Compare Essex County Vermont
Medicare Advantage Plans

A Medicare Advantage Plan in Essex County, VT can provide additional benefits above and beyond Original Medicare. There are 25 Medicare Advantage Plans (Part-C) available in Essex County from 5 different health insurance providers to compare in 2023. 10 of these Medicare Advantage Plans offer additional gap coverage to help avoid the “donut hole”. The plan with the lowest out-of-pocket expense is $4000 and the highest out-of-pocket is $8300. Essex County Vermont qualifying beneficiaries can also pick from 0 Medicare Special Needs Plans. The highest rated Medicare Advantage Plan in Essex County Vermont received a 5 overall star rating from CMS.



Most Popular Plans by Enrollment in Essex County, Vermont

Plan Name Plan ID Marketing Name Monthly
Premium
Enrollment
AARP Medicare Advantage Choice (Regional PPO)
R7444-001
UnitedHealthcare $53.00 16578
HumanaChoice H5216-058 (PPO)
H5216-058
Humana $0 6128
AARP Medicare Advantage Choice Plan 1 (PPO)
H3442-010
UnitedHealthcare $0 3870
HumanaChoice H5216-138 (PPO)
H5216-138
Humana $0 3762
AARP Medicare Advantage Plan 3 (HMO-POS)
H1944-032
UnitedHealthcare $0 3564


2023 Medicare Advantage Plans in Essex County, VT

(Click the Plan Name for More Details)
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Vermont Part-C Plans Without Drug Coverage

Plan Name ⇅ Premium Type MOOP 2023 Plan
Stars
Rating
Vermont Blue Advantage Tribute PPO (PPO)
(H6898-003)

$0 LocalPPO* $4,000
MVP Medicare Preferred Gold without Part D (HMO-POS)
(H3305-020)

$0 LocalHMO* $6,700
Humana Honor (PPO)
(H5216-059)

$0 LocalPPO* $4,500
AARP Medicare Advantage Patriot (PPO)
(H3442-008)

$0 LocalPPO* $4,500







Types of MA Plan in VT


HMO - Health Maintenance Organization. A Health Maintenance Organization manages your Part A and Part B health insurance benefits. In most cases you need to choose a primary care doctor. Health Maintenance Organization's offers services through a network of contracted hospitals, doctors and other providers, and the plan pays the providers directly. You generally must receive all Healthcare from the plan providers or through referrals from the plan provider. Emergency care, and out-of-area urgent care is still covered. An HMO-POS plan allows you to get some services out-of-network.

PPO - Preferred Provider Organization. A Preferred Provider Organization offers a network of doctors, hospitals, and other providers you can choose from. Because providers are preferred, you can save money by using in network providers or usually pay a higher cost to use out-of-network providers. A primary care doctor is not required.

PFFS - Private Fee For Service. A Private Fee For Service plan allows you greater flexibility in choosing a Vermont provider. You may obtain covered services from any Medicare eligible provider who is willing to accept the plan's terms. The Healthcare provider must agree to accept the plan's terms before each visit. Some of these plans have a network of approved providers that have agreed to treat plan members.

SNP - Special Needs Plan. A Special Needs Plan is for individuals who receive Medicare and Medicaid, have specific severe or disabling chronic conditions or reside in a licensed nursing home or skilled facility. SNP plans must provide prescription drug coverage to Essex County Vermont residents.

Cost - Cost Plan. A cost plan doesn't replace your Original Medicare. It offers additional benefits to Original Medicare. If the cost plan doesn't include prescription drug coverage, you can enroll in a Part-D plan separately.





Can I get help in the coverage gap in Essex County, VT?


Yes. 10 Medicare Advantage Plans in Essex County offer additional gap coverage. Once in the coverage gap, you’ll pay no more than 25% of the cost for brand-name and generic prescription drugs. If you choose a drug plan that includes coverage in the gap, you may get a discount applied to the drug's price.

Are there Medicare Advantage Plans in Essex County, VT?


There are 25 Medicare Advantage Plans available in Essex County, Vermont from 5 different health insurance providers. These plans offer additional benefits that aren't available through Original Medicare. Medicare beneficiaries who are interested in a Part-C policy may choose among many plans to compare versus Franklin County Medicare Advantage Plans.



How much is a Medicare Plan in Essex County, VT?


Individuals who are interested in a Medicare Advantage Plan in Vermont may choose among many cost options depending on your necessary benefits. The lowest plan premium is $0 and the highest premium is $130. The deductibles in Essex County range from $0-$505. The plan with the lowest out-of-pocket (MOOP) expense is $4000 and the highest out-of-pocket is $8300.



Things to consider when choosing a MA Plan in Essex


  • Are you eligible for a Medicare Advantage Plan?

  • How much are the premiums, deductibles, and other costs?

  • Is there a yearly limit on what you could pay out-of-pocket?

  • Does the plan cover your prescription drugs?

  • Will you hit the prescription drug coverage gap?

  • Is your pharmacy in the plan’s network?

  • Will your prescription drugs require prior authorization?

  • How well does the plan cover the services you need like vision, hearing, or dental?

  • Are your doctors in-network?

  • Will you need to be referred to see a specialist?

  • Does the plan cover services from out-of-network providers?

  • How does the plan compare to your current coverage?

  • Do you want to juggle multiple Medicare plans?


When to sign up for a Vermont Medicare Advantage Plan?


Below mentioned are the types of the enrollment period, along with the instructions on what to do during this period:

Initial Enrollment Period (IEP). This period starts 3 months prior to the month you will turn 65. It ends after 3 months you have turned 65. At this stage, you can sign up for a Vermont Medicare Advantage Plan.

Annual Enrollment Period (AEP). Also known as the Open Enrollment Period, it starts on the 15th of October and ends on the 7th of December. At this stage, you can either sign up for the plan, switch or leave your current plan.

Special Enrollment Period (SEP). This enrollment period depends on the personal circumstances of the beneficiaries, like if you move or lose insurance coverage. Check to determine if you qualify to modify your plan.

Open Enrollment Period. Jan 1 – Mar 31. If you’re enrolled in a Vermont Medicare Advantage Plan, you can switch to a different Medicare Part-C Plan in Essex County, VT or switch to Original Medicare once during this time.

5-star Special Enrollment Period. Dec 8 - Nov 30. If a Centers for Medicare and Medicaid Services (CMS) 5-star plan is available in your area you can switch to the 5-star plan once during this period.



Check for CMS Star Ratings

Centers for Medicare & Medicaid Service (CMS) assesses the quality of medical services of Medicare Advantage Plan using a 5-star rating system. A report is released yearly for the public to assess the quality of healthcare services. Thus, if you are searching for the highest Medicare Advantage Plan in your state, research the CMS ratings and costs of the plans report for further information.


Can I get a Medicare Advantage Plans in Essex County, VT?

Yes. There are 25 Medicare Advantage Plans available in Essex County, Vermont from 5 different health insurance providers. These plans offer additional benefits that aren't available through Original Medicare.

How much is a Medicare Plan in Essex County, Vermont?

Vermont residents who are interested in a Medicare Advantage Plan may choose among many cost options depending on your necessary benefits. The lowest plan premium is $0 and the highest premium is $130. The deductibles in Essex County range from $0-$505

Can I get help in the coverage gap in Essex County, VT?

Yes. 10 Medicare Advantage Plans in Essex County offer additional gap coverage. Once in the coverage gap, you’ll pay no more than 25% of the cost for brand-name and generic prescription drugs. If you choose a drug plan that includes coverage in the gap, you may get a discount applied to the drug's price.

What is the most popular plan in Essex, VT?

The most popular plan by enrollment in Essex is the AARP Medicare Advantage Choice (Regional PPO) with 16578 enrollment.



Source: CMS. Data as of Oct 1, 2022.
Plans are subject to change as contracts are finalized.
Includes 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded. For 2023, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit.


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MedicareHelp.org is a privately-owned Non-governmental agency. The government website can be found at HealthCare.gov.

Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. Enrollment depends on the plan’s contract renewal.

Every year, Medicare evaluates plans based on a 5-star rating system.