Vermont Blue Advantage Unity HMO (HMO)

Vermont Medicare Advantage Plan (2025 Plan)


Monthly Premium

Your Cost
$0
by Vermont Blue Advantage

Additional Coverage

HearingVisionDental

Overall Government Star Rating

(coming soon)

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Plan Name
Vermont Blue Advantage Unity HMO (HMO)
Insurance Carrier
Vermont Blue Advantage
Plan Type
Medicare Advantage Plan With Part D Prescription Drug Coverage
Network Type
HMO

Vermont Blue Advantage Unity HMO (HMO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Vermont and offered by the health insurance company Vermont Blue Advantage. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.

Monthly Premium
$0
Annual Deductible
$0
Max Out-of-Pocket
$6,000
Primary doctor visit
$0 copay
Specialist visit
$55 copay per visit
ER visit
$125 copay per visit (always covered)
Ambulance
$350 copay

Vermont Blue Advantage Unity HMO (HMO) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $6,000 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Vermont Blue Advantage Unity HMO (HMO) are defined below.

Yes
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

Vermont Blue Advantage Unity HMO (HMO) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Vermont Blue Advantage Unity HMO (HMO) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. Vermont Blue Advantage Unity HMO (HMO) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Limited coverage
Over the counter drug benefits
Limited coverage
In-home support services
Not covered
Home and bathroom safety devices
Not covered
Meals for short duration
Not covered
Annual physical exams
Limited coverage
Telehealth
Limited coverage

Monthly Premium
$0
Health Portion of Premium
$0
Drug Portion of Premium
$0
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$6,000 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes

Doctor Services

Primary doctor visit
$0 copay
Specialist visit
$55 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures
$0-50 copay
Lab services
$5 copay
Diagnostic radiology services (like MRI)
$0-300 copay
Outpatient x-rays
$10 copay
Emergency care
$125 copay per visit (always covered)
Urgent care
$30 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
$450 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient hospital coverage
$350 copay per visit

Skilled nursing facility

Skilled nursing facility
$0 per day for days 1 through 20
$195 per day for days 21 through 55
$0 per day for days 56 through 100

Preventive services

Preventive services
$0 copay

Ambulance

Ground ambulance
$350 copay

Therapy services

Occupational therapy visit
$35 copay
Physical therapy & speech & language therapy visit
$35 copay

Mental health services

Outpatient group therapy with a psychiatrist
$20 copay
Outpatient individual therapy with a psychiatrist
$20 copay
Outpatient group therapy visit
$20 copay
Outpatient individual therapy visit
$20 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
0-20% coinsurance per item
Prosthetics (like braces, artificial limbs)
20% coinsurance per item
Diabetes supplies
$0 copay

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseCatastrophic coverage phase
Preferred Generic$0.00 copay$0 copay
Generic$10.00 copay$0 copay
Preferred Brand$47.00 copay$0 copay
Non-Preferred Drug$100.00 copay$0 copay
Specialty Tier30% coinsurance$0 copay

Part B Drugs

Chemotherapy drugs
0-20% coinsurance
Other Part B drugs
0-20% coinsurance

Hearing

Hearing exam
$0-55 copay
Fitting/evaluation
$0 copay
Hearing aids - All types
$0 copay

Preventive Dental

Oral exam
In-network: $0 copay
Out-of-network: $0 copay
Cleaning
In-network: $0 copay
Out-of-network: $0 copay
Fluoride treatment
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays
In-network: $0 copay
Out-of-network: $0 copay

Comprehensive dental

Restorative services
In-network: $0 copay
Out-of-network: $0 copay
Endodontics
In-network: $0 copay
Out-of-network: $0 copay
Periodontics
In-network: $0 copay
Out-of-network: $0 copay
Prosthodontics, removable
In-network: $0 copay
Out-of-network: $0 copay
Prosthodontics, fixed
In-network: $0 copay
Out-of-network: $0 copay
Maxillofacial prosthetics
Not covered
Implant services
Not covered
Oral and maxillofacial surgery
In-network: $0 copay
Out-of-network: $0 copay
Orthodontics
Not covered
Adjunctive general services
Not covered

Vision

Routine eye exam
$0 copay
Contact lenses
$0 copay
Eyeglasses (frames & lenses)
Not covered
Eyeglass frames (only)
$0 copay
Eyeglass lenses (only)
$0 copay
Upgrades
$0 copay

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