The Medicare Landscape in Vermont in 2026

Navigating the 2026 Medicare Landscape in Vermont: A Guide for Seniors

For years, many Vermont seniors have relied on Medicare Advantage (Part C) plans as an alternative to Original Medicare. These plans often boasted low premiums and bundled benefits like prescription drug coverage, dental, and vision.

However, the landscape has shifted dramatically. As of January 1, 2026, the individual Medicare Advantage market in Vermont has largely collapsed. Two of the major carriers, including Vermont Blue Advantage (Blue Cross Blue Shield of Vermont) and UnitedHealthcare, have discontinued their individual Advantage plans across most of the state.

If you are one of the tens of thousands of Vermonters affected by these changes, you are likely feeling a mix of frustration, anxiety and uncertainty. This post is designed to provide a clear, professional, and educational roadmap to help you secure the coverage you need for the year ahead.

Why Is This Happening?

It is important to understand that these changes are not a reflection of your health or your eligibility. Instead, they are the result of several converging economic and regulatory factors:

  • Rising Healthcare Costs: Insurers have reported that the cost of providing care in Vermont has risen faster than the federal payments they receive.

  • High Utilization: Vermont has an aging population with high rates of medical service usage, making the “all-inclusive” model of Medicare Advantage financially unsustainable for many insurance providers.

  • Market Consolidation: Following the exit of other insurers in previous years, remaining companies experienced an unsustainable influx of new members, straining their resources.

While this shift is disruptive, it is important to remember that your right to healthcare remains intact. You are simply transitioning from a private “bundled” system back to the federal government’s foundational system.

Understanding Your New Coverage Options

With the exit of most Advantage plans in Vermont, your path forward generally leads in one of two directions.

1. Returning to Original Medicare (Parts A & B)

For the vast majority of Vermonters, this is now the standard option. Original Medicare is managed by the federal government.

  • Part A (Hospital Insurance): Covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

  • Part B (Medical Insurance): Covers certain doctors’ services, outpatient care, medical supplies, and preventive services.

  • The Pro: You can see any doctor or visit any hospital in the United States that accepts Medicare—there are no “networks” to worry about. The Con: Original Medicare typically only covers about 80% of costs, leaving you responsible for the remaining 20% (the “gap”).

2. Enrolling in a Medigap (Medicare Supplement) Plan

To cover the 20% gap left by Original Medicare, most seniors can choose to purchase a Medigap policy from a private insurer.

  • Benefit: These plans help pay for deductibles, copayments, and coinsurance.

  • Network: Like Original Medicare, Medigap plans have no networks. If a provider accepts Medicare, they should accept your Medigap plan.

3. Limited Medicare Advantage Options

As of 2026, Humana is the only provider offering individual Medicare Advantage plans in Vermont, and only in specific counties.

Your “Guaranteed Issue” Rights: A Critical Protection

Normally, if you try to buy a Medigap policy after your initial enrollment period, insurance companies can use “medical underwriting” to charge you more or deny you coverage based on pre-existing conditions.

Because your Advantage plan was discontinued, you have “Guaranteed Issue” rights. This means insurance companies cannot deny you a Medigap policy or charge you more because of your health history, provided you apply within the required window.

Important Deadline: Your Guaranteed Issue rights for a Medigap plan generally last until March 4, 2026 (63 days after your Advantage coverage ended on December 31).

Don’t Forget Part D: Prescription Drug Coverage

One of the most significant changes when moving from Medicare Advantage to Original Medicare is that prescription drug coverage is no longer bundled.

If you move to Original Medicare, you must enroll in a standalone Medicare Part D plan to avoid late-enrollment penalties and to ensure your medications are covered.

  • If you missed the December 7 Open Enrollment deadline, you may still have a Special Enrollment Period (SEP) because your previous plan was discontinued.

  • The last day to sign up for a Part D plan through this SEP is February 28, 2026.

Step-by-Step Action Plan

  1. Review Your Notices: Locate the “non-renewal” notice sent by your 2025 insurance carrier. Keep this document. It is your proof that you have Guaranteed Issue rights for a new Medigap plan.

  2. Compare Medigap Plans: Visit the Vermont Department of Financial Regulation (DFR) website to compare current Medigap rates. Popular plans include Plan G (comprehensive) and Plan N (lower premium, some small copays).

  3. Choose a Part D Plan: Use the Plan Finder tool at Medicare.gov to enter your specific medications and find the most cost-effective drug plan for 2026.

  4. Confirm Your Doctors: Since you are moving to Original Medicare, call your doctors to ensure they accept “traditional” Medicare. (Most do, but it is always best to verify).

  5. Check for Financial Assistance: Vermont has expanded income limits for Medicare Savings Programs and VPHARM. These programs can help pay for Part B premiums and prescription costs.

Resources for Vermont Seniors

You do not have to navigate this transition alone. There are free, unbiased resources available to help you:

  • Vermont SHIP (State Health Insurance Assistance Program): Call the statewide helpline at 1-800-642-5119. They offer free, confidential counseling through local Area Agencies on Aging.

  • Medicare.gov: The official federal site for plan comparisons and enrollment.

  • 1-800-MEDICARE: Available 24/7 for help with disenrollment and new plan questions.

  • Vermont Legal Aid (Health Care Advocate): Provides assistance if you encounter issues with coverage denials or billing.

  • Vermont Area Agencies on Aging: https://vermont4a.org/  Depending on where you live in Vermont, there is an area agency on agency with resources that can help you navigate this process.

While the “collapse” of the Medicare Advantage market in Vermont is a significant change, the transition back to Original Medicare with a Supplement plan often provides seniors with more stability and greater freedom in choosing healthcare providers.