As of 2025, over 160,000 Vermont residents have signed up for Medicare. Those eligible can choose between Original Medicare or Medicare Advantage and a Part D plan for their prescription drug needs.
As in other states, Medicare in Vermont offers healthcare coverage to people meeting certain criteria: being 65 years or older or having certain disabilities or health conditions.
However, while Original Medicare benefits are consistent across the country, Medicare Advantage and Part D plans may differ based on location. This article examines what people living in Vermont need to know about their local Medicare coverage choices.
The following are highlights about Medicare in Vermont in 2025:
- Enrollment: 164,127 people in Vermont are currently enrolled in Medicare.
- Part C: When comparing 2024 to 2025, the average monthly premium for a Medicare Advantage plan increased from $18.46 to $31.70, with 24 options in 2025 compared to just eight in 2024.
- Part D: In 2025, 16 stand-alone Medicare prescription drug plans were available, with the lowest monthly premium being $6.30.
There are four main parts to the federally-funded Medicare program, each covering different types of healthcare services. While the program primarily serves older individuals in the United States, those with certain disabilities or medical conditions may also be eligible. These parts include:
Original Medicare
Under Original Medicare, individuals have the freedom to choose any doctor, clinic, or hospital in the country as long as they accept Medicare payment. The government directly pays for the healthcare services they provide.
People eligible to enroll in Medicare often choose Original Medicare, which includes Part A and Part B. These two parts offer the same coverage options nationwide.
Other options
In contrast, states offer different options for Medicare Advantage (Part C) and Part D. Private insurance companies administer these and set their own costs and coverage choices according to factors such as a person’s location.
Part C plans must offer the same benefits as Original Medicare, but some plans may include added perks such as vision, dental, and prescription drug coverage. On the other hand, they may require members to stay within a specific network of doctors and providers or obtain prior approval for out-of-network services.
In addition, people selecting between Original Medicare and Part C can choose to enroll in Part D or a Part C plan with prescription drug coverage. To see what options are available in their area, a person can search using their ZIP code on Medicare.gov.
In addition, the Centers for Medicare & Medicaid Services (CMS) provides annual star ratings for Medicare Part C and Part D plans. These ratings can help individuals make informed decisions about their healthcare options, both nationally and at the state level.
In Vermont, no health insurance companies offering Part C or D plans had a 5-star ranking, the highest rating possible. That said, UnitedHealth Group, Inc. ranked 4 in various regions.
The costs of Original Medicare remain consistent throughout all states. Most people do not pay a premium for Part A, but there is a deductible of $1,676. For Part B, a person will pay a premium of $185 or higher, depending on their income, and will need to meet a deductible of $257.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
For reference, the chart provided showcases various costs for Part C and D plans in Vermont.
| Plan Type | Area | Plan | Premium | Max out of pocket or deductible | Coinsurance |
|---|---|---|---|---|---|
| Part C | Windsor, VT | Vermont Blue Advantage Tribute PPO (PPO) | $0 | $6,750 in-network | primary doctor: $0 specialist: $55 |
| Part C | Windsor, VT | Vermont Blue Advantage Unity HMO (HMO) | $0 | $250 drug deductible $6,000 in-network | primary doctor: $0 specialist: $55 |
| Part D | Windsor, VT | Wellcare Value Script (PDP) | $12.40 | $590 | NA |
| Part C | Orange, VT | Humana USAA Honor Giveback (PPO) | $0 | $8,950 in and out-of-network $4,950 in-network | primary doctor: $0 specialist: $40 |
| Part C | Orange, VT | Vermont Blue Advantage Unity HMO (HMO) | $0 | $250 drug deductible $6,000 in-network | primary doctor: $0 specialist: $55 |
| Part D | Orange, VT | Blue MedicareRx Value Plus (PDP) | $49.60 | $590 | NA |
Generally speaking, people can get Original Medicare regardless of their income as long as they qualify by age or disability status. That said, individuals may have to pay a premium for Part A or a higher premium for Part B.
Income limits come into play when it comes to Medicaid. For people of lower economic means who qualify for both Medicare and Medicaid, three programs are available that can help cover Medicare costs:
If a person’s monthly income and available resources meet the requirements, they can be eligible to apply. There are federal income limits for these programs, but states can also set their own.
The chart below outlines the income limits in Vermont for these programs as of 2024.
| Yearly income limit | individual | couple |
|---|---|---|
| QMB | $15,060 | $20,448 |
| SLMB | $18,072 | $24,528 |
| QI | $20,340 | $27,600 |
However, these limits are subject to change, so people can contact Vermont’s Agency of Human Services. In addition, they can call Green Mountain Care at 800-250-8427 Monday through Friday, 8 a.m. to 4:30 p.m. to learn more about Medicare savings options.
For questions about Medicare enrollment, a person can call 800-MEDICARE (800-633-4227) or visit Medicare.gov or the Social Security Administration’s website.
Information about starting Medicare in Vermont is also available on the state’s Department of Health Access website.
In addition, a person can contact the Central Vermont Council on Aging with questions or to get help enrolling in Medicare plans in Vermont by calling the Senior HelpLine at 800-642-5119.
Vermont’s Medicare program, like those in other states, provides healthcare coverage for individuals ages 65 and older or with certain disabilities or health conditions. However, coverage and benefits vary depending on a person’s ZIP code.
As of 2025, over 160,000 residents in Vermont have enrolled in Medicare. Eligible individuals can select between Original Medicare or Medicare Advantage plans and a Part D plan for prescription drugs.
