Medicare Coverage for Kidney Disease in Vermont
| Medicare Part A Coverage | Yes — hospital and inpatient care |
|---|---|
| Medicare Part B Coverage | Yes — 80% after deductible |
| Medicare Part D Coverage | Yes — prescription drugs covered |
| Your Cost Share (Part B) | 20% after $240 deductible |
| Average Annual Medicare Cost (Kidney Disease) | $42,800 |
| Medicare Beneficiaries in Vermont | 160,000 |
Does Medicare Cover Kidney Disease in Vermont?
Yes — Medicare covers kidney disease treatment in Vermont under both Part A (hospital/inpatient) and Part B (outpatient/physician services). The average annual Medicare cost for Kidney Disease is approximately $42,800, with Medicare paying 80% of approved charges after the Part B deductible ($240 in 2026).
What Medicare Covers for Kidney Disease in Vermont
- dialysis (3x/week)
- kidney transplant
- immunosuppressants post-transplant
- EPO injections
- renal diet counseling
- vascular access surgery
- home dialysis training
Your Out-of-Pocket Costs for Kidney Disease in Vermont
Under Original Medicare in Vermont, you pay 20% of all Part B-covered kidney disease services after meeting the annual deductible ($240 in 2026). There is no out-of-pocket maximum under Original Medicare, which means costs can add up significantly for serious conditions. The average Vermont Medicare beneficiary with kidney disease pays approximately $8,560/year in out-of-pocket costs under Original Medicare.
Cost Comparison: Original Medicare vs. Medicare Advantage for Kidney Disease in Vermont
| Coverage Type | Annual Out-of-Pocket (Estimated) | Out-of-Pocket Maximum | Prescription Coverage |
|---|---|---|---|
| Original Medicare (Parts A+B) | $8,560 | No limit | Separate Part D plan required |
| Original Medicare + Medigap Plan G | $2,380 + $1,944 Medigap premiums | Effectively capped | Separate Part D plan required |
| Medicare Advantage (avg in Vermont) | Varies by plan | Capped (varies) | Usually included |
Medicare Advantage Coverage for Kidney Disease in Vermont
Medicare Advantage plans in Vermont must cover all services that Original Medicare covers for kidney disease, but may have different cost-sharing structures. With 6 MA plans available in Vermont, you can compare plans specifically for their kidney disease coverage, including specialist networks, prior authorization requirements, and drug formularies. The average MA plan in Vermont is rated 4.0 stars by CMS.
Medicare Part D Coverage for Kidney Disease Medications in Vermont
Medicare Part D covers prescription drugs used to treat kidney disease in Vermont. In 2026, the maximum out-of-pocket cap for Part D drugs is $2100/year — a significant protection for patients with high drug costs. Vermont has 18 standalone Part D plans available. Drug coverage varies by plan formulary, so compare plans at medicare.gov/plan-compare to find the best coverage for your specific medications.
Medicaid and Kidney Disease in Vermont
Vermont has fully expanded Medicaid under the Affordable Care Act, meaning adults earning up to 138% of the Federal Poverty Level ($22,025/year for an individual) qualify for Medicaid coverage. For dual-eligible individuals in Vermont with kidney disease, Medicaid covers Medicare cost-sharing (premiums, deductibles, and copays), providing comprehensive coverage with minimal out-of-pocket costs.
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