The federal government funds Vermont Medicare insurance with the goal of providing proper health insurance coverage to persons over the age of 65. However, some workers with disabilities may also be eligible for the program. Vermont also assists Medicare beneficiaries in the state.
Medicare starts with Original Medicare – Part A and Part B. Medicare Part A offers hospital insurance, covering services such as inpatient care. Medicare Part B is for medical insurance, as it covers outpatient care, durable medical supplies, preventive services, and other medically necessary treatments.
Medicare costs are much more affordable than the typical health insurance packages in Vermont, which come with an average monthly premium of $607. In contrast, Part A doesn’t normally require a premium and Part B premiums for those who earn less than $85,000 a year only cost $134 per month. However, beneficiaries are still expected to pay for out of pocket expenses such as deductibles, copays, and coinsurance costs.
For those who feel that Original Medicare coverage isn’t sufficient enough, supplemental plans are available from Medicare-approved private carriers throughout the state. These plans will also require a separate premium, aside from the standard premium for Part B.
However, these plans can offer additional coverage for services that are not covered by Medicare Part A and Part B. They can cover the cost of Medicare prescription drugs, which is the type of coverage known as Medicare Part D. They can even help pay for deductibles, coinsurance, and copays.
Medicare beneficiaries can opt to purchase Medicare Advantage Plans that combine the benefits of Original Coverage and various types of supplemental plans. In essence, Medicare beneficiaries can purchase a single plan that provides Part A, Part B, and Part D coverage plus coverage for services not included in Original Medicare coverage.
These plans can have different added benefits, and they can be purchased from Medicare-approved private health insurance companies as well. These plans are also known as Medicare Part C.
Even though Medicare expenses are notably more affordable than the expenses associated with private policies, some beneficiaries still have difficulty paying for Medicare expenses due to low income and assets. To assist these beneficiaries, Vermont has several Medicare Savings programs that can cover part of the Medicare expenses for qualified beneficiaries. Unlike the MSPs in other states, Vermont has no asset limits for their MSPs.
The program for Qualified Medicare Beneficiaries pays for almost all Medicare expenses. These include premiums for Part A and Part B, along with the deductibles, copays, and coinsurance. To qualify for the QMB program, an individual needs to earn less than $1,032 a month. A married couple has to have a combined monthly income of less than $1,392.
The program for Specified Low-Income Medicare Beneficiaries (SLMB) pays for Part B premiums, and the beneficiary can still receive Medicaid benefits as well. To qualify, an individual cannot earn more than $1,234 a month while the income limit for a married couple is $1,666 per month.
The Qualified Individuals (QI) program also pays for Part B premiums, but the QI cannot also receive Medicaid benefits at the same time. This program is also limited in its funding, and the granting of applications is on a “first come, first served” basis. An individual needs to earn less than $1,386 a month to qualify, while for married couples the income limit is $1,872 per month.
These programs all automatically qualify the beneficiaries for the Low-Income Subsidy (LIS) program that pays for Medicare Part D expenses. The income of the beneficiary will determine the percentage of Part D costs the LIS will pay for.
Another program that can offer savings is for the Qualified Disabled and Working Individuals (QDWI) which pays for Medicare Part A premiums. For this, the income limit for individuals is $4,132 and $5,572 for married couples.
The Vermont State Health Insurance Assistance Program (SHIP) offers counseling and answers for Medicare beneficiaries in the state regarding Medicare issues. Medicare beneficiaries in Vermont can contact SHIP at 800-642-5119 for advice regarding any issue with Medicare and other related matters.