Looking for a health insurance plan that gives you more than the bare minimum? Medicare Advantage might be for you!

Original Medicare can be a solid source of basic, foundational medical coverage. Medicare Part A can cover many of your hospital (inpatient) needs, and Medicare Part B can cover your more regular, preventive (outpatient) needs. But what if you need more coverage than that? If you’re looking for much more expanded medical benefits—like hearing, vision, mental health, or prescription drug coverage—Medicare Advantage can provide you with what you need.

If you’re ready to get your search started right this second, check out Insurify’s plan-comparison tool! It’s free and easy to use and can give you all the details you need to make an informed and beneficial decision for your healthcare needs.

 

 

What Are the Best Medicare Advantage Plans in Vermont?

Before you start your Medicare Advantage search in earnest, it’s important to take your own medical needs and financial limitations into consideration. Though the following list includes many of the highest-rated plans in Vermont, these plans may not necessarily work for you and your situation.

As a disclaimer, this list is not intended as an endorsement of these plans or their providers. This is intended as a list of the top-rated Medicare Advantage plan options in Vermont.

#1 MVP Medicare Preferred Gold with Part D H3305-021 (HMO-POS)

    • Monthly Premium: $140
    • Prescription Drug Plan Deductible: $0
    • Out-of-Pocket Maximum: $5,800
    • Service Area Counties: Orange, Grand Isle, Franklin, Essex, Lamoille, Orleans, Caledonia, Addison, Bennington, Rutland, Chittenden, Washington, Windham, Windsor

With a hefty monthly premium, this plan will have a baseline annual cost of $1,680, along with an out-of-pocket cost maximum that is fairly moderate. Despite these costs, the prescription drug deductible is $0, alongside prescription co-pays and costs that are extremely competitive. There are some inherent cost-sharing plans for those with specific conditions, as well as affordable vision and hearing coverage. Given the great prescription drug costs, this plan gets 4.5 stars out of 5.

#2 MVP Medicare Secure Plus with Part D H3305-022 (HMO-POS)

    • Monthly Premium: $90
    • Prescription Drug Plan Deductible: $0
    • Out-of-Pocket Maximum: $7,550
    • Service Area Counties: Lamoille, Bennington, Grand Isle, Addison, Caledonia, Franklin, Essex, Chittenden, Orleans, Orange, Windsor, Rutland, Windham, Washington

Though this plan’s premium is lower than the previous plan on our list, it will still cost $1,080 annually, along with a somewhat higher out-of-pocket maximum. Despite this, the plan does have some fairly competitive prescription drug rates and a $0 prescription drug deductible. There are some optional supplemental benefits, as well as coverage for wellness benefits. In-network doctor and specialist co-pays are fairly affordable, and so are co-pays for vision and mental health services. All told, this plan earns 4.5 stars out of 5.

#3 MVP Medicare Secure with Part D H3305-032 (HMO-POS)

    • Monthly Premium: $40
    • Prescription Drug Plan Deductible: $150
    • Out-of-Pocket Maximum: $7,550
    • Service Area Counties: Franklin, Essex, Chittenden, Caledonia, Bennington, Addison, Washington, Grand Isle, Rutland, Lamoille, Orleans, Orange, Windsor, Windham

The last of our MVP Medicare Secure plans, this one has a lower monthly premium than the other two but does come with a higher prescription drug deductible. The prescription drug component of this plan is similar to the previous two in terms of co-pays and coinsurance rates; however, it should be noted that co-pays and coinsurance rates for diabetes and other medical supplies are extremely low. So if you have diabetes, this plan could help save you money on things like test strips. This plan earns 4.5 stars out of 5.

#4 AARP Medicare Advantage Plan 1 H1944-018 (HMO)

    • Monthly Premium: $20
    • Prescription Drug Plan Deductible: $250
    • Out-of-Pocket Maximum: $6,700
    • Service Area Counties: Lamoille, Bennington, Addison, Grand Isle, Franklin, Caledonia, Essex, Chittenden, Orleans, Orange, Windsor, Rutland, Windham, Washington

The first on our list from AARP, this plan has a very low monthly premium, along with a prescription deductible that is a lot higher than some of our previous plans. While the prescription drug co-pay and coinsurance rates are slightly higher than the MVP Medicare plans, they are still fairly affordable. However, it’s important to point out that any prescription drug costs will not contribute to the yearly out-of-pocket maximum. While there are a handful of additional benefits, if you would like to include dental coverage, it’ll cost an additional premium of $45. This plan earns 4 stars out of 5.

#5 AARP Medicare Advantage Plan 2 H1944-028 (HMO)

    • Monthly Premium: $62
    • Prescription Drug Plan Deductible: $150
    • Out-of-Pocket Maximum: $5,900
    • Service Area Counties: Addison, Rutland, Orleans, Essex, Bennington, Franklin, Orange, Lamoille, Grand Isle, Windham, Washington, Windsor, Caledonia, Chittenden

With a more expensive premium and a slightly less expensive out-of-pocket maximum, this plan has many similarities to the previous plan on this list. Firstly, the prescription drug rates are nearly identical, save for a slightly lower deductible of $150. The regular doctor and specialist co-pays are extremely low, as are co-pays for preventive and diagnostic services. Though this plan doesn’t offer comprehensive dental, it does offer some preventive dental, hearing, vision, and mental health benefits. At present, this plan gets 4 stars out of 5. 

#6 AARP Medicare Advantage Plan 3 H1944-032 (HMO)

    • Monthly Premium: $0
    • Prescription Drug Plan Deductible: $0
    • Out-of-Pocket Maximum: $6,700
    • Service Area Counties: Bennington, Addison, Caledonia, Lamoille, Grand Isle, Chittenden, Franklin, Essex, Rutland, Windsor, Orleans, Orange, Windham, Washington

Of the three AARP plans on this list, this one has the lowest baseline cost given the monthly premium of $0 and the similarly priced prescription plan deductible. While the prescription drug plan rates aren’t particularly high, some of the additional benefit co-pay and coinsurance rates are. For example, comprehensive dental services have a co-pay of 50 percent, and hearing aids have a co-pay ranging from $375 to $2,075. This plan, like the previous three, earns 4 stars out of 5.

#7 HumanaChoice H5216-057 (PPO)

    • Monthly Premium: $59
    • Prescription Drug Plan Deductible: $0
    • Out-of-Pocket Maximum: $5,400
    • Service Area Counties: Orange

Rounding out the final two plans on this list are plans from HumanaChoice. The monthly premium of $59 can create an annual cost of $708, and it has an out-of-pocket maximum of $5,400. The prescription drug plan deductible is $0, and the prescription drug rates are fairly moderate. The plan even has some vision, dental, and hearing coverage, but the one big drawback is the plan’s service area. Unless you live in Orange County, this plan is out of your reach. Despite the extremely narrow service area, this plan earns 4 stars out of 5.

#8 HumanaChoice H5216-058 (PPO)

    • Monthly Premium: $0
    • Prescription Drug Plan Deductible: $300
    • Out-of-Pocket Maximum: $6,700
    • Service Area Counties: Orange

Much like the previous plan, this plan’s major drawback lies in its service area of only one county: Orange. Despite that, the plan has an extremely low monthly premium but a somewhat hefty prescription plan deductible. There are some additional benefits, including some vision, hearing, and dental, as well as variable co-pay and coinsurance rates for diagnostic services and medical supplies. Like the previous plan, this one earns 4 stars out of 5.

Want to see more Vermont Medicare Advantage plans? Try Insurify’s plan-comparison tool. With detailed side-by-side comparisons, you’ll find the right plan for you in no time!

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How Much Does Medicare Advantage Cost in Vermont?

For 2021, the average premium for a Vermont Medicare Advantage plan is $25.69, meaning that you can expect to pay a baseline cost of $308.28 just to maintain your plan. This may seem like a fairly affordable cost to take on annually, but it’s important to consider some of the following factors that will impact your annual cost: 

    • Co-payment and coinsurance rates, which can vary from plan to plan
    • Service area coverage, which could make various Vermont residents ineligible for plans that provide needed coverage at affordable rates
    • Additional plan benefits and coverage options, which if selected, could directly increase the overall cost of the plan
    • A plan’s actual network of healthcare providers, which can vary in size and costs for medical services
    • Medicare Part B premiums, which you will still be required to pay in addition to regular MA plan costs

What Is Medicare Advantage?

Medicare Advantage (Medicare Part C) is an alternative to Original Medicare. Offered by private insurance companies (approved by the Centers for Medicare & Medicaid Services), Medicare Advantage plans are bundled policies that include Original Medicare coverage

They can also include various additional benefits, like Medicare Part D prescription drug, vision, hearing, and dental coverage, among many others. Some health plans might also tailor their coverage to benefit individuals suffering from specific chronic illnesses, such as diabetes or end-stage renal disease (ESRD).

Given that these plan options come from private insurers, their overall cost, coverage, and service areas can vary. The baseline portions of Medicare Parts A and B will always be included in an MA plan, but everything beyond that is not standardized and will require closer research to ensure that a plan can work for you.

For more information on Medicare Advantage, please visit www.medicare.gov, or call 1 (800) 633-4227; TTY users can call 1 (877) 486-2048.

What Types of Medicare Advantage Plans Are Available in Vermont?

Health Maintenance Organization (HMO): HMO plans provide coverage for doctors, hospitals, and other healthcare providers in your plan’s network. Any visits outside your provider network will generally not receive coverage (unless those visits are for emergency or urgent care). For specialist services, you will need a doctor’s referral.

Preferred Provider Organization (PPO): A PPO plan is more flexible than an HMO, allowing you to visit doctors or other healthcare providers out of your network (albeit at a higher cost). For in-network providers, you can expect to pay less in coinsurance and co-pays.

Private Fee-for-Service (PFFS): PFFS plans generally have few limits on which medical service providers you can visit. However, these plans also reserve the right to decide how much they will cover for doctor visits, hospital visits, and other medical services.

Special Needs Plan (SNP): SNP insurance policies restrict eligibility to individuals who live in an institution (such as a skilled nursing facility or nursing home) or suffer from a chronic health condition (such as HIV/AIDS, end-stage renal disease, or diabetes). Dual special needs plans (D-SNPs) exist for individuals who qualify for both Medicare and Medicaid.

Medicare Advantage Prescription Drug Plan (MA-PD): MA-PD plans combine health and prescription drug coverage into one plan. This type of plan serves as an alternative to the Medicare Part D plans you would have to enroll in if you had Original Medicare.

 

 

FAQ: Vermont Medicare Advantage

How do I enroll in a Medicare Advantage plan?

The first way to enroll in Medicare Advantage is during your Initial Enrollment Period, which begins three months prior to your 65th birth month and ends three months after. During this time, you can enroll in a Medicare Advantage plan, provided that you’ve enrolled in Original Medicare to obtain your Medicare number.

Another way to enroll in Medicare Advantage is during the Open Enrollment Period, which is from October 15 to December 7 each year. During this time, you can switch from Original Medicare to Medicare Advantage, switch from MA back to Original Medicare, or switch between MA plans.

Finally, if you experience a qualifying life event, you can enroll during a Special Enrollment Period. For more information on qualifying life events, visit www.medicare.gov.

Is it possible to enroll in both Medicare Advantage and Medicaid?

Provided that you are eligible for both, yes, you can enroll in both Medicare Advantage and Medicaid services. You cannot, however, be simultaneously enrolled in Medicare Advantage and Medicare Supplement Insurance (also known as Medigap plans or Medicare Supplement plans).

Are there any downsides to Medicare Advantage?

Though Medicare Advantage can have a lot to offer, there are some considerable downsides.

MA plans tend to be more expensive than Original Medicare. Things like variable co-pays and coinsurance rates, optional benefits, and monthly premiums have a serious impact on how much you can expect to pay. Things like formularies can also vary, and you may end up having to pay more for a plan that actually includes needed medication in its formulary.

Also, unlike Original Medicare, MA plans have service areas that can severely limit the number of plans available to you. If you live outside of a plan’s service area, you simply cannot enroll in the plan.

If you’re looking for a much more affordable and basic plan, the standardized nature of Original Medicare might be more suitable for you.

Conclusion: Compare to Find the Right MA Plan for You!

The star rating system is a great tool to help you find plans that are great on paper. However, being highly rated doesn’t always mean a plan will be to your benefit, and you should always start your search by taking stock of your medical needs and financial limitations. If you have a limited income, some of the more expensive plans might be beyond your reach. If you require a steady stream of a specific prescription medication, you’ll want to make sure you choose a plan that covers that medication. With your own situation in mind, you’ll be able to find the right plan for you.

Do you already have a solid handle on your health insurance situation? Then you’re all set to start your search with Insurify’s plan-comparison tool! With an easy-to-use platform that is totally free, you’ll find your perfect plan in no time!

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Updated April 26, 2021

Originally from Los Angeles, California, Adrian Coto is a writer living in Brooklyn, New York. A graduate of the NYU Creative Writing MFA program, he's worked as a legal assistant, a law school administrator, and now as a copywriter and editor.