Medicare offers healthcare coverage to Vermont residents age 65 or older, or to those Vermont residents that suffer from certain medical disabilities. In 2016, 127,000 people are enrolled in Medicare in Vermont, accounting for 20.5% of the population in Vermont. In 2009 approximately $8,719 was spent per Medicare enrollee in Vermont, about 15.88% lower than the national average of $10,365. Between 2015 to 2030 the senior population in Vermont is expected to increase by an estimated 53.27% according to calculations based off of the 2000 Census. Therefore the number of eligible Medicare beneficiaries in the state is also projected to grow.
In Vermont Medicare beneficiaries, their families, and their caregivers can receive free, comprehensive, one-on-one, and unbiased health insurance counseling from the Vermont State Health Insurance Assistance Program (SHIP). The state also participates in a Senior Medicare Patrol (SMP) program which aims to educate individuals on how to identify, avoid, and report potential cases of healthcare waste, fraud, errors, and/or abuse.
Individuals that qualify for Medicare can sign up for Medicare Part A (hospital services) and Part B (medical services) through the Federal government. Part A is generally paid for by paycheck deductions from their working years (or their spouse's) but most Medicare beneficiaries pay for Part B through monthly premiums unless they qualify for financial assistance. If you are eligible for Original Medicare (Parts A & B) or if you are already enrolled in it, you also have the option to enroll in a Medicare Advantage plan (Part C) instead of Original Medicare or add a stand alone prescription drug plan (Part D) to your current Original Medicare coverage. Medicare Advantage and Medicare Part D insurance plans are sold by private insurance companies that have a contract with Medicare. Original Medicare offers its beneficiaries flexibility in choosing their providers and you are not limited to a network. However, there is no limit on out-of-pocket medical expenses and you must always pay 20% coinsurance for medical service costs. Many Medicare beneficiaries will elect to enroll in a Medicare Advantage plan that includes prescription drug coverage (MAPD) or purchase a stand alone prescription drug plan to go with their Original Medicare coverage. Medicare Advantage plans require you to stay in network but some plans will also cover out-of-network care at a higher cost. Additional benefits of Medicare Advantage plans such as dental, vision, or hearing coverage can help reduce out-of-pocket expenses for seniors with certain medical needs.
Using CMS data HealthPocket found that:
- The average total monthly premium for a 2017 Medicare Advantage plan in Vermont is $49.83, 20.25% less than the national average of $62.48. 28.3% of 2017 Medicare Part C insurance plans in Vermont have a $0 monthly premium.
- The maximum possible annual drug deductible in any 2017 Medicare Advantage plan with a drug component is $400, but in Vermont the average annual drug deductible for Medicare Part C insurance plans with drug components is $209.15. 25.53% of 2017 Medicare Part C insurance plans with a drug component in Vermont have a $0 annual drug deductible.
- The average total monthly premium for a 2017 Medicare Advantage plan without a drug component in Vermont is $29. None of 2017 Medicare Part C insurance plans without a drug component in Vermont have a $0 monthly premium.
- The average medical out-of-pocket limit for 2017 Medicare Part C insurance plans in Vermont is $6,085.37. None of 2017 Medicare Advantage plans in Vermont had a medical out-of-pocket limit of $3,400 or less.
To assist seniors in choosing Medicare plans, CMS assigns star ratings to Medicare Part C and Part D plans each year based on preventive care, chronic condition management, customer service, member satisfaction, and drug pricing. Ratings range from 1 star (a poor plan) to 5 stars (an excellent plan).
- The average overall CMS star rating assigned to Medicare Part C insurance plans in Vermont was 4.1 stars in 2017.
- Among Vermont's 2017 Medicare Advantage plans with CMS star ratings:
- 77.36% earned a score of 4 or 4.5 stars
- 22.64% earned a score of 3 or 3.5 stars
Data on Medicare eligibility, enrollment, and spending by state from Kaiser Family Foundation