Medicare in Vermont: Plans and Coverage (2026)

Vermont made a significant change to its Medicare Savings Programs effective January 1, 2026. As of that date, Vermont eliminated SLMB as a separate category, moving former SLMB enrollees into QMB, which covers more costs and bars providers from billing you for Medicare's share. This guide covers Medicare in Vermont for 2026: what each part costs, what plan choices exist in the state, and how to get help.

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. For the most current figures, contact Medicare at 1-800-633-4227 (1-800-MEDICARE) or Vermont SHIP at 1-800-642-5119.

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.

The hospital deductible rose $60 from 2025. A benefit period starts the day you're admitted and ends 60 days after you leave. Get readmitted after that, 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. It doesn't cover routine dental, vision, or hearing.

• Monthly premium: $202.90 (higher if your 2024 income was above $109,000 single or $218,000 married, under the income-related adjustment)
• Annual deductible: $283
• After the deductible: you pay 20% of the Medicare-approved amount for most services

Part B is technically optional, but nearly everyone signs up. Delay past your enrollment window without other creditable coverage 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.

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.

Vermont's Medicare Advantage market is more limited than in most states. 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 deciding.

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.
• 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.
• Plans usually require prior authorization for certain services, which Original Medicare generally does not.
• 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.

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. 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).
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.

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 also has to offer the Medicare Prescription Payment Plan, which lets you spread your out-of-pocket drug costs into capped monthly payments across the year rather than paying in full at the pharmacy. People who qualify for Extra Help often pay much less, sometimes nothing.

Medigap in Vermont

Medigap policies are sold by private insurers to fill the gaps in Original Medicare: the deductibles, coinsurance, and copays. They work only with Original Medicare, never with Medicare Advantage. In Vermont, these policies are regulated by the Vermont Department of Financial Regulation.

Vermont offers the federally standardized plans, labeled A through N. Plans C and F are closed to anyone who became Medicare-eligible on or after January 1, 2020. 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.

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.

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?

You can't hold both. 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.

Help Paying for Medicare in Vermont

If you're on a fixed income, two programs can cut your Medicare costs sharply.

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 income and assets.

As of January 1, 2026, Vermont eliminated SLMB as a separate enrollment category. Most members who were in SLMB were automatically moved into QMB with expanded 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 Medicare's share. SLMB had only paid the Part B premium.

Vermont's QMB program now covers a wider income range than the national standard, because former SLMB enrollees (who previously only qualified for Part B premium help) were moved into QMB on January 1, 2026. Confirm the current QMB income ceiling with DVHA before assuming you do not qualify — it is higher than the federal standard. Vermont applies a resource test: the 2026 limit is $9,950 for one person and $14,910 for a couple, not counting your home, one car, and certain burial funds. Enrolling in Vermont's QMB program automatically qualifies you for Extra Help with Part D. Apply through DVHA or with help from Vermont SHIP.

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. 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
• Resource limits: $16,590 for an individual, $33,100 for a married couple
• If you qualify for QMB or QI, you're enrolled in Extra Help automatically

Apply through Social Security at ssa.gov or call 1-800-772-1213.

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.

Changes you make during Annual Open Enrollment take effect January 1. If you're already receiving Social Security before 65, you're enrolled in Parts A and B automatically; if not, you sign up through Social Security.

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 administered through the Adult Services Division of the Department for Aging and Independent Living (DAIL). Counselors are trained, give free and unbiased help, and don't sell insurance.

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

Call 1-800-642-5119 to reach Vermont SHIP.

Learn More

• Medicare: The National Guide
• Original Medicare vs. Medicare Advantage
• How Medigap Works
• Medicare Part D Drug Coverage
• Medicare Enrollment Periods

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.