There are more than 145,000 beneficiaries enrolled in Vermont Medicare plans. This includes Original Medicare, Medicare Advantage, Medicare Supplements, and Part D plans. Your Medicare journey will differ from your neighbor. Which health benefits are important to you?
Original Medicare consists of Part A (hospital coverage) and Part B (medical coverage). Part A covers hospital stays, nursing homes, hospice, and home health services, whereas Part B covers ambulance travel, medical equipment, mental health, partial hospitalization, lab tests, and X-rays. You can get additional benefits (health/financial benefits or prescription drug coverage) through other types of plans.
Once you enroll in Original Medicare, you can start to explore other types of plans that are specific to your location. Your first option is to enroll in a Medicare Advantage (MA) plan. MA plans offer health benefits (like hearing, vision, and dental). If you would prefer financial benefits (like help paying for your coinsurance and copayments), you can enroll in a Medicare Supplement plan. However, these must be purchased to work alongside Original Medicare, and cannot be purchased as a stand-alone plan. Lastly, you can enroll in a Part D plan to work alongside your parts A and B to provide prescription drug coverage. You should consider enrolling in some type of prescription drug coverage to avoid incurring any late-enrollment penalties down the road. Some Medicare Advantage plans provide prescription drug coverage as well.
More than 13,000 beneficiaries throughout Vermont are enrolled in a Medicare Advantage (MA) plan. MA plans have the same coverage as Original Medicare, but most plans provide several additional benefits. The most popular benefits include hearing, dental, vision, over-the-counter drugs, non-emergency transportation, and group fitness classes (like SilverSneakers and Silver & Fit). If these benefits sound like something you’re interested in, one of our licensed agents can help you enroll. To get started, click here or call 833-438-3676.
Medicare Supplement (Medigap) plans work alongside Original Medicare and provide financial protection and benefits. These benefits include:
There are ten different types of Medigap plans (A, B, C, D, F, G, K, L, M, N), and each letter represents a different combination of benefits. Generally, the more benefits a plan has, the higher the monthly premium you will pay. You must be enrolled in part A and B to purchase a Medigap plan, and Medigap plans do not replace your Original Medicare (they work together). One of our licensed agents can help you find a Medicare Supplement plan in your area. To get started, click here or call 833-438-3676.
Part D plans provide prescription drug coverage and work alongside Original Medicare. If you purchase a Part D plan, you will first have to pay your annual deductible ($415 in 2019). Some plans may reduce or waive your deductible up front. After you meet the deductible, your coverage begins, and you will be responsible for a copay per each prescription drug you purchase. You will continue to pay a copay until you reach the spending limit ($3,820 in 2019). After this point, you are considered to be in the “donut hole.” (Don’t worry - the donut hole is going away in 2020!) While you’re in the donut hole, you will be responsible for 37% of generic drug costs and 25% of brand-name drug costs until your annual spending reaches $5,100. You are then considered to be in the catastrophic coverage phase, and you are only responsible for 5% of your total drug costs.
The cost of Medicare will vary on which type of plan you select (Original Medicare, Medicare Advantage, Medicare Supplements, or Part D). Part A will be premium-free if you have worked and paid Medicare taxes for at least 40 quarters. If you only worked 30-39 quarters, you will pay $240/month. If you worked any amount less than 30 quarters, you will pay $437/month. Your Part B premium will depend on your income, but most beneficiaries will pay $135.50/month in 2019. If you choose to enroll in any additional plan outside of Original Medicare, your costs will vary based on the carrier, location, and plan benefits.
Most people become eligible for Medicare by turning 65. However, if you have ESRD (end-stand renal disease) or ALS (Lou Gehrig’s Disease), you can qualify for Medicare before your 65th birthday. You’ll be automatically enrolled in Original Medicare if you have been receiving SSDI (Social Security Disability Insurance) for at least 24 months. To qualify for Medicare Advantage, Medicare Supplements, or Part D, you must be enrolled in Original Medicare first.
Yes, you can have Medicaid and Medicare in Vermont. In fact, qualifying for Medicare may also qualify you for a Dual Specials Needs Plan (DSNP). DSNPs are a special type of Medicare Advantage plan that provide extra benefits, lower costs, and a Special Enrollment Period (SEP). Most people can only make changes to their health coverage once per year, but a SEP allows you to make changes at any time!
If you qualify for a DSNP, you may be eligible for other cost-saving programs. Medicare’s prescription drug program, Extra Help, can help you save more than $4,000 per year on prescription drug costs. Other Medicare Saving Programs can help provide coverage for other Medicare-related costs like premiums, deductibles, copayments, and coinsurance.
Several programs throughout Vermont are designed to help older adults, disabled individuals, and families maintain health and comfort. These programs include:
Meals: The Nutrition Program provides meals and nutrition counseling at community sites and to individuals who live at home and need a nutritious meal delivered.
Counseling: Each Area on Aging office throughout the state has a Counseling Program and an office with staff who provide counseling to Medicare beneficiaries and those about to become eligible for Medicare.
Caregiver Support: The Caregiver Support Program provides support groups and other opportunities throughout the state to give a much-needed break to family caregivers.
Care Management: The Care Management Program provides older adults and their families with options regarding in-home care, hospital or home transitions, and personal care plans.
You can sign up for Original Medicare through Social Security. You can visit www.SocialSecurity.gov, call 1-800-772-1213, or apply in person at your local Social Security office.
Once you are enrolled in Original Medicare, you can schedule an appointment with a licensed agent and discuss other types of plans. Click here or call 833-438-3676 to speak with a licensed agent.
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