Compare Medicare Advantage vs Original Medicare in Vermont. ~9 plans available. Average premium $26/month.
Vermont has approximately 9 Medicare Advantage plans available in 2026 with an average premium of $26/month. MA plans in Vermont must cover all Original Medicare services plus typically include extra benefits like dental, vision, and hearing. The 2026 out-of-pocket maximum for in-network services is $9,350. Free plan comparison help is available through Vermont SHIP at 1-800-642-5119.
Medicare Advantage (Part C) plans in Vermont are offered by private insurance companies approved by Medicare. They bundle Part A (hospital), Part B (medical), and usually Part D (drugs) into a single plan. With approximately 9 plans available, Vermont seniors have meaningful choices for Medicare Advantage coverage.
The average Medicare Advantage premium in Vermont is $26/month — above the national average of $17/month.All MA plans have an annual out-of-pocket maximum (capped at $9,350 in-network for 2026), unlike Original Medicare which has no cap.
The main trade-off with Medicare Advantage in Vermont is network restrictions and prior authorization requirements. Unlike Original Medicare, which lets you see any doctor or hospital nationwide that accepts Medicare, MA plans use networks — HMOs require referrals and restrict you to network providers, while PPOs offer more flexibility. If you travel frequently or have specialists you want to keep, carefully check each Vermontplan's network before enrolling.
Robert is 67 and lives in Vermont. He's in good health, sees his primary care doctor 4 times per year, and takes 2 generic prescriptions. He's flexible about changing doctors.
Original Medicare
Medicare Advantage (Vermont)
For Robert, Medicare Advantage saves approximately $196/month in premiums. However, he'd have copays for each doctor visit (typically $0–$30) and face network restrictions. If he has a major health event, the $9,350 OOP maximum protects him. For a healthy senior flexible with providers, Medicare Advantage may be the right choice in Vermont. Contact Vermont SHIP at 1-800-642-5119 for free guidance.
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In 2026, there are approximately 9 Medicare Advantage plans available in Vermont, though the exact number varies by county. The average Medicare Advantage premium in Vermont is $26/month. Vermont seniors can compare all available plans during the Annual Enrollment Period (October 15 – December 7) at medicare.gov or by calling 1-800-MEDICARE. Contact Vermont SHIP at 1-800-642-5119 for free plan comparison assistance.
In 2026, Medicare Advantage plans in Vermont are required to have an annual out-of-pocket maximum of no more than $9,350 for in-network services ($14,000 for combined in-network and out-of-network). Once you reach this limit, the plan pays 100% for covered services for the rest of the year. This is a major advantage over Original Medicare, which has no out-of-pocket cap for Part B services unless you have a Medigap supplement. Actual OOP maximums vary by plan — many Vermont plans offer lower caps.
Most Medicare Advantage plans in Vermont include extra benefits that Original Medicare does not cover, including dental care (cleanings, exams, sometimes major dental work), vision care (eye exams and glasses/contacts allowance), hearing benefits, and sometimes fitness memberships, transportation, and over-the-counter allowances. The extent of these extra benefits varies significantly by plan. Plans with richer extra benefits may have higher premiums or different network restrictions. Use our comparison tool above or contact Vermont SHIP at 1-800-642-5119 to find Vermont plans with the extra benefits you need.
Yes, you can switch from Medicare Advantage back to Original Medicare during the Annual Enrollment Period (October 15 – December 7) or during the Medicare Advantage Open Enrollment Period (January 1 – March 31). However, if you want to add a Medigap supplement policy when switching back to Original Medicare, be aware that insurers in Vermont can use medical underwriting — EXCEPT that Vermont requires guaranteed issue rights regardless of health status, making it easier to switch. Plan your transition carefully.
Prior authorization means your Medicare Advantage plan must approve certain services (hospitalizations, surgeries, specialty referrals, durable medical equipment) before you receive them. This is required by many Vermont Medicare Advantage plans and can cause delays in care. In 2024, CMS implemented new rules requiring MA plans to respond to prior authorization requests within 72 hours for urgent cases and 7 calendar days for standard requests. If denied, you have appeal rights. If prior authorization requirements concern you, Vermont Medigap coverage offers no prior authorization requirements.
Medicare Disclaimer
These calculators provide estimates based on 2026 Medicare data for educational purposes only. Contact Medicare at 1-800-MEDICARE or medicare.gov for official plan comparison. Consult a licensed Medicare advisor for personalized guidance. Not affiliated with Medicare or the US government.