Typically, when you become eligible for Medicare, you have a choice between traditional Medicare and Medicare Advantage. As of January 1, 2026, UnitedHealthcare and Vermont Blue Advantage – both Medicare Advantage plans – will stop offering coverage in Vermont. Humana Medicare Advantage is the only insurer currently offering Medicare coverage in Vermont, and they do not cover Washington County.
For the 50,000 Vermonters impacted by the shift in coverage options going into 2026, we are here to provide education on traditional Medicare so that you feel like you understand the ins and outs of your new plan and that you are getting the coverage you need. Plan holders will be automatically enrolled in traditional Medicare for 2026 unless they opt to make changes, such as adding a Part D plan or Medigap plan.
Traditional Medicare and Medicare Advantage are categorized in four separate parts: Part A, Part B, Part C, and Part D. Medicare Part A covers inpatient hospital care and stays in skilled nursing facilities, and Medicare Part B covers doctor visits and outpatient care, tests, and some preventive services. Medicare Advantage (MA) is known as Medicare Part C. Traditional Medicare and MA plans are both regulated by the Centers for Medicare & Medicaid Services, but MA is offered by private insurance companies who contract with Medicare to provide health coverage. These plans are “bundled,” or a mix of Medicare Parts A, B, and Medicare Part D, which covers prescription drug costs.
Enrollees can also purchase Medicare Supplement insurance policies, known as Medigap, to help pay for out-of-pocket expenses not covered through Parts A and B, such as copays and annual deductibles. Medigap generally does not cover long-term care, such as care in a nursing home, vision or dental care, hearing aids, eyeglasses, and private-duty nursing. Benefits and monthly premiums vary depending on your plan.
According to the Central Vermont Council on Aging:
- If your Medicare Advantage plan ends in 2025, you have a 63-day Special Enrollment Period (which ends on Feb 28, 2026) to enroll in a Medigap plan.
- The letters you receive from CMS and your Advantage Plan serve as proof of your Special Enrollment Period.
- If you do not enroll in a Medigap plan during your Special Enrollment Period, no insurer has to offer you a policy outside that timeframe.
- You do not need a Medigap plan if you have Medicaid. To qualify for Medicaid, your gross monthly income generally needs to be below needs to be below $1,333.
- Medigap plans are federally regulated, and all plans of the same type (Plan F, Plan F High Deductible, Plan G, or Plan G High Deductible) cover the same benefits Once enrolled in a Medigap plan, you can keep that plan for life.
Please refer to this resource from CVCOA or visit the Vermont Department of Financial Regulation’s website for more information about purchasing a Medigap policy.
What’s the difference?
Premiums and deductibles
If you or your spouse paid Medicare payroll taxes for at least 10 years, you qualify for Part A without a monthly premium. However, there is a $1,676 deductible per benefit period. Part B has an annual deductible of $257, and most enrollees pay a $185 premium per month. Traditional Medicare uses a fee-for-service model (meaning you pay per visit or appointment), and enrollees are responsible for a 20% coinsurance per service after reaching their deductible. There is no annual out-of-pocket maximum through traditional Medicare.
The cost of Part C, or MA plans, can vary depending on your plan, your care, and where you receive it, but plan holders are also responsible for the Part B monthly premium of $185, as well as the Part C premium which has an estimated average monthly cost of $17. MA caps annual out-of-pocket expenses at $9,350. Instead of a fee-for-service system, Medicare Advantage insurers receive a fixed fee per enrollee.
Care providers and networks
Traditional Medicare does not have a provider network, meaning you can visit any doctor or hospital in the U.S. that accepts Medicare. Most do.
Many MA plans have geographical network limits, and you may be responsible for the cost of seeing a provider who is out-of-network for non-emergency care. The loss of coverage from UnitedHealthcare and Vermont Blue Advantage means that plan holders will now have to confirm that their current providers accept traditional Medicare, an example of how network limits can create delays in accessing healthcare.
Prior approvals
Traditional Medicare does not require referrals or prior authorization under most circumstances, so you don’t have to wait to receive the care that your doctor recommends.
Many Medicare Advantage plans require referrals and prior approval for care. This means that the insurance company that manages your MA plan can decide if the care your physician recommends is medically-necessary. Waiting for prior authorization and appealing denials can delay care and be a financial and administrative burden for you and your provider.
Benefits
Many Medicare Advantage plans offer additional coverage that traditional Medicare plans may not. These benefits can include hearing, vision, and dental services, prescription drug coverage, discounts on gym memberships, and financial assistance with groceries.
Medicare Part B may cover some vision, hearing, and dental-related care, depending on the circumstances that necessitate care, but these are often out-of-pocket expenses for those with traditional Medicare.
There are several things to consider when choosing or switching between Medicare and Medicare Advantage plans. It’s important to understand your care options so you can make the best choice for your health, finances, and lifestyle.
Have questions? Helpful resources can be found on medicare.gov, through the Medicare helpline at 1-800-633-4227, through the Central Vermont Council on Aging, and the State of Vermont’s Department of Disabilities, Aging and Independent Living, including contact information to discuss options with knowledgeable guides
