Medicare is open for enrollment for 2026, what do Vermonters need to know?

COLCHESTER — A Medicare seminar brought over a dozen people to Burnham Memorial Library and ended with more questions than answers about Medicare Advantage and rising healthcare costs in Vermont.

Medicare is a national health insurance program that provides health insurance to Americans over age 65 and some younger people with disabilities. The seminar was led by Chad Piche, a licensed agent and consultant from Good Harbor Insurance Group.

"I wouldn't be an expert with everything all the time," Piche said, referring to plans in other states. "No one is, and if they're telling you they are, they're probably not telling you the truth."

Medicare is divided into four basic parts including Part A for hospital insurance, Part B for medical insurance and Part D for prescription drug coverage. Part C is Medicare Advantage, which provides Part A and B through private insurance companies. Additionally, those interested in covering additional costs can enroll in "Medigap" or supplemental coverage.

The amount a person with Medicare pays for their health insurance varies on the coverage they pursue as well as if they qualify for financial help. The Part B premium for most is currently $185 in 2025 but will rise to $202.90 in 2026. Premiums are usually deducted from Social Security checks.

Medicare Advantage plans will not be offered in most of Vermont starting in 2026 due to rising costs to insurers to provide the healthcare plans, excluding one plan offered in five counties. Current members of plans that are ending will have a special enrollment period to choose new coverage options.

Generally, Vermonters who are leaving Medicare Advantage will have to revert back to Original Medicare (Part A and B) and if they want or need additional coverage, choose a "Medigap" plan.

One seminar attendee asked if University of Vermont Health Network lowering medical costs might make a difference in keeping Medicare Advantage, but Piche said the decision to get rid of the plan was made with more information than just that in mind.

"Vermont is a state that has medical costs that are higher than others are looking at," Piche said. "We've got different reasons for that. We're right on Lake Champlain, which isn't the cleanest water. We have a lot of farms and runoff from their fertilizer, so we have higher cancer rates around here than other places in the country."

Vermont also has one of the oldest populations in the country, and older people tend to have more health issues than younger populations.

Piche walked through how to browse Part D Prescription Drug plans on Medicare.gov. The website allows users to input the medicines they take as well any extra help they get for an approximate estimate of which plan is better financially for their needs.

Overall, the decision of which plan is "best" depends on a person's needs and their willingness to pay more or less for healthcare.

"Your health, income, prescriptions, all of that will determine the best option for you, so there isn't one over another that's better, per se," Piche said.

It's also important to review plan information each year as it is subject to change annually. For example, a drug covered by one part D plan one year may not be covered next year, Piche said.

There are resources that can help people navigate making this decision. There are insurance brokers like Piche and the State Health Insurance Assistance Program which in Chittenden and Franklin County is operated by Age Well and can be reached by calling their helpline (1-800-642-5119).