Medicare in Vermont

Jory Cross by Jory Cross | Licensed since 2012
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This article was updated on: 09/16/2018

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Medicare beneficiaries in Vermont may have many options when it comes to Medicare. Whether you get your coverage through Original Medicare or a Medicare Advantage plan, it’s important to consider all of your choices carefully so that you find coverage that meets both your health and budget needs.

Here’s an overview of how you can get Medicare coverage in Vermont.

About Medicare for Vermont residents

If you’re a Vermont resident, keep in mind that Original Medicare (Part A and Part B) works the same way in every state. Original Medicare is the federal program for United States citizens and permanent residents that insures adults 65 and older, as well as certain individuals with disabilities. It comes in two parts. Medicare Part A covers inpatient hospital and skilled nursing facility care, limited home health services, and hospice care. Medicare Part B covers certain medical items and services, including (but not limited to) doctor visits, preventive care, and some durable medical equipment.

In Original Medicare, you’ll still be responsible for out-of-pocket costs like copayments, deductibles, and the Medicare Part B premium. If you haven’t worked the 10 years (40 quarters) while paying Medicare taxes to qualify for premium-free Medicare Part A, you may owe a premium for Part A as well. There’s no out-of-pocket spending limit in Original Medicare.

Original Medicare doesn’t cover everything. You won’t be covered for routine vision and dental services, hearing aids, dentures, or long-term nursing care. Original Medicare also doesn’t include prescription drug benefits, which you can buy separately under a Medicare Part D Prescription Drug Plan.

Types of Medicare coverage in Vermont

You may be able to get coverage for some benefits that aren’t included in Original Medicare through a Medicare plan offered by a private Medicare-approved insurance company. Some of the most common Medicare plan options are Medicare Advantage plans, Medicare Part D Prescription Drug plans, and/or supplemental coverage (via Medicare Supplement plans).

One option you might consider is receiving your Medicare Part A and Part B coverage   through a Medicare Advantage (Medicare Part C) plan. These plans are offered by insurance companies that contract with Medicare. Medicare Advantage plans must cover at least the same benefits as Original Medicare Part A and Part B (excluding hospice care), and some plans include additional benefits, such as routine dental services, wellness programs, and/or prescription drug coverage. Your costs may be different from Original Medicare; some plans may cost less. However, you’ll need to keep paying the Medicare Part B premium.

Vermont beneficiaries can get Medicare Part D Prescription Drug coverage (Medicare Part D). If you’re enrolled in Original Medicare, you can add this coverage by joining a stand-alone Medicare Part D Prescription Drug Plan. Or, instead, you can choose to get all your Medicare coverage, including drug coverage, through a Medicare Advantage Prescription Drug plan.

Medicare beneficiaries who stay with Original Medicare can also enroll in a Medicare Supplement (Medigap) plan, which is an optional policy that covers some Original Medicare out-of-pocket costs. This may include deductibles, copayments, coinsurance, and possibly some overseas emergency medical coverage. These plans only work with Original Medicare and can’t be used to pay for Medicare Advantage costs.

Medicare resources in Vermont

  • Medicare Savings Programs: If you’re a Vermont beneficiary with limited income, you may qualify for help with Medicare Part A and Part B costs. Medicare Savings Programs pay for costs like copayments, deductibles, and premiums for individuals who meet income and asset requirements. You can apply through your state’s Medicaid department.
  • Medicare Extra Help: The Extra Help (or Low-Income Subsidy) program helps with Medicare prescription drug costs if you have limited income and meet eligibility criteria.
  • Vermont State Health Insurance Counseling and Assistance Program (SHIP): The Vermont State Health Insurance Assistance Program provides free counseling for Medicare beneficiaries with questions about the Medicare program.

How to apply for Medicare in Vermont

Applying for Original Medicare is the same process in Vermont as in any other state. To qualify for Medicare, you must be either a United States citizen or a legal permanent resident of at least five continuous years. You may be automatically enrolled at age 65 if you already get retirement benefits though the Social Security Administration (SSA) or the Railroad Retirement Board (RRB). Disabled residents can be eligible before age 65 if they receive Social Security disability benefits, or certain benefits through the Railroad Retirement Board, for 24 consecutive months. In this case, you’d be automatically enrolled in the 25th month of disability benefits. You may also qualify for Medicare coverage before 65 if you have certain conditions, like End-Stage Renal Disease or amyotrophic lateral sclerosis (Lou Gehrig’s disease).

If you have to apply for Medicare manually (for example, if you have End-Stage Renal Disease), you may want to apply as soon as you’re eligible to avoid possible late-enrollment penalties. You can do so online, over the phone or in person through Social Security:

  • By visiting the Social Security website.
  • By calling Social Security at 1-800-772-1213 (TTY users should call 1-800-325-0778), Monday through Friday, 7AM to 7PM.
  • By applying in person at a Social Security office.

If you worked for a railroad, you’d apply through the Railroad Retirement Board. Call the RRB at 1-877-772-5772 (TTY users call 312-751-4701), Monday through Friday, 9AM to 3:30PM.

Enrollment in a Medicare plan offered by a private Medicare-approved insurance company, such as Medicare Advantage, Medigap, or Medicare Part D, works differently from enrolling in Original Medicare. If you’re interested in Medicare plan options, it may be a good idea to shop around, since benefits and costs often vary by insurance company and location. If you’d like to know more, I can help you find some options that might fit your needs in your location. You can follow the “View profile” link below to get a better idea of my background in insurance. If you’d like to speak over the phone or have recommendations emailed to you, I can do that, as well: just use the links below to set that up. Or, if you’d like to view some available plans right now, use the “Compare Plans” button on this page to compare plans in your area.

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