Medicare in Vermont: Plans and Coverage (2026)

Medicare in Vermont runs on federal rules, but for 2026 the state ended SLMB as a separate savings program and moved those enrollees into the more generous QMB. Vermont also counts no assets at all when it decides who qualifies for that help.1

This guide covers Medicare in Vermont for 2026: what each part costs, which plan types the state offers, and how to get free help paying, through Vermont SHIP at 1-800-642-5119.2

In This Guide

• Key Takeaways
• Original Medicare: Parts A and B
• Medicare Advantage in Vermont (Part C)
• Medicare Part D: Prescription Drugs
• Medigap in Vermont
• Help Paying for Medicare in Vermont
• Medicare Enrollment Periods
• Free Medicare Help: Vermont SHIP
• Frequently Asked Questions

About these numbers: The premiums and deductibles below come from CMS for calendar year 2026, effective January 1. Medicare costs change every year, so check that CMS fact sheet or medicare.gov for the current figures.3 To talk to a person about your own coverage, call Medicare at 1-800-633-4227 (1-800-MEDICARE), staffed 24 hours a day, 7 days a week except some federal holidays; TTY users call 1-877-486-2048.6 Vermont SHIP at 1-800-642-5119 can also help.2

Original Medicare: Parts A and B

Original Medicare is run directly by the federal government and comes in two parts. The mechanics and costs are the same in Vermont as in every other state.

Part A (Hospital Insurance)

Part A covers inpatient hospital stays, limited skilled nursing facility care, hospice, and some home health care.3

The hospital deductible rose $60 from 2025, to $1,736 per benefit period.3 A benefit period starts the day you're admitted and ends once you've gone 60 days in a row without inpatient hospital care or skilled care in a nursing facility. Get readmitted after that gap, and the deductible applies again.

Part B (Medical Insurance)

Part B covers doctor visits, outpatient care, preventive services, durable medical equipment, and mental health care. Original Medicare doesn't cover routine dental, vision, or hearing.3,7

• Monthly premium: $202.90 (higher if your 2024 income was above $109,000 single or $218,000 married, under the income-related adjustment)3
• Annual deductible: $2833
• After the deductible: you pay 20% of the Medicare-approved amount for most services3

Part B is technically optional, but nearly everyone signs up. Miss your enrollment window without qualifying for a Special Enrollment Period or a Medicare Savings Program and you'll owe a late penalty of 10% for every 12 months you could have had it, for as long as you keep Part B.8

Medicare Advantage in Vermont (Part C)

Medicare Advantage plans are an alternative to Original Medicare, sold by private insurers. They cover everything Parts A and B do, except hospice, which Original Medicare keeps covering. Most bundle in Part D drug coverage along with extras like dental, vision, and hearing.7

Vermont's Medicare Advantage choices are concentrated in its populated corner. The Burlington and South Burlington metro area has a modest selection of plans, while rural Vermont, which accounts for most of the state's geography, typically sees fewer options. Plan availability, networks, and prices change every year and differ by county, so compare what's actually available at your address before you decide.

How These Plans Work

• You keep paying your Part B premium ($202.90) on top of any plan premium. CMS estimates the average Medicare Advantage premium at about $14 a month in 2026, and many plans charge $0 extra. CMS also notes that some plans may help pay all or part of your Part B premium itself.3,7
• Plans run on networks (HMO or PPO). Confirm your doctors and hospitals are in-network before you enroll, and check whether your preferred hospitals are included. Emergency care, out-of-area urgent care, and temporary out-of-area dialysis are covered whether you get them in the plan's network or outside it.7
• Plans usually require prior authorization for certain services, which Original Medicare generally does not.7
• Every plan caps your annual in-network out-of-pocket spending (federally limited to $9,250 in 2026; many plans set it lower). Original Medicare has no such cap of its own, and CMS names supplemental coverage as what bounds that spending: Medigap, Medicaid, employer, retiree, or union coverage.7

Use the Medicare Plan Finder at medicare.gov to compare plans by ZIP code. Enter your doctors and prescriptions and it shows which plans cover them and your estimated costs. If you want help reading the results, a Vermont SHIP counselor will go through them with you for free.

Medicare Part D: Prescription Drugs

Part D covers outpatient prescription drugs. You can get it as a standalone plan paired with Original Medicare, or built into a Medicare Advantage plan.

The Inflation Reduction Act eliminated the old coverage gap, the donut hole, so that higher-cost middle stage is gone.4 Part D now moves through three phases:

1. Deductible: you pay full price until you meet your plan's deductible (up to $615 in 2026).9
2. Initial coverage: you pay copays or coinsurance while your plan and drug makers cover the rest.
3. Catastrophic: once your out-of-pocket spending reaches $2,100, you pay $0 for covered drugs the rest of the year.4

That $2,100 cap is the number that matters most in Part D. It was $2,000 in 2025 and rises with drug-spending growth. Every plan must also offer the Medicare Prescription Payment Plan, which lets you spread your out-of-pocket drug costs into capped monthly payments across the year instead of paying in full at the pharmacy.4 People who qualify for Extra Help often pay much less, sometimes nothing.

For a deeper look at how Part D works, see our guide to Medicare Part D drug coverage.

Medigap in Vermont

Medigap policies are sold by private insurers to fill the gaps in Original Medicare: the deductibles, coinsurance, and copays. They work with Original Medicare, and a Medigap policy can't pay a Medicare Advantage plan's copays, coinsurance, deductibles, or premiums.7

Vermont offers the federally standardized plans, labeled A-D, F, G, and K-N. Plans C and F are closed to anyone who first became Medicare-eligible on or after January 1, 2020.10 Plan G is the popular choice for people newly eligible: it covers the Part A deductible, Part A and Part B coinsurance, and skilled nursing coinsurance, leaving only the $283 Part B deductible on you.5,3

Your One Guaranteed Window

Your strongest opening is the federal Medigap Open Enrollment Period, the six months that begin when you're 65 and enrolled in Part B. During that window an insurer must sell you any plan it offers at the standard rate, regardless of your health.5

Vermont has no annual birthday rule or other recurring window to switch Medigap plans without health screening. Once your six-month window closes, an insurer can use medical underwriting, meaning it can charge more or decline you based on your health, unless a federal guaranteed-issue right applies. If you think you might want Medigap, the safest time to buy is during that initial six-month window.

Medigap or Medicare Advantage?

While you're in a Medicare Advantage plan it's illegal for anyone to sell you a Medigap policy unless you're switching back to Original Medicare. Choose Medigap and you stay on Original Medicare with the freedom to see any provider who accepts Medicare nationwide, at a higher monthly premium. Choose Medicare Advantage and you trade some of that freedom for a network and often a lower upfront cost. For a side-by-side look at the trade-off, see our guide to Original Medicare vs. Medicare Advantage.7

Help Paying for Medicare in Vermont

If you're on a fixed income, two programs can cut your Medicare costs sharply, and Vermont's rules are more generous than the federal minimum.

Vermont's Medicare Savings Programs

Vermont administers its Medicare Savings Programs through the Department of Vermont Health Access (DVHA), the state's Medicaid agency. They pay some or all of your Medicare premiums and cost-sharing based on your income.1

Effective December 31, 2025, Vermont ended SLMB as a separate program. Most members who had been in SLMB were automatically moved into QMB, which provides more benefits and uses higher income limits. Under QMB, Vermont pays your Part A and Part B premiums plus deductibles and coinsurance, and federal law bars providers from billing you for that Medicare cost-sharing. SLMB had only paid the Part B premium.1

One rule makes Vermont's programs markedly more generous than the federal standard: Vermont applies no resource (asset) test to QMB or QI, counting only your income, not your savings or property.1 The exception is QDWI, a separate program for people under 65 who lost premium-free Part A after returning to work, which does keep a resource limit.1 Starting April 1, 2026, a household-size rule change may also help applicants who financially support relatives living with them.1 Enrolling in QMB or QI automatically qualifies you for Extra Help with Part D drug costs; QDWI does not.1

To apply, contact DVHA at dvha.vermont.gov or 1-800-250-8427, or get free in-person help with the application from a certified Assister.1 The figures above are the 2026 limits DVHA publishes, so confirm the current one with DVHA before assuming you don't qualify. DVHA's own advice is that people whose income runs over the listed limits should apply anyway.1

Extra Help for Part D

Extra Help, also called the Low-Income Subsidy, pays Part D premiums, deductibles, and copays for people with limited income and resources.11 Since 2024, the partial-subsidy tier is gone, so everyone who qualifies now gets the full subsidy.

• Income limit (2026): up to about $1,995 a month for an individual, $2,705 for a couple (the limits for the 48 contiguous states and DC, Vermont included; Alaska and Hawaii are higher)11
• Resource limits: $16,590 for an individual, $33,100 for a married couple, or $18,090 and $36,100 if you tell SSA you expect to use some of your resources for burial expenses11
• If you qualify for QMB or QI, you're enrolled in Extra Help automatically1

Apply through Social Security at ssa.gov or call 1-800-772-1213 (TTY 1-800-325-0778).11,12

Medicare Enrollment Periods

Miss a deadline and you can face coverage gaps or permanent penalties. These dates are federal and the same in Vermont as everywhere else.13

Changes you make during Annual Open Enrollment take effect the following January 1.13 If you're already receiving Social Security before 65, you're enrolled in Parts A and B automatically; if not, you sign up through the Social Security Administration. If you're still working past 65 with group health coverage based on that current employment, you can delay Part B without penalty and use an eight-month Special Enrollment Period to sign up, counted from the month that job or coverage ends, whichever comes first. COBRA and retiree coverage do not count as coverage based on current employment, and if you're self-employed or your plan isn't available to everyone at the company, ask your insurer whether it qualifies before you delay; if it doesn't, sign up at 65. This Special Enrollment Period does not apply if you're eligible for Medicare based on End-Stage Renal Disease (ESRD).14

For a full breakdown of how each period works and the penalties to avoid, see our Medicare enrollment periods guide.

Free Medicare Help: Vermont SHIP

You don't have to work through this alone, and you don't need to pay a broker. Vermont's State Health Insurance Assistance Program (SHIP) is run by the Adult Services Division, a division of the Vermont Department of Disabilities, Aging and Independent Living (DAIL). It provides information, assistance and support to people on Medicare who need help selecting or managing public and private health insurance benefits, and CMS describes SHIP counseling nationally as free, personalized, and unbiased, and not connected to any insurance company or health plan.2

A Vermont SHIP counselor can help you:

• Understand your Medicare options and what each part covers
• Compare Medicare Advantage, Part D, and Medigap plans side by side
• Apply for Vermont's Medicare Savings Programs and Extra Help
• Sort out billing problems, denials, and appeals

Key Vermont Medicare Contacts

Learn More

Find personalized help with Medicare in Vermont at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.