Vermont's Medicare Advantage market underwent the sharpest single-year contraction of any state heading into 2026. Vermont Blue Advantage, the Blue Cross Blue Shield of Vermont plan that covered roughly 26,000 individual Medicare Advantage members plus about 7,000 retired teachers, exited the market entirely at the end of 2025 after reporting $152 million in losses between 2021 and 2024. UnitedHealthcare, which covered about 7,800 more Vermonters, also withdrew. More than 90% of Vermont's 2025 Medicare Advantage enrollees had their plan terminated for 2026, one of the highest disruption rates in the country according to KFF's Medicare Advantage 2026 Spotlight.
Vermont's remaining individual market for 2026 consists of exactly 3 Humana PPO plans, available in only 6 of the state's 14 counties: Bennington, Caledonia, Essex, Orange, Windham, and Windsor. Eight counties, including Chittenden County (home to Burlington and roughly a quarter of Vermont's population) and Washington County (the state capital, Montpelier), have zero Medicare Advantage plans on medicare.gov Plan Finder for 2026. Residents in those counties who want Medicare coverage beyond Original Medicare must choose Original Medicare plus a Medigap policy and a standalone Part D drug plan, or enroll through an employer or retiree group plan if one is available to them.
Vermont's 2026 Medicare Advantage picture, covered in this guide, comes down to which counties have coverage, what Humana's plans cost, why the market collapsed, and what Vermonters in the 8 uncovered counties should do instead. The Annual Election Period runs October 15 to December 7, 2026, for coverage starting January 1, 2027, and Vermont also opened a special guaranteed-issue Medigap window through March 4, 2026, for members displaced by the exits.
2026 Medicare Advantage Market Overview in Vermont
In 2026, Vermont has 3 Medicare Advantage plans available, with 20,642 beneficiaries enrolled (12% MA penetration). The average monthly premium is $0 and the statewide average Star Rating is 3.8.
Top Medicare Advantage carriers in Vermont (2026)| Carrier | Plans | Avg Star Rating | Avg Premium |
|---|
| Humana | 3 | 3.9 | $0/mo |
| HealthSpring | 3 | 3.7 | $0/mo |
| Vermont Blue Advantage (Blue Cross Blue Shield of Vermont) | 0 | — | — |
| UnitedHealthcare | 0 | — | — |
Source: KFF Medicare Advantage 2026 Vermont data, CMS Medicare Plan Finder Q4 2025, Vermont Department of Financial Regulation
Plan Types in Vermont: HMO vs PPO vs SNP
Medicare Advantage plan-type breakdown in Vermont| Plan Type | Plans Available (2026) | Avg Premium | Best For |
|---|
| PPO (individual, Humana) | 3 | $0/mo | Vermonters in the 6 covered counties who want an individual MA plan with out-of-network flexibility |
| HMO (individual) | 0 | N/A | Not available anywhere in Vermont for 2026 after Vermont Blue Advantage's exit |
| Special Needs Plan (SNP) | 0 | N/A | Vermont has zero SNP plans and zero SNP enrollment in 2026, one of only two states nationally with this profile |
| Employer/Retiree Group Plan (EGWP) | 3 | $0-$109/mo | VSTRS-eligible retired teachers only, administered by HealthSpring, not sold on the open market |
Vermont's individual Medicare Advantage market shrank from 8 plans in 2025 to 3 plans in 2026, and the state lost its only HMO options entirely. Group retiree plans exist alongside the individual market but are restricted to specific former employers.
Source: CMS Medicare Plan Finder Q4 2025, Vermont Office of the State Treasurer VSTRS 2026 rate sheet
County-Level Variance in Vermont
Vermont's county-level Medicare Advantage variance is now binary rather than gradual: a county either has Humana's 3 plans or it has zero. Six counties (Bennington, Caledonia, Essex, Orange, Windham, and Windsor) retain individual MA access in 2026; the other eight, including the state's two largest population centers, do not.
Plan count and average premium by county in Vermont| County | Plans Available | Avg Premium |
|---|
| Chittenden County | 0 | — |
| Washington County | 0 | — |
| Rutland County | 0 | — |
| Windsor County | 3 | $0/mo |
| Bennington County | 3 | $0/mo |
| Essex County | 3 | $0/mo |
Plan counts reflect Vermont's 2026 individual Medicare Advantage market from CMS Medicare Plan Finder Q4 2025 data. Run a personalized search at medicare.gov to confirm exact plans for your ZIP code, since availability can shift during the plan year.
Source: CMS Medicare Plan Finder Q4 2025, Vermont county data
What to Look For in a Medicare Advantage Plan in Vermont
Vermont Medicare shoppers in 2026 face a narrower decision tree than almost any other state. Here's what matters when you shop, whether you're in one of the 6 covered counties or one of the 8 without individual MA plans:
- County of residence, first. Before comparing anything else, confirm whether your Vermont county is one of the 6 with Humana coverage (Bennington, Caledonia, Essex, Orange, Windham, Windsor). If not, Medicare Advantage is not an option for you in 2026 unless you qualify for a group retiree plan.
- Provider network, since Humana's Vermont plans are PPO. PPOs let you see out-of-network providers at a higher cost share, which matters in a rural state where specialists often practice across state lines in New Hampshire or New York. Confirm your doctors and hospital before enrolling.
- Prescription drug coverage (formulary). Confirm your specific medications are on Humana's 2026 formulary at a tier you can afford. The 2026 Part D out-of-pocket cap is $2,100 across all plans nationwide, including Vermont's remaining MA-PD options.
- Star Ratings. CMS rates plans 1 to 5 stars annually. Humana's Vermont PPO plans carry a 3.86 rating for 2026, slightly above the roughly 3.8 national average; the HealthSpring group plan for retired teachers carries 3.68.
- Maximum out-of-pocket (MOOP). The 2026 federal MOOP ceiling for in-network Medicare Advantage spending is $9,250, down $100 from $9,350 in 2025. Check where Humana's Vermont plans set theirs, since Original Medicare has no MOOP at all.
- Fallback options if you're in one of the 8 uncovered counties. Original Medicare plus a Medigap policy is your main path, and Vermont requires community rating on Medigap for beneficiaries 65 and older, meaning your premium doesn't rise just because you're older. A standalone Part D plan handles drug coverage.
Key Medicare Dates in Vermont
Vermont Medicare and Medicare Advantage have several enrollment windows in 2026, and 2026 carries extra weight for Vermonters because most prior Medicare Advantage plans were discontinued at the start of the year.
- Annual Election Period (AEP): October 15 - December 7, 2026 — Switch between Original Medicare and MA, change MA plans, or change Part D plans. Coverage starts January 1, 2027. Vermonters in the 8 counties with no MA option can use this window to shop Medigap and Part D instead.
- Medicare Advantage Open Enrollment Period (MA OEP): January 1 - March 31, 2026 — If you're already in a Vermont MA plan, you can switch to a different MA plan (limited to Humana's 3 plans if available in your county) or return to Original Medicare. One switch only.
- 2026 Guaranteed-Issue Medigap Window (Vermont-specific): Through March 4, 2026 — Vermonters whose Medicare Advantage plan was discontinued for 2026 (Vermont Blue Advantage or UnitedHealthcare members) had a guaranteed-issue right to buy a Medigap policy without medical underwriting through this date, per the Vermont Department of Financial Regulation.
- Initial Enrollment Period (IEP): 7-month window around your 65th birthday — Starts 3 months before your 65th birthday month, includes the birth month, and runs 3 months after. Enroll in Medicare Parts A and B, then choose Humana MA (if your Vermont county is covered) or Original Medicare plus Medigap and Part D.
- Special Enrollment Periods (SEPs): Varies by qualifying event — Triggered by moving out of your plan's service area (common in Vermont given how few counties are covered), losing employer coverage, or your Medicare Advantage plan leaving the market, as Vermont Blue Advantage and UnitedHealthcare did for 2026.
Notable Extras in Vermont Plans
Vermont Medicare Advantage shoppers should know about several state-specific features that shape the 2026 market:
- Green Mountain Care and dual eligibility: Vermont's Medicaid program is branded Green Mountain Care, administered by the Department of Vermont Health Access. Vermonters who qualify for both Green Mountain Care and Medicare are dual eligible, but unlike most states, Vermont currently has zero Dual Special Needs Plans (D-SNPs) and zero total SNP enrollment, one of only two states nationally in that position. Dual-eligible Vermonters should coordinate coverage through Original Medicare and Green Mountain Care directly rather than a Medicare Advantage SNP.
- Medigap community rating: Vermont requires community rating on Medigap policies for beneficiaries age 65 and older, meaning insurers cannot charge older applicants more just for their age. This is a stronger consumer protection than most states offer and matters more than usual in 2026, since most Vermonters displaced from Medicare Advantage are shifting to Medigap.
- Vermont State Health Insurance Program (SHIP): Vermont's free Medicare counseling program, run through the Vermont Association of Area Agencies on Aging, is especially useful in 2026 for residents navigating the Vermont Blue Advantage and UnitedHealthcare exits. Reach SHIP counselors at 1-800-642-5119 for one-on-one help comparing Humana, Medigap, and Part D options.
- Employer and retiree group plans outside the individual market: Vermont's individual MA market is limited to 6 counties, but Employer Group Waiver Plans (EGWPs) like HealthSpring's Advantage 65 plan for Vermont State Teachers' Retirement System (VSTRS) retirees operate statewide regardless of county, because eligibility is tied to your former employer rather than your ZIP code. If you're a retired Vermont public employee, check with your pension system before assuming you have no Medicare Advantage option.
Medicare Advantage vs Original Medicare in Vermont
Vermont residents choosing between Medicare Advantage and Original Medicare in 2026 face an unusual constraint most states don't have: geography decides the choice for two-thirds of the state before cost or network even enters the conversation. In the 8 counties without a Humana plan, Original Medicare plus a Medigap supplement and a standalone Part D plan is the only path to comprehensive coverage. Original Medicare gives you nationwide provider freedom and no prior authorization for most services, useful in a small state where care sometimes crosses into New Hampshire or New York, and where the nearest specialist may practice at Dartmouth-Hitchcock in Lebanon, New Hampshire, rather than inside Vermont. Of Vermont's roughly 169,000 Medicare beneficiaries, only about 36% live in a county where Medicare Advantage is even sold in 2026, which is why Original Medicare remains, by default, the plan most Vermonters carry.
In the 6 counties where Humana operates (Bennington, Caledonia, Essex, Orange, Windham, and Windsor), Medicare Advantage still offers a real trade-off: $0 monthly premium and often lower out-of-pocket costs for routine care, against a defined PPO network and prior authorization requirements for many services. Original Medicare plus Medigap in Vermont typically runs $150 to $350 per month combined for Medigap and Part D, versus $0 for Humana's MA plans, so the math still favors MA for many budget-conscious Vermonters who live in a covered county.
Vermont's guaranteed-issue Medigap window, open through March 4, 2026, gave displaced Vermont Blue Advantage and UnitedHealthcare members a fair shot at Medigap without medical underwriting, and Vermont's year-round community rating rule means that protection doesn't disappear once the window closes. Vermonters turning 65 after March 2026 still get their own 6-month Medigap open enrollment window with guaranteed issue, regardless of what happened to the 2026 Medicare Advantage market. Sixteen insurers sell Medigap policies in Vermont as of 2026, giving displaced Vermont Blue Advantage and UnitedHealthcare members meaningfully more choice on the supplement side than they had on the Medicare Advantage side.
How Star Ratings work in Vermont
Vermont Medicare Advantage Star Ratings, like every state's, come from CMS, which publishes ratings every October on roughly 40 quality measures: chronic condition management, member complaints, customer service, and Part D drug safety. Plans rated 4 stars or higher earn quality bonus payments from CMS, which typically fund richer benefits the following plan year. For a state with only two active carriers, Star Ratings carry outsized weight in 2026, since there's no long list of alternatives to fall back on if your assigned plan underperforms; the rating is one of the few objective quality signals Vermonters have left to compare Humana against HealthSpring.
Vermont's 2026 market has only two rated carriers to track. Humana's individual PPO plans hold a 3.86 Star Rating, slightly above the roughly 3.8 national average, while HealthSpring's group EGWP plan for retired teachers holds 3.68. Blended across Vermont's estimated 60% group-plan and 40% individual-plan enrollment split (per KFF), the statewide weighted average works out to about 3.75 stars for 2026. Neither carrier holds a 5-star rating in Vermont, so no year-round Special Enrollment Period into a 5-star plan is available to Vermonters in 2026.
How to enroll in Vermont Medicare Advantage
Vermont residents enrolling in Medicare Advantage in 2026 should start by confirming plan availability for their exact county, since 8 of Vermont's 14 counties have no options at all. Use medicare.gov/plan-compare as your starting point. CMS publishes a personalized plan-finder tool keyed to your ZIP code that will show you immediately whether Humana operates where you live.
- Step 1: Confirm Medicare Part A and Part B eligibility. You must already be enrolled in both before joining an MA plan. If you're newly turning 65, your Initial Enrollment Period covers this.
- Step 2: Gather your documents. You will need your Medicare card (showing your Medicare number and Part A/B effective dates), ZIP code and county of residence (to confirm you're in one of Vermont's 6 covered counties), a list of current prescriptions, a list of current doctors and hospitals, and your Green Mountain Care card if you are dual eligible.
- Step 3: Compare plans at medicare.gov/plan-compare. Filter by your Vermont ZIP code first, since most ZIP codes will return zero Medicare Advantage results. If Humana appears, compare its 3 plans by Star Rating, drug formulary, and provider network. Call the Vermont State Health Insurance Program at 1-800-642-5119 for free, unbiased counseling.
- Step 4: Apply. You can enroll directly through medicare.gov, by calling 1-800-MEDICARE (1-800-633-4227), or through Humana directly if you're in a covered county. If you're in one of the 8 uncovered counties, apply for a Medigap policy and a standalone Part D plan instead, using your guaranteed-issue right if your prior plan was discontinued.
- Step 5: Confirm your coverage start date. AEP enrollments start January 1, 2027. SEP enrollments typically start the first of the month after you enroll. You will receive a member ID card and Evidence of Coverage from Humana within 7 to 10 business days of enrolling.
- Common reasons Vermont Medicare Advantage applications are delayed or denied: applying from a ZIP code outside Humana's 6-county service area, late or incomplete Part B enrollment, missing Green Mountain Care documentation for dual-eligible applicants, identity verification issues, and attempting to enroll in the HealthSpring VSTRS group plan without qualifying retiree status.
$0 premium plans in Vermont for 2026
Vermont's entire individual Medicare Advantage market in 2026 is $0 monthly premium: all 3 of Humana's PPO plans carry no premium, and the statewide average MA premium fell from $22.41 in 2025 to $0 in 2026 as the higher-premium Vermont Blue Advantage and UnitedHealthcare plans exited. $0 premium does not mean $0 cost. You still pay the Part B premium ($202.90 per month in 2026), plus any drug copays, deductibles, and out-of-pocket costs your plan charges.
$0 premium plans in Vermont for 2026 detail| Carrier | Plan Type | Star Rating | Counties Available |
|---|
| Humana PPO Plan 1 | PPO | 3.86 | Bennington, Caledonia, Essex, Orange, Windham, Windsor |
| Humana PPO Plan 2 | PPO | 3.86 | Bennington, Caledonia, Essex, Orange, Windham, Windsor |
| Humana PPO Plan 3 | PPO | 3.86 | Bennington, Caledonia, Essex, Orange, Windham, Windsor |
| HealthSpring Advantage 65 (VSTRS group plan) | PPO (EGWP, retired teachers only) | 3.68 | Statewide (VSTRS-eligible retirees only, not sold individually) |
Vermont's 2026 individual Medicare Advantage market consists of just 3 Humana PPO plans, all $0 monthly premium, available only in the 6 counties listed above. Run a personalized search at medicare.gov to confirm exact plan IDs for your address.
Source: CMS Medicare Plan Finder Q4 2025, Vermont carrier filings
Why Vermont's Medicare Advantage market collapsed for 2026
Vermont Blue Advantage, owned by Blue Cross Blue Shield of Vermont, announced in October 2025 that it would exit the Medicare Advantage market entirely for 2026, citing $152 million in losses between 2021 and 2024, with at least 20% of that shortfall tied to the Medicare Advantage line specifically. The carrier had proposed a nearly 50% rate increase for its VSTRS retired-teacher plan for 2026, well above the 10% cap in its state contract, and ultimately chose to leave rather than absorb further losses.
UnitedHealthcare's simultaneous exit compounded the disruption, and together the two carriers' departure meant more than 90% of Vermont's 2025 Medicare Advantage enrollees had to actively choose a new plan for 2026, one of the highest disruption rates of any state per KFF's Medicare Advantage 2026 Spotlight. The Vermont Department of Financial Regulation responded by securing a guaranteed-issue Medigap window through March 4, 2026, and the Vermont State Treasurer's Office negotiated the transition of VSTRS retired teachers to HealthSpring rather than leaving them without coverage.
Vermont's small, rural, low-density population makes it structurally difficult for national Medicare Advantage carriers to build the negotiated provider networks and enrollment scale that make the product profitable, which is why the state has historically had the lowest Medicare Advantage penetration in the country. The 2026 collapse accelerated a trend that was already visible: Vermont's MA penetration dropped from about 31% in 2025 to 12.2% in 2026, and only about 36% of Vermont Medicare beneficiaries now live in a county with any Medicare Advantage access at all.
Frequently Asked Questions
How many Medicare Advantage plans are available in Vermont in 2026?
Vermont has just 3 Medicare Advantage plans available statewide in 2026, all sold by Humana, down from 8 plans in 2025. This follows the exits of Vermont Blue Advantage (Blue Cross Blue Shield of Vermont) and UnitedHealthcare from the individual market at the end of 2025. Humana's 3 PPO plans are only available in 6 of Vermont's 14 counties: Bennington, Caledonia, Essex, Orange, Windham, and Windsor. Run a ZIP-code search at medicare.gov to confirm whether your county has any options.
What is the average Medicare Advantage premium in Vermont for 2026?
Vermont's statewide average Medicare Advantage premium is $0 per month in 2026, down from $22.41 in 2025. All 3 of Humana's remaining individual plans carry no monthly premium, since Humana's higher-premium competitors left the state. You still owe the standard 2026 Part B premium of $202.90 per month, plus any plan cost-sharing for drugs, copays, and services your specific plan charges. The HealthSpring group plan for VSTRS retired teachers is also $0 per month for most subsidized retirees, though the full unsubsidized single premium runs $109 per month for those without a service-based subsidy.
When can I sign up for Medicare Advantage in Vermont?
The main enrollment window is the Annual Election Period (AEP) from October 15 to December 7, 2026, for coverage starting January 1, 2027. You can also enroll during your 7-month Initial Enrollment Period around your 65th birthday, or during a Special Enrollment Period triggered by moving, losing employer coverage, or your plan leaving the market. Vermonters displaced by the 2026 Vermont Blue Advantage and UnitedHealthcare exits also had a guaranteed-issue Medigap window through March 4, 2026, as an alternative to Medicare Advantage. Existing Humana members can switch during the MA Open Enrollment Period, January 1 through March 31, 2026.
Who has the best Medicare Advantage plans in Vermont?
Humana is the only individual Medicare Advantage carrier left in Vermont for 2026, so it is the only option to evaluate for most Vermonters, with a 3.86 Star Rating across its 3 PPO plans, slightly above the national average of roughly 3.8. Retired Vermont teachers enrolled through VSTRS instead use HealthSpring, rated 3.68 for 2026. Because Vermont has so few carriers left, the more important question for most residents isn't which carrier is best, it's whether any Medicare Advantage plan is available in their county at all. Eight of Vermont's 14 counties have none.
Can I switch from Medicare Advantage back to Original Medicare in Vermont?
Yes. You can switch during the Annual Election Period (October 15 to December 7, 2026) or the Medicare Advantage Open Enrollment Period (January 1 to March 31, 2026). Vermont's community rating rule for Medigap means your age alone cannot be used to raise your premium once you're enrolled, which is more favorable than most states. However, outside a guaranteed-issue window, Medigap insurers can still medically underwrite new applicants and deny coverage based on health history. Plan the switch carefully with free help from Vermont's State Health Insurance Program (SHIP) at 1-800-642-5119.
What is the difference between an HMO and a PPO in Vermont Medicare Advantage?
Vermont has zero HMO Medicare Advantage plans in 2026 after Vermont Blue Advantage's exit; all 3 remaining plans from Humana are PPOs. HMOs generally require in-network providers and referrals to see specialists, but usually cost less. PPOs let you see out-of-network providers at a higher cost share and typically don't require referrals, which matters in Vermont given how often care crosses into neighboring New Hampshire or New York. Vermont had HMO options as recently as 2025, but none are sold in the state for 2026, so the HMO-versus-PPO choice is now moot for most Vermonters.
Does Medicare Advantage cover prescription drugs in Vermont?
Yes. Humana's Vermont Medicare Advantage plans include Part D prescription drug coverage built in (MA-PD plans), as does the HealthSpring group plan for VSTRS retirees. The 2026 Part D annual out-of-pocket maximum is $2,100 across all plans nationwide, set by the Inflation Reduction Act (signed August 16, 2022), and the insulin copay is capped at $35 per month. Always check the plan's formulary to confirm your specific medications are covered and at what tier before enrolling, since formularies differ plan by plan.
Are dental, vision, and hearing covered by Medicare Advantage in Vermont?
Humana's Vermont Medicare Advantage plans include supplemental dental, vision, and hearing benefits that Original Medicare does not cover, though the exact scope (cleanings only versus crowns and hearing aids) varies by plan. Check the Evidence of Coverage for each of Humana's 3 plans for annual dollar limits before assuming a benefit is included. Vermonters in the 8 counties without a Humana plan, and anyone who chooses Original Medicare plus Medigap instead, won't have these extras built in and will need to buy standalone dental or vision coverage separately.
What is a Special Needs Plan (SNP) and who qualifies in Vermont?
A Special Needs Plan (SNP) is a type of Medicare Advantage plan designed for people with specific needs: Dual Special Needs Plans (D-SNPs) for those with both Medicare and Medicaid, Chronic Special Needs Plans (C-SNPs) for certain chronic conditions, and Institutional Special Needs Plans (I-SNPs) for nursing home residents. Vermont is unusual: it has zero SNP plans and zero SNP enrollment in 2026, one of only two states in the country (with Alaska) in that position. Dual-eligible Vermonters coordinate benefits through Original Medicare and Green Mountain Care directly instead.
