network of health care providers and facilities where your care will cost less. You can use out-of-network providers as well but your care will cost more. You usually do not need a primary care doctor to get referrals to see specialists or receive treatment. Most PPO plans include prescription drug coverage.
  • Private fee-for-service (PFFS): PFFS plans allow you to use any Medicare-approved provider. Some PFFS plans have networks of providers where you can receive lower-cost care. You don’t need referrals to see specialists in PFFS plans but prescription drugs are not always covered.
  • Special needs plans (SNPs): SNPs are for beneficiaries with specific diseases or characteristics. These plans tailor benefits and providers to the special needs of the group they serve. Generally, you are limited to the network of providers the plan offers and need a primary care doctor and get referrals to specialists. All SNP plans include prescription drug coverage.

The best Medicare Advantage Plan is the one that meets your individual needs and matches what is most important to you in terms of costs, choice of providers, and ease of access. Vermont has 26 plans available in 2022. Medicare Advantage has continued to rise in popularity with Vermont residents.

Who Medicare Advantage Plans are best for: This type of plan is best if you are on a fixed income or you are in good health and don’t want to overpay for coverage you don’t use very often. Having one card to use and the additional benefits bundled in the plan can be attractive. To be eligible, you need to be enrolled in Medicare Part A and Part B.

The downsides to Medicare Advantage Plans are mostly related to a limited choice of providers and service areas. Prior authorizations and referrals may also be necessary before receiving certain procedures.

Compare Vermont Medicare Advantage insurance companies:
Medicare Advantage insurance company Medicare rating A.M. Best rating Better Business Bureau (BBB) rating J.D. Power ranking
Blue Cross Blue Shield Logo 3.9 stars A B 5th out of 9
Humana Logo 4.2 stars A- A+ 2nd out of 9
UnitedHealthcare Logo 4.2 stars A Not rated 4th out of 9
Wellcare Logo 3.7 stars Not rated A- Not ranked in the top 9
Compare Vermont Part C plan options:
Plan name Monthly premium Yearly drug and premium cost Deductibles
UVM Health Advantage Select (PPO) $0 $0 Health: $0
Drug: $250
MVP Medicare Well Select with Part D (HMO-PPO) $0 $0 Health: $0
Drug: N/A
AARP Medicare Advantage Plan 3 (HMO) $0 $0 Health: $950
Drug: $0

Plans calculated based on Montpelier ZIP code 05602.

Medicare Prescription Drug Coverage Plans

Medicare Part D is offered by private insurance but is regulated by Medicare. Part D can be purchased as a stand-alone PDP or as part of a Medicare Advantage Plan (MA-PD).

Vermont Part D premiums start at $6.80 a month.

Currently, there are 24 stand-alone PDPs in Vermont. Seven of the stand-alone plans and six Medicare Advantage Plans with prescription drug coverage participate in the Senior Savings Model, which lowers the cost of insulin out of pocket.

Who Part D plans are best for: PDPs are always best even if you don’t take any medications. If you do not enroll when becoming eligible, you will be penalized for every month you do not have one.

Compare Vermont Part D insurance companies:
Medicare Advantage insurance company Medicare rating A.M. Best rating BBB rating J.D. Power ranking
Aetna Logo 3.8 stars A A+ 6th out of 9
Cigna Logo 4 stars A Not rated 8th out of 9
Humana Logo 4.2 stars A- A+ 2nd out of 9
UnitedHealthcare Logo 4.2 stars A A+ 4th out of 9
Wellcare Logo 3.7 stars Not rated A- Not ranked in the top 9
Compare Vermont Part D plan options:
Plan name Monthly premium Yearly drug and premium cost Deductible
SilverScript SmartSaver (PDP) $6.80 $81.60 $505
Wellcare Value Script (PDP) $8.60 $103.20 $505
Humana Walmart Value RX Plan (PDP) $34.10 $409.20 $505

Plans calculated based on Montpelier ZIP code 05602.

Medicare Supplement Insurance Plans

Medigap plans are standardized plans sold by private insurance companies. These plans are designed to pick up costs where Original Medicare leaves off in coverage. There are 12 standardized plans available in Vermont designated by different letters of the alphabet (A, B, C, D, F, G, K, L, M, and N). Plans C & F are only eligible to those who became eligible for Medicare prior to Jan. 1, 2020.

A Plan G for a 65-year-old nonsmoking female in Montpelier ranges from $145 to $343 per month. You will also be responsible for the Part B deductible of $233.

Who Medigap plans are best for: Medigap is a good fit if you utilize benefits frequently, do not want to be restricted to a small coverage area, and prefer to choose your own provider. You should not choose a supplement if you cannot afford the monthly premium and you want extra benefits available with Medicare Advantage, such as having the PDP, dental, vision, and hearing benefits included.

If you are considering purchasing a supplement, always check to see if the company offers additional discounts for having people that live in your household or for nonsmoking.

Compare Vermont Medigap plan options:
Plan name Monthly premium range Copays/coinsurance Deductibles Plan benefits
Plan F $168 to $378 $0 $0 hospital (Part A)
$0 medical (Part B)
  • Skilled nursing facility
  • Part A deductible
  • Part B deductible
  • Part B excess charges
  • Foreign travel emergency
Plan G $145 to $343 $0 $0 hospital (Part A)
$233 medical (Part B)
  • Skilled nursing facility
  • Part A deductible
  • Part B excess charges
  • Foreign travel emergency
Plan N $124 to $209 $0 Generally your cost for approved Part B services with some $20 and $50 copays $0 hospital (Part A)
$233 medical (Part B)
  • Skilled nursing facility
  • Part A deductible
  • Foreign travel emergency

Calculated based on a nonsmoking 65-year-old female in Montpelier ZIP code 05602.

How To Compare Vermont Medicare Plans

Vermont residents have many plan options available. It is always good to make a list of pros and cons of the plans. Important things to consider are out-of-pocket costs, provider network, coverage area, insurance company ratings and the overall ability of the plan to meet your specific need.

Expert tips for comparing Medicare plans:

  • Premiums: This is how much you pay for coverage monthly, regardless of the care you receive. You may need to pay your plan’s premium in addition to the Medicare Part B premium, although some plans have $0 premiums or help pay for your Part B premium.
  • Deductible: Your deductible is the amount you must pay before your insurance plan starts helping cover the costs. Medicare Advantage Plans set their deductibles and these may change only once per year on Jan. 1.
  • Copay/coinsurance: A copay is an amount you pay as your share of the cost for a service, such as a doctor’s visit or prescription drug. It is usually a set payment. Coinsurance is a percentage, for example, 20%, that you pay as your share of the cost for a service after you pay deductibles.
  • Out-of-pocket cost: Medicare Advantage Plans come with an out-of-pocket maximum dollar amount that is the most you may have to pay for your Medicare-covered benefits in a year. Costs for health care services or supplies that are not covered or partially covered, such as dental, vision, and hearing benefits, do not count toward your maximum out-of-pocket amount. If you have Original Medicare without a Medigap policy to cover out-of-pocket costs, there is no cap on how much you will have to pay.
  • Coverage area: The specific geographic area that your plan covers. Original Medicare has a large coverage area. It can be used throughout the U.S. and its territories. A Medicare Advantage Plan may be more restrictive. Sometimes, the coverage area is only in a specific state or ZIP code area.
  • Star rating: Measures performance of Medicare Advantage and PDP plans. Medicare uses this system to score things like quality of care and customer service. The range is from 1 to 5, with 5 being the highest and 1 the lowest.
  • Benefits: The perks of what your plan covers. Benefits are the items included in your plan that go toward your medical cost. For example: A Medicare Advantage Plan has an additional benefit by offering dental coverage.
  • Provider choice: It is when you choose the provider you want to use. Sometimes, choosing to have a provider network and seeing specific providers can be beneficial. These types of plans that have you select a provider can have discounted costs. The provider has elected to participate in-network discounts.

How Much Does Medicare Cost in Vermont?

  • Original Medicare: Part A premiums can range from $0 to $506 per month. The Medicare Part A hospital deductible is $1,600 for each benefit period. Part B, most people pay the standard premium of $164.90 per month. The deductible for Part B is $233.
  • Medicare Advantage Plans: The average cost of a Vermont Medicare Advantage Plan is $18.43 in 2023. Some plans start as low as a zero premium.
  • Part D plans: The lowest monthly premium starts at $6.80.
  • Medigap plans: Plan G cost for a nonsmoking female age 65 in Montpelier $145 to $343.

Medicare in Vermont by the Numbers

People enrolled in Original Medicare Average plan cost Annual Vermont spending per beneficiary Spending per beneficiary compared to the national average
129,452 Part A: $0 to $506 per month*
Part B: $164.90 **
$9,040 23% less

*Most people pay no premium but this can vary depending on how long they paid Medicare taxes.
**This is the average number but it can vary based on income.

Medicare Resources in Vermont

Choosing the right Medicare plan can be a tough decision, especially if you have a lot of options. Vermont offers a number of resources for seniors and their families to help educate beneficiaries about the Medicare enrollment process and answer questions about different plans. One example is the State Health Insurance Program (SHIP), which offers free counseling for those who have Medicare questions.

Check out these Vermont Medicare resources to get started:

Vermont Medicare Resources
Organization How you can get help Contact Information
Vermont SHIP Vermont’s SHIP provides Medicare information via the state’s Adult Services Division. SHIP counselors are on hand to offer free assistance and answer questions about Medicare in an unbiased way. Website | (800) 642-5119
V4A (Vermont Association of Area Agencies on Aging) The V4A is the association of the state’s five Area Agencies on Aging. These agencies are available to help older Vermonters and their caregivers with information and services related to aging well. Website | (802) 225-6210
Vermont  Disabilities, Aging and Independent Living (DAIL)  The Vermont DAIL offers programs and services for residents who are 60 or older, as well as those with disabilities. Website | (802) 241-2401
Insurance and health care consultant

Tammy Burns is an experienced health insurance advisor. She earned her nursing degree in 1990 from Jacksonville State University, obtained her insurance billing and coding certification in 1995, and holds a health and life insurance license in Alabama, Georgia, Iowa, Mississippi, and Tennessee. Burns is Affordable Care Act (ACA)-certified for health insurance and other ancillary, life, and annuity products. She maintains an active nursing license and practices private-duty nursing.

Burns’ background as a nurse, insurance biller and coder, and insurance consultant includes infectious disease, oncology, gynecology, phlebotomy, post operative, family medicine, geriatrics, home health, hospice, human resources, management, billing, coding, claims, fixed annuities, group and individual health and life products, and Medicare. She’s always been driven by a desire to help people, spending more than 25 years as a practicing nurse in hospitals, private doctors’ offices, home health, and hospice. As a nurse, Burns supported patients filing insurance claims with Medicare, Medicaid, and private insurance companies as well as responding to billing questions from confused patients.

Seeing firsthand how unsuspecting patients are frequently confused by an overly complex system they don’t understand led Burns to become an insurance agent and health care consultant, now helping people understand the medical system. Since becoming an insurance agent in 2013, she has worked with some of the largest and most reputable insurance carriers and agencies in the nation, and she has built a large and loyal clientele by way of her commitment to transparency and personalized service.