Vermont Medicare Advantage Plans Explained
Unlike Original Medicare, which only covers major medical, a Medicare Advantage plan can include many extras, including prescriptions, vision, hearing, dental, and fitness, just to name a few. And, good news, they are available in Vermont.
Althought the extra benefits are nice to have, it's important to fully understand what you're getting if you join a Medicare Advantage plan in Vermont. Specifically, Medicare Advantage is managed care health insurance and the plan controls your access to healthcare providers. If you have ever had an HMO plan through your employer's group health insurance, you have a good idea of what managed care is all about.
Medicare vs. Medicare Advantage: What's the Difference?
The big differences between traditional Medicare coverage and what you get with Medicare Advantage are easy to see by pointing out the pros and cons. Neither type of insurance is perfect. They each suit different needs.
The Pros and Cons of Vermont Medicare Advantage Plans vs Original Medicare
- With Medicare Advantage you must use Vermont healthcare providers within the plan's network. With Original Medicare, you can use the Medicare-approved provider of your choice.
- If you travel and have a medical emergency, Medicare Advantage covers you. However, if you are a snowbird and winter or summer in another state, non-emergency doctor outside of your plan's network won't be covered.
- All Medicare Advantage plans sold in Vermont protect you with an annual maximum out-of-pocket (MOOP) limit. Once you reach this spending limit the plan pays all additional copays and coinsurance that you'd normally pay out-of-pocket. Original Medicare does not have an out-of-pocket maximum.
- Most Medicare Advantage plans come bundled with a Vermont Medicare Part D plan for prescription coverage. With Original Medicare, you must enroll in a stand-alone Part D plan. But, the stand-alone plans offer more choices to get lower-cost prescriptions.
- With Original Medicare your costs (copays, coinsurance, etc) are predictable, and you can get a Medicare supplement to help pay these costs. In the Medicare Advantage program, each plan can charge what they want for copays and coinsurance, making it very difficult to compare actual costs.
Medigap vs. Medicare Advantage
Three of the most common questions we get are:
- Why are Medicare Advantage plans bad?
- What are the disadvantages of Medicare Advantage plans?
- Is it better to have Medicare Advantage or Medigap?
Let's answer these three questions right now.
Why Vermont Medicare Advantage Plans are Bad
This is a myth. There's nothing wrong with Medicare Advantage plans. In fact, over 20 percent of all Medicare beneficiaries in Vermont choose Medicare Advantage.
What you really need to know is that these plans are not for everyone. Some people are better served with traditional Medicare and a Medicare supplement. The question is, which option is best for you?
MedicareWire advises people who have one or more serious chronic conditions to keep their Original Medicare, particularly if you have specialists treating you and you want to stay with them. Our opinion is that Medicare Advantage is an excellent option for those who qualify for both Medicare and Medicaid (dual eligible) and for extremely healthy, active seniors.
Similarly, traditional Medicare, plus Medicare supplement insurance, work best for people with chronic health conditions, as well as those who can afford a higher monthly premium. Most experts agree that this is the best health insurance seniors can get in Vermont.
Are There Disadvantages to Joining a Medicare Advantage Plan in Vermont?
As you have already read, both Medicare Advantage and traditional Medicare have their benefits. But the two types of coverage are like apples and oranges. However, if you remove the issue of doctor choice from the equation, the primary difference is when and how you pay.
With most Medicare Advantage plans you pay a little each month (the monthly premium) and a copay when you use medical services. With most Medigap plans you pay most of your costs upfront with your monthly premium. As a result, your costs are more predictable than they might be if you have Medicare Advantage and use a lot of healthcare services
Is it better to have Medicare Advantage in Vermont or Medigap?
- If you can afford Medigap Plan F or G, then keep your Original Medicare and add one of these supplements.
- If you are a healthy senior and have good health in your family heritage, Medigap Plan N will let you save money by sharing some costs when you see your doctor.
- If you are a healthy senior but you cannot afford a Medigap Plan F, G, or N, Medicare Advantage is a good choice.
- If you are turning age 65, have one or more chronic health conditions that require frequent doctor visits, and you do not qualify for both Medicare and Medicaid (dual eligible), the most Medigap coverage you can afford is the best option.
- If you qualify for both Medicare and Medicaid, regardless of your health condition, Medicare Advantage is your best option.
- If you have special needs (i.e., a full-time nursing home resident, diabetes, etc.) and an appropriate Medicare Advantage Special Needs Plan (SNP) is available, this is your best option.
Frequently Asked Questions About Vermont Medicare Advantage Plans
Medicare Advantage plans vary from County to County in Vermont. This is due to the local nature of healthcare provider networks. If you enter your zipcode into this tool it will show you all of your plan options and 5-star ratings.
More than 90% of all Medicare Advantage plans in Vermont include a Part D plan for prescriptions, but not all. However, coverage is different with each plan. It is very important to verify that a plan covers your most important medications before you join. You can do so using this tool.
While not for everyone, Medicare Advantage plans have their benefits. The best way to understand these plans is to evaluate your health and financial situation. Here is an article that will help you make the right choice.