Medicare is a federal health insurance program, designed specifically for seniors who are of 65 years or older and for certain young people with disabilities receiving Social Security Disability Insurance for a certain amount of time and for people under 65 having End-Stage Renal Disease. Around 23% of the Vermont residents are enrolled in Medicare, as the state has more older population. 91% of Medicare beneficiaries are enrolled in Original Medicare whereas rest of the 9% are enrolled in Medicare Advantage plans. About 73% of the Medicare beneficiaries in Vermont have Part D prescription drug coverage either as a stand-alone Part D plan or as a part of Medicare Advantage plan. Around 16% of Medicare beneficiaries in Vermont are under age 65, who qualify for Medicare plans due to disability.
Medicare Plans available in Vermont:
Original Medicare is a plan for eligible citizens and legal permanent residents of the U.S. The U.S. residents qualify for Original Medicare plan by age or by disability. Most of the Medicare beneficiaries in Vermont qualifies for Original Medicare based on their age and few qualifies through disability or because they have end-stage renal disease. In Vermont just like any other states, beneficiaries automatically get enrolled in Original Medicare program as soon as they reach 65 years of age and if they have worked ten years and paid their Medicare taxes. Medicare beneficiaries in order to be eligible for premium-free Part A should be receiving Social Security or RRB benefits at least 4 months before being eligible for Medicare and residing in the United States. Original Medicare comprises of Medicare Part A, which is hospital insurance and Part B, which is medical insurance. Medicare Part A coverage include hospital care, skilled nursing facility care, hospice care and some home health care. Medicare part B coverage include partial hospitalization, ambulance travel, outpatient care, medical supplies like wheelchairs and walkers along with lab tests and X-rays. Medicare Part A is premium free for individuals who have worked and paid Medicare taxes for at least 10 years, whereas beneficiaries have to pay premium for Medicare Part B. Medicare beneficiaries enrolled in Original Medicare are free to visit any doctor and hospital enrolled in Medicare who is willing to accept new Medicare patients. The beneficiaries do not have to obtain a referral to see a specialist. In order to cover the out-of-pocket expenses like co-payments, coinsurance and deductibles beneficiaries may choose a Medicare Supplement Insurance plan. original Medicare enrollees every year have to pay a set amount of deductible for their healthcare before Medicare starts paying its share. Enrollees do not require to file Medicare claims, as healthcare providers need to file claim for the covered services and supplies rendered to insured.
Medicare Advantage or Part C Plans
Medicare Advantage or Part C plan is alternative way of receiving Original Medicare benefits. The Medicare Part C plan is offered through private insurance company having contract with Medicare. In 2019 around 11% of Medicare beneficiaries in Vermont were enrolled in Medicare Advantage plans. Part C plans available in Vermont should cover everything that are covered under Original Medicare with the only exception of Hospice care. Medicare Advantage plans are free to include additional benefits that are not covered under Original Medicare like routine vision, hearing and dental care. The cost of the Medicare Advantage plans in Vermont include premiums, co-payments, and deductibles. Unlike Original Medicare, Medicare Advantage plans have our-of-pocket maximums, which is an added advantage of this plan. Individuals who want to enroll in the Medicare Part C plan must first be enrolled in Medicare Part A and Part B plan. Individuals can first enroll in Medicare Part C during their Medicare Initial Enrollment Period, which starts three month prior the birth month of the enrollees, include the birth month and continues for another three months after the birth month. The plan’s coverage begins the first of the month after the beneficiary enroll for this plan. Several insurance carriers are offering Medicare Advantage Plans in Vermont, though not every plan may be available in each and every area of Vermont. Individuals might seek help of the licensed insurance agent or advisors of firm like InsureMeNow to avail help for comparing different Medicare Advantage plans sold by insurance carriers of their area. Different types of Medicare Advantage plans available in Vermont include:
- Private Fee-for-Service
Medicare Advantage Prescription Drug Plans in Vermont
The Medicare Advantage plans, which combine health insurance and prescription drug benefits into one comprehensive package are known as Medicare Advantage Prescription Drug Plan. Like any other Medicare Advantage Plan, Medicare Advantage Prescription Drug Plans too have to cover everything that are covered under Original Medicare, with the only exception of hospice care. Individuals interested in obtaining prescription drug benefits along with their Medicare Advantage Plan should enroll in a Medicare Advantage Prescription Drug Plan if available in their area instead of a stand-alone Medicare prescription Drug Plan. Each of this plan covers a documented list of prescription medications called a formulary, which individuals while enrolling in this plan should check to ensure that plan include the medications used by them. Each Medicare Advantage Prescription Drug Plan must offer two or more medications within each category. Individuals are able to enroll in this plan if they have both Medicare Part A and Part B and they live within the plan’s service area.
Medicare Part D or Prescription Drug Plans in Vermont
Medicare beneficiaries who want help with their prescription drug costs in Vermont should enroll in Medicare Part D plan offering prescription drug coverage. Medicare Part D is not automatically included with the Original Medicare but beneficiaries need to obtain this coverage by enrolling in a stand-alone medicare Part D plan that works alongside Original Medicare. Medicare Part D plans are offered by private insurance companies having contract with Medicare, therefore costs and availability of plan differ between insurance companies and location. Individuals are eligible for Medicare prescription drug coverage is they are enrolled in Original Medicare and if they live in the service area of a Medicare plan that includes prescription drug coverage. Every Medicare Part D plan comes with its own formulary, which is a list comprising of all the covered generic and brand-name prescription drugs. Every Part D plan should cover certain categories of medications, but the specific drug covered in each category varies by insurance company and by Medicare plan. Thus, individuals should check the plan’s formulary before enrolling in a Medicare Part D plan to ensure that their specific medications are covered. Individuals should keep in mind that the formulary may change though they will receive notice when required.
Medicare Supplement Plans in Vermont
It is a well known fact that Medicare insurance company helps insured to pay a major part of the medical bills however, it doesn’t pay absolutely everything. As a result the insured may have to pay large medical bills and this is the time when Medicare Supplement plans in Vermont can help insured to bring down these costs. Medicare Supplement plans are also known as Medigap plans because these plans fill the gaps that Original Medicare leaves for the insured to cover. Beneficiaries enrolled in Medicare Supplement plans obtain coverage for out-of-pocket expenses such as co-payments, coinsurance, and deductibles that are not covered under Original Medicare. These plans are offered by private insurance companies approved by Medicare and these plans work alongside Original Medicare and cannot work as stand-alone plans. There are ten standardized Medicare Supplement plans available in Vermont denoted through letter A, B, C, D, F, G, K, L, M, and N. The cost of each Medicare Supplement plan usually depends upon the insurance company offering the plan and the location of the plan. Medicare Supplement plans coverage in Vermont include:
- Costs of both hospital and Part A coinsurance up to an additional 365 days after the use of Medicare benefits.
- Coinsurance and co-payment of Medicare Part B, an d Medicare Part A hospice care.
- Coinsurance of skilled nursing care facility.
- Deductible of Medicare Part A and Part B.
- Additional charges included with Medicare Part B.
- Blood’s first three pints