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Vermont Blue Advantage Unity HMO (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Vermont Blue Advantage Unity HMO (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Vermont Blue Advantage Unity HMO (HMO) in 2025, please refer to our full plan details page.
Vermont Blue Advantage Unity HMO (HMO) is a HMO plan offered by Blue Cross Blue Shield of Michigan Mutual Ins. Co. available for enrollment in 2025 to people living in State of Vermont. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Vermont Blue Advantage Unity HMO (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Vermont Blue Advantage Unity HMO (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Vermont Blue Advantage Unity HMO (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $250.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6000.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Vermont Blue Advantage Unity HMO (HMO) plan has an "Enhanced Alternative" drug benefit. The plan has a $250 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For example, preferred generic drugs have a $10 copay, while standard generic drugs have a $47 copay. Specialty tier drugs have no copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Vermont Blue Advantage Unity HMO (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $450 copay for the first five days, with no copay for subsequent days, while outpatient services range from no copay to a $350 copay. Emergency services have a $125 copay, and primary care visits are covered with no copay. Additional benefits include coverage for hearing and vision services, with routine hearing exams covered with no copay, and vision services that include eye exams and eyewear benefits. Dental services are also included, such as oral exams and restorative services, with some services requiring a copay. The plan also covers home health services with no copay, and offers benefits for medical equipment, diagnostic services, and more.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $450 copay for days 1-5, and no copay for days 6-90; additional days are covered with no copay. For Inpatient Hospital Psychiatric, you also pay a $450 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for Outpatient Hospital Services with a $350 copay, Observation Services with a $350 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a $30 copay for both individual and group sessions, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Vermont Blue Advantage Unity HMO (HMO) plan, and requires prior authorization. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Vermont Blue Advantage Unity HMO (HMO) plan. Ground and Air Ambulance Services have a $350 copay, and there is no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Vermont Blue Advantage Unity HMO (HMO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $30 copay, and Worldwide Emergency Coverage has a $100 copay; there is no coinsurance for any of these services. Worldwide Urgent Coverage has a $40 copay and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Vermont Blue Advantage Unity HMO (HMO) plan covers primary care physician services with no copay, and chiropractic services with a $15 copay for Medicare-covered services. Occupational therapy and physical therapy services have a $35 copay, while physician specialist services have a $55 copay. Mental health and psychiatric services have a $20 copay for individual and group sessions, and other health care professionals have a copay between $0 and $55. Additional telehealth benefits and Opioid Treatment Program Services are also covered.
Preventive Services See details
Preventive Services include coverage for Annual Physical Exams with no copay, and additional services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit all with no copay. Some services, such as Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
Hearing services are covered, including routine hearing exams with no copay. Prescription hearing aids are covered with a maximum benefit of $500 per year, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay between $0 and $55, and eyewear benefits. The plan covers one routine eye exam per year, one pair of contact lenses per year with a maximum benefit of $100, one pair of eyeglass lenses per year, and one eyeglass frame per year with a maximum benefit of $100.
Dental Services See details
Dental services with the Vermont Blue Advantage Unity HMO (HMO) include Medicare dental services with a $55 copay, oral exams (3 visits per year), dental x-rays (1 per year), prophylaxis (cleaning) (3 per year), fluoride treatment (1 per year), restorative services (1 per year), endodontics (1 per lifetime), periodontics (1 per year), prosthodontics, removable (1 per year), prosthodontics, fixed (1 per year), and oral and maxillofacial surgery (unlimited). Orthodontic services are also covered with a maximum benefit of $1200 per year. Adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Vermont Blue Advantage Unity HMO (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a coinsurance between 0% and 20%, while Prosthetics/Medical Supplies and Medical Supplies have a 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Diabetic Supplies have no coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $50, and lab services with a $5 copay. Diagnostic radiological services have a copay of at most $300, and therapeutic radiological services have a coinsurance of at most 20%. Outpatient X-ray services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the Vermont Blue Advantage Unity HMO (HMO) plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally covered, but the plan doesn't cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. The copay for covered services is listed elsewhere in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Vermont Blue Advantage Unity HMO (HMO) plan, but require prior authorization. For days 1-20, there is no copay. For days 21-55, the copay is $195, and for days 56-100, there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Other Services benefit for the Vermont Blue Advantage Unity HMO (HMO) plan covers Over-the-Counter (OTC) items, with a maximum benefit of $55.00 every three months, but does not cover acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, or other services.
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