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Medicare in Vermont

October 6, 2016

If you’re a Vermont resident with Medicare, you generally have two main ways to get your coverage. You can get your health coverage through Original Medicare, Part A and Part B, and enroll in  a stand-alone Medicare Part D Prescription Drug Plan to go alongside your Original Medicare and/or add a Medicare Supplement plan if you like. Or you may be able to receive your Original Medicare benefits through a Medicare Advantage plan and get all your Medicare coverage under one plan.

Here’s an overview of how Medicare works in Vermont (as in the other states).

Original Medicare for Vermont beneficiaries

Original Medicare, Part A and Part B, is a federally administered health insurance program. It includes Part A (hospital insurance) and Part B (medical insurance). Medicare Part A generally covers inpatient hospital or skilled nursing facility care, home health services, and hospice care. Medicare Part B may cover outpatient care, such as (but not limited to) physician services, preventive services and screenings, lab tests, and durable medical equipment.

Original Medicare doesn’t cover everything. It doesn’t include prescription drug coverage except in limited situations (such as when you’re a hospital inpatient). You can sign up for this coverage separately through a stand-alone Medicare Part D Prescription Drug Plan. Original Medicare also doesn’t cover routine vision and dental services, chiropractic services, and most overseas coverage.

You may have some Medicare plan options in Vermont that might include some of the benefits described above. Eligibility for Original Medicare, and the coverage it provides, are the same in all states, including Vermont. Many people become eligible for Medicare when they turn 65. Other people can qualify for Medicare before the age of 65 if they receive Social Security or Railroad Retirement Board disability benefits for at least two years or have certain conditions, such as end-stage renal disease or amyotrophic lateral sclerosis (known as Lou Gehrig’s disease).

If you’re already receiving retirement benefits from Social Security or the Railroad Retirement Board, in most cases you’ll be automatically enrolled in Medicare Part A and Part B when you turn 65. Otherwise, you can first sign up for Medicare during your Initial Enrollment Period, the seven-month period that starts three months before you turn 65, includes your 65th birthday month, and ends three months later. There are other Medicare enrollment periods if you don’t sign up for Medicare during your Initial Enrollment Period, but you may owe a late enrollment penalty.

Eligible Vermont beneficiaries can apply for Medicare Part A and/or Part B through Social Security:

  • By calling 1-800-772-1213, Monday through Friday, from 7AM to 7PM. For TTY services, call 1-800-325-0778.
  • By submitting an online application through the Social Security website.
  • By applying in person at a local Social Security office.

If you worked at a railroad, apply for Medicare by calling the Railroad Retirement Board at 1-1-877-772-5772, Monday through Friday, from 9AM to 3:30PM. For TTY services call 1-312-751-4701.

Medicare plan options in Vermont

Vermont beneficiaries might also have many Medicare plan options. Availability, benefit details, and costs of the plan options described below may vary by location. Medicare plan options in Vermont may include the following:

The Medicare Advantage (Medicare Part C) program provides another way to get your Medicare Part A and Part B benefits. These plans are required to provide at least the same level of coverage as Original Medicare (except hospice care, which Part A still covers). However, some Medicare Advantage plans include additional benefits, such as routine vision and dental services, fitness programs, or prescription drug coverage. For more information on how these plans work, see Medicare Advantage in Vermont.

Medicare Supplement

Medicare Supplement (Medigap) plans help pay for some of your out-of-pocket costs under Original Medicare, including cost-sharing expenses and limited emergency overseas travel coverage. In most states, including Vermont, plan benefits are standardized across 10 plan types (labeled letters A through N), and each plan includes different benefits and level of coverage. These standardized Medigap plans offer the same benefits for plans of the same letter type. However, some plans might offer additional innovative benefits.

These plans can only be used to help with Original Medicare costs, and you’ll need to stay enrolled in Part A and Part B for your hospital and medical coverage. In addition, keep in mind that prescription drug coverage isn’t included in these plans, so if you want help with your medication costs, you should enroll in a stand-alone Medicare Prescription Drug Plan.

Specific plan types and premium amounts may vary depending on where you live in the state.

Medicare prescription drug coverage (Medicare Part D) is typically available in two ways. Stand-alone Medicare Part D Prescription Drug Plans work alongside Original Medicare, Part A and Part B, coverage. Alternatively, you may be able to get prescription drug coverage through a Medicare Advantage Prescription Drug plans. To learn more, see Medicare Part D in Vermont.

Vermont resources for Medicare beneficiaries

If you have Medicare in Vermont, you may find the following resources useful, as listed by Medicare.gov:

  • Vermont Medicaid: For information, visit the Vermont Medicaid website.
  • Vermont State Health Insurance Assistance Program (SHIP):Vermont beneficiaries can get help with Medicare and free counseling on health coverage issues. To find a SHIP counselor in your area, visit the Vermont SHIP website.

If you’d like help figuring out your Medicare choices in Vermont, you can visit eHealthMedicarePlans.com and enter your zip code where requested to see a quote.

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