Medicare

Changes: With most Medicare Advantage Plans in Vermont ending on December 31, 2025, Vermonters need to take action.

Scams: Watch out for Medicare enrollment scams!

Get the free “Medicare & You” handbook from Medicare.gov
You can get it in English or Spanish. You can get a paper copy or download the PDF or eBook. You can also get a podcast of the handbook or get it in braille.

Medicare is the federal health insurance program for:

people 65 or older
people under 65 and receiving Social Security Disability Insurance for a certain amount of time
people under 65 with End-Stage Renal Disease.

When you first enroll in Medicare, you can enroll in either “Original Medicare” or a Medicare Advantage Plan, also known as Part C.

Original Medicare

“Original Medicare” includes Part A and Part B. If you want prescription coverage, you can enroll in a separate Part D plan.

Medicare Part A (hospital insurance)
Part A covers hospital care, care in a skilled nursing facility, hospice care, and some home health care.
Medicare Part B (medical insurance)
Part B covers certain doctors’ services, outpatient care, medical supplies (like wheelchairs and walkers), and preventive services.
Medicare Part D (prescription drug coverage)
Part D offers prescription coverage. It consists of prescription drug insurance plans offered by private companies approved by Medicare.

Medicare Advantage Plans / Part C

A Medicare Advantage Plan, also known as Medicare Part C, is private insurance contracted with Medicare. It should cover all the same benefits as Original Medicare. Many plans also include the prescription coverage, so you do not need to enroll in a separate Part D plan. Some plans may also cover additional benefits that are not covered by “Original Medicare” such as vision, hearing and dental.

Even if you enroll in a Part C plan, you still likely have to pay your Part B premium.

With most Medicare Advantage Plans in Vermont ending on December 31, 2025, Vermonters need to take action.

Differences

It is important to be aware of the differences between Original Medicare and Part C plans. Part C plans may have different:

networks of providers
coverage rules
premiums (in addition to the Part B premium)
cost-sharing for coverage services.

Before you enroll in a Part C plan, you need carefully consider the costs and the network of providers. Things to consider:

Some Part C plans do cover services that are not covered by Original Medicare, such as dental and vision and coverage abroad.
Do your current providers accept your desired Part C plan? Part C plans have networks of providers. You need to understand the network.
The plan may also require you to get referral to see a specialist and get prior authorizations.
A Part C plan won’t necessarily be cheaper than Original Medicare. You need to compare the costs of the premiums, deductibles and copayments while considering your health care needs.

Here are some ways to learn more:

Call SHIP (the State Health Insurance Assistance Program) at 1-800-642-5119 to discuss your options.
Use the Medicare Plan Finder.

Who is eligible for Medicare?

Medicare eligibility for people age 65 and older

In most cases, you will become eligible for Medicare when you turn 65.

If you are 65 years old and collect or qualify to collect Social Security or Railroad Retirement benefits, you are eligible for Medicare.
If you are 65 years old but do not qualify to collect Social Security our Railroad Retirement yet, you qualify for Medicare if:
- You are a current US resident and are either
  - a U.S. citizen, or
  - a permanent U.S. resident who has lived in the U.S. for 5 continuous years

Medicare eligibility for people younger than 65

If you are younger than 65, you can be eligible for Medicare if:

you are disabled and have been receiving Social Security Disability Insurance (SSDI) for more than 24 months, or
you have Amyotrophic Lateral Sclerosis (Lou Gehrig’s disease) and are receiving SSDI, or
you have been diagnosed with End-Stage Renal Disease (ESRD), and
- you are getting dialysis treatments or have had a kidney transplant, AND
- you are eligible to receive SSDI (Social Security Disability Insurance), or
- you are eligible to receive Railroad Retirement benefits, or
- you have enough “work credits” to be considered to be “fully” insured by Social Security

How to enroll in Medicare

Some people are automatically enrolled in Medicare and some people need to sign up.

Automatic

If you are already getting benefits from Social Security or Railroad Retirement Board (RRB): You will automatically get Part A and Part B starting the first day of the month you turn 65. (If your birthday is on the first day of the month, Part A and Part B will start the first day of the month before your birthday.)

If you are under 65 and have a disability: You will automatically get Part A and Part B after you get disability benefits from Social Security or certain benefits from Railroad Retirement for 24 months.

If you have ALS (Amyotrophic Lateral Sclerosis, also called Lou Gehrig’s disease): You will get Part A and Part B automatically the month your Social Security benefits start.

Sign up

If you are eligible for Medicare but do not qualify for automatic enrollment: You will need to sign up to start receiving Medicare benefits. For example, you need to sign up to start receiving Medicare benefits if:

you are 65 years old and aren’t collecting Social Security or Railroad Retirement Board benefits. You should contact Social Security before you turn 65.
you have End-Stage Renal Disease and want to enroll in Medicare

Visit the Social Security Administration website for more information and to sign up for Medicare benefits.

Resource from the Medicare website: Understanding Medicare Advantage & Medicare Drug Plan Enrollment Periods.

Medicare & your Health Savings Account (HSA)

When you enroll in any part of Medicare (Part A, B, C or D), you can no longer contribute to a Health Savings Account (HSA). If you or your employer put money into your HSA while you are enrolled on any part of Medicare, you will pay a penalty on your taxes.

However, you can spend the money already in the HSA. HSA money that you use for “qualified medical expenses” will be tax-free and penalty-free.

You can download and print our HSA flyer to learn more.

Follow this link to a web page with the text of the HSA flyer.
Our PDF file does not fully comply with all applicable guidelines for accessible digital documents. For the most accessible experience, use the link above.
Download a PDF of the flyer.

Who pays first?

If you have Medicare and other insurance coverage (Medicaid, TRICARE, private insurance or other), it can be confusing to know which insurance pays first. This booklet from the US Department of Health and Human Services provides helpful information about who pays first.

More about Medicare

This section of our website provides information about the Medicare topics we are asked about most often. See the menu of links to choose from.

Learn more about:

You can also find more information at Medicare.gov.

Note: Some states have Medicare Special Needs Plans (SNPs). However, no one offers these plans in Vermont.