24 Medicare Part D Drug Plans in Vermont for 2023

All Medicare has 24 Medicare Part D prescription drug plans available in Vermont for you to compare.   See Plans

All Plans Have Four Cost Phases

A Medicare prescription drug plan is extra coverage you can get in Vermont to help you pay for your prescriptions. Part D plans, or PDPs, don't cover all costs, but they do cover a lot. But, how these plans work can be confusing, so let's go over the four phases of cost-sharing.

Phase 1: The Annual Deductible

An insurance deductible is an amount you must pay before your policy pays its share. Most Medicare Part D plans have a deductible, but a few plans don't. When a plan has a zero-dollar deductible, you have first-dollar coverage. However, if you choose a plan with a $450 deductible, that's what you'll pay at the pharmacy before the plan kicks in and starts paying its share.

NOTE: Some Medicare Part D plans exclude Tier 1 drugs from the annual deductible. With these plans, you get first-dollar coverage on most of your generic drugs.

Phase 2: Initial Coverage Limit

The Initial Coverage Limit starts once the deductible is paid. It is the same for all plans. The amount this year is $4,660. In this phase, you and your plan split all costs up until your total retail spend on prescriptions exceeds $4,660. You pay the formulary amount. The plan will pay the rest. If your medication costs $50, and the formulary calls for a 10% copay, your share will be $5.

CRITICAL: When the total cost of your prescriptions exceeds $4,660, you go into the next please, the Coverage Gap (aka, "donut hole").

Phase 3: The Donut Hole (Coverage Gap)

In the Coverage Gap phase (i.e., the "Donut Hole"), you pay a 25% copayment for all of your brand-name medications. The manufacturer will give a 70% discount and your Medicare Part D plans covers the remaining 5%. The 25% plus 70% discount you receive from the manufacturer count towards your combined True Out Of Pocket Costs (TrOOP). Once your TrOOP reaches $7,400 you exit the Donut Hole.

TIP: A few Vermont plans offer additional coverage in the coverage gap phase, so look for it on the plan information pages.

Generic drugs have a different situation. The 25% you pay yourself counts towards your TrOOP. However, your Part D pays the other 75%., which does not count towards tour TrOOP.

Phase 4: Catastrophic Coverage

After you have spent $7,400 in 2023, you get out of the coverage gap phase and you automatically receive "catastrophic coverage". In this phase, you will only have to pay a small percentage of coinsurance or payment on covered drugs for the rest of the year. All Vermont Part D plans include this coverage.

Costs That Help You Get Catastrophic Coverage

1. Your plan's deductible;
2. What you paid during the initial coverage limit period;
3. Most of the full cost of brand-name drugs (and the manufacturer’s discount) purchased in the coverage gap;
4. The amount paid by others, including family members, most charities, and other persons on your behalf; and
5. The amount paid by State Pharmaceutical Assistance Programs (SPAPs), AIDS Drug Assistance Programs, and the Indian Health Service.

Most Vermont Medicare Advantage Plans Include Part D Benefits

There are two ways can you get Part D prescription drug benefits. All Medicare prescription drug plans sold in Vermont work with Original Medicare. But, there's a second way to get coverage. Perhaps you would like more benefits that Original Medicare provides. In this case, a Medicare Advantage health plan might be exactly what you're looking for. Most Medicare Advantage in Vermont and Medicare SNP Plans in Vermont include Part D coverage.

A Medicare Supplement + Medicare Part D = Full Coverage

Original Medicare offers 80/20 coverage on your major medical costs. With Original Medicare, you pay about 20 percent of all hospital and medical bills and Medicare pays 80 percent. Without additional coverage to help pay your 20 percent share, even a brief hospital stay can be a big expense. That's why we maintain a complete directory of Vermont Medicare supplement insurance companies. The Medicare Wizard makes it super simple to get the best rates on the coverage you want. All Medicare supplement policies sold in Vermont are compatible with Medicare Part D plans. You can mix and match.

Medicaid and Your Vermont Medicare Part D Plan

If you are eligible for Medicare and Medicaid (aka "dual eligible", or "Medi-Medi") you may be automatically enrolled in a pre-selected Vermont Medicare Prescription Drug plan and Social Security’s Extra Help program. You must meet strict eligibility requirements to receive Extra Help, which will pay most of your prescription costs. Contact your local Medicaid office for more information.

The 2023 Medicare Part D Plan information for Vermont was last updated by the All Medicare team on January 9, 2023