Medicare in Vermont: 2025 Guide

Vermont is a small, rural New England state with approximately 170,000 Medicare beneficiaries and one of the lowest Medicare Advantage penetration rates in the country, at around 25%. Most Vermonters enrolled in Medicare use Original Medicare (Parts A and B) combined with a Medigap supplement policy, reflecting both the state's rural character and the limited number of Medicare Advantage plans available statewide. Vermont has expanded Medicaid under the Affordable Care Act and maintains several state-funded pharmaceutical assistance programs, giving lower-income beneficiaries meaningful support for out-of-pocket costs.

Medicare Advantage Plans in Vermont

Vermont's Medicare Advantage market is one of the smallest and least competitive in the nation. The state's rural geography, small total population, and dispersed provider network make it difficult for insurers to build the kind of robust provider networks required to offer comprehensive Medicare Advantage plans throughout the state. In 2025, the primary Medicare Advantage insurers operating in Vermont are Blue Cross and Blue Shield of Vermont and MVP Health Care, both of which are regional carriers with established Vermont networks. The Burlington metropolitan area (Chittenden County) has the greatest concentration of available plans, while more rural areas of the state — including the Northeast Kingdom, the Green Mountains corridor, and southwestern Vermont — may have very few or no MA plan options.

Given Vermont's limited Medicare Advantage market, the majority of Vermont Medicare beneficiaries choose Original Medicare (Parts A and B) combined with a Medigap (Medicare Supplement Insurance) policy. Medigap plans cover Original Medicare's deductibles, copayments, and coinsurance, providing predictable and comprehensive coverage that works with any Medicare-accepting provider in the country. This is well suited to Vermont's healthcare landscape, where residents may rely on regional medical centers such as the University of Vermont Medical Center in Burlington or Dartmouth-Hitchcock Medical Center (across the border in New Hampshire) for specialist care. A Medicare Part D prescription drug plan is required separately for drug coverage. Vermont SHIP counselors can help beneficiaries evaluate whether Original Medicare with Medigap or a Medicare Advantage plan (where available) is the better fit for their individual situation.

Medicare Savings Programs in Vermont

Vermont's Medicare Savings Programs (MSPs) are administered through the Agency of Human Services (AHS) under Vermont Medicaid, which operates under the brand name "Green Mountain Care." Vermont has fully expanded Medicaid under the ACA and has one of the more generous Medicaid programs in the country relative to its size. The MSPs — including QMB, SLMB, QI, and QDWI — help low-income Medicare beneficiaries pay for Part B premiums and, at the QMB level, Part A and Part B cost-sharing as well. Qualifying for QMB also provides automatic eligibility for the federal Extra Help program for Part D drug costs.

To apply for a Medicare Savings Program in Vermont, contact Vermont Medicaid at 1-800-250-8427 or visit a local AHS District Office. Vermont's combined application process allows residents to be screened for multiple assistance programs simultaneously, including Medicaid, MSPs, and other state programs. Vermont SHIP counselors at 1-800-917-7787 can help with eligibility screening and application assistance at no charge. Vermont's generous Medicaid expansion means that some beneficiaries who do not qualify for Medicare Savings Programs may still qualify for other forms of Medicaid-funded assistance.

State Pharmaceutical Assistance in Vermont

Vermont offers two state pharmaceutical assistance programs for Medicare beneficiaries. VPharm (Vermont Pharmaceutical Assistance Program) provides assistance with prescription drug costs for Vermont residents who are enrolled in a Medicare Part D plan and whose income falls within the program's eligibility guidelines. VPharm helps reduce out-of-pocket drug costs for participants, coordinating with their Part D plan to provide supplemental coverage. The Vermont Health Access Program (VHAP) provides broader Medicaid-based coverage for qualifying lower-income individuals, including prescription drug assistance. Together, these programs make Vermont one of the more supportive states for Medicare beneficiaries who struggle with prescription drug costs.

Vermont beneficiaries who do not qualify for VPharm or VHAP should also explore the federal Extra Help program (Low Income Subsidy) through the Social Security Administration, which can significantly reduce Medicare Part D premiums and cost-sharing. Vermont SHIP counselors at 1-800-917-7787 can help determine eligibility for VPharm, VHAP, and Extra Help, and can assist with applications for all three programs during a single counseling session. Because Vermont's pharmaceutical assistance programs have specific income thresholds that are adjusted periodically, beneficiaries who have been denied in the past are encouraged to reapply if their circumstances have changed.

Getting Free Medicare Help in Vermont

Vermont's State Health Insurance Assistance Program (SHIP), operated through the Vermont Department of Financial Regulation, provides free, unbiased Medicare counseling to all Vermont Medicare beneficiaries. Vermont SHIP counselors help beneficiaries compare the limited Medicare Advantage plans available in their area versus Original Medicare with Medigap, understand their Part D options, apply for financial assistance through VPharm, VHAP, and Extra Help, and navigate billing disputes and enrollment decisions. The statewide toll-free number is 1-800-917-7787, and local counseling is available at senior centers, Area Agencies on Aging, and other community sites throughout Vermont.

Vermont SHIP is especially valuable for newly eligible Medicare beneficiaries who are used to employer-sponsored insurance and may be surprised by the complexity of the Medicare system — particularly the decision between Original Medicare with Medigap versus Medicare Advantage. Given Vermont's limited MA market, most beneficiaries benefit from a careful Medigap comparison, which SHIP counselors can provide at no cost. Vermont SHIP also conducts group education seminars and community outreach events throughout the year, with increased activity during the Annual Enrollment Period (October 15 – December 7).