If you’re one of Vermont’s 600,000 residents and you have questions about health insurance, you should know that you have options, whether you’re looking for coverage for yourself, your family or your employees.1
You can get healthcare coverage through your job, through an Affordable Care Act (ACA) health plan or, if you qualify, through a government-run program such as Medicare, Medicaid and/or the Children’s Health Insurance Program (CHIP).
Despite the implementation of the ACA (also called Obamacare) and its expansion of Medicare to cover more Vermonters, the percentage of uninsured people in the state hasn’t dropped much. In 2014, it was at 5%, and from 2015 to 2018 it remained at 4%.2
Here are answers to some questions you might be asking as you look for the right health insurance for your needs.
WHAT YOU NEED TO KNOW:
The Open Enrollment Period to sign up for or change your health insurance in Vermont is November 1 to December 15.
You can enroll for an Affordable Care Act (ACA) plan through Vermont Health Connect, the state’s health insurance Marketplace.
The average monthly premium in 2020 for an ACA plan for a 40-year-old ranges from $476 to $652, but you may qualify for help in paying your premiums.
Applying through Vermont Health Connect will also tell you if you qualify for other coverage or subsidies.
When Is Vermont’s 2021 Open Enrollment Period?
The state’s annual Open Enrollment Period (OEP) to sign up for or change your health coverage takes place from November 1 to December 15.
If you’re already enrolled through Vermont Health Connect, the state’s Health Insurance Marketplace, you’ll need to go through a renewal process that begins in October.3 If it’s your first time getting healthcare coverage through the Marketplace, you can compare plans online to choose one that’s right for you. All of the plans on the Marketplace must follow ACA requirements..
In 2020, more than 27,000 Vermonters signed up for an ACA policy, over 8% more than the number of enrollees the year before.4
If you miss the OEP, you might be eligible for a Special Enrollment Period (SEP) that lets you sign up for health insurance at any time of the year. Situations that change your income (like losing your job) or the size of your family (like having a baby) qualify you for a SEP.5 You may also qualify because of an exceptional circumstance such as a very serious medical condition or a natural disaster.6
How Do I Enroll in the Vermont Health Insurance Marketplace?
As mentioned above, you can enroll in ACA health coverage through Vermont Health Connect. The site allows you to apply for and buy coverage, compare plans and find out if you qualify for subsidies to help you pay your monthly premiums and other assistance programs through the state.
You can access this one-stop-shop marketplace (also called an “exchange”) and its application checklist at Vermont Health Connect.
Brokers trained and certified by Vermont Health Connect can help you find a plan that’s right for you.7
How Much Does Vermont Individual Health Insurance Cost?
When comparing plans on the Marketplace, you’ll notice that they’re listed by “metal” names: bronze, silver and gold. The more valuable the metal, the more coverage you get and the higher the cost of the plan.
No matter the level, though, every metal plan includes the “essential health benefits” required by the Affordable Care Act. Catastrophic (high-deductible) plans are also available for people up to age 30 and those with hardship exemptions. These plans have high out-of-pocket costs in addition to the monthly premium.
From 2018 to 2020, premiums in Vermont for qualified bronze plans went up by almost 8%, while silver rose by 36% and gold by over 14%. Here are the average monthly costs for a 40-year-old Vermont resident for bronze, silver and gold plans sold through the state’s Marketplace:8
Average Premiums for Vermont Marketplace Plans (for a 40-year-old person)
|Lowest-Cost Bronze Plan||$442||$426||$476|
|Lowest-Cost Silver Plan||$474||$598||$645|
|Lowest-Cost Gold Plan||$569||$584||$652|
Vermont Health Connect provides a full listing of 2020 Plan Designs & Monthly Premiums. Remember that these are the costs before any savings you might be eligible for based on your family size and household income.
Your monthly premium could be much less if you qualify for an ACA subsidy for a plan you buy from the Marketplace. How much you’ll pay also depends on the type of plan you choose. Among metal plans, bronze-level coverage typically has the cheapest monthly premiums in Vermont but the highest out-of-pocket costs for things like deductibles and copayments.
Subsidies to help you pay your monthly premiums are calculated based on a Marketplace silver “benchmark” plan. In Vermont, on average, that benchmark plan will cost you $662 a month for 2020, up from $622 in 2019 and $505 in 2018.9
For 2021, the state approved a 3.5% increase for individual plans, or $22 more a month for the unsubsidized average plan.10
Which Companies Offer Individual Health Insurance Plans in Vermont?
You can choose from two health insurance companies for 2021 individual and family plans on Vermont’s Marketplace:11
- Blue Cross and Blue Shield of Vermont
- MVP VT (MVP Health Care)
What Are My Coverage Options If I’m Low-Income and I Live in Vermont?
ACA Marketplace Plans (Obamacare)
With one application to Vermont’s Health Insurance Marketplace through Vermont Health Connect you can see what savings you might qualify for on a private Marketplace plan or through Medicaid or the Children’s Health Insurance Program (CHIP), called Dr. Dynasaur.12
To qualify for advance premium tax credits (subsidies) on an ACA plan, you must buy it through the Marketplace, not a private broker. Your household income must also be below four times the federal poverty level (FPL).13 That means, for example, that a family of three’s annual household income would have to be under $85,320 in 2020 to qualify for assistance in Vermont.14
Eight out of 10 Vermonters enrolled in an individual plan through the Marketplace received this assistance.15
Here are some examples of cost savings with subsidies:
- A 28-year-old in Montpelier who earns $24,000 a year could get a 2020 silver plan for $122 per month after subsidies.16 The same policy would cost $662 per month without the premium tax credits, which cover 82% of the cost.
- A family of three in Burlington with an income of $50,000 a year could pay $322 per month after subsidies for a 2020 silver plan.17 This policy would cost them $1,859 per month without the premium tax credits, which cover 83% of the cost.
Cost-sharing reductions (CSRs) are another way you can save money on health insurance. They go to pay for copays, prescription drugs and other out-of-pocket expenses, but they only apply to silver plans you buy through the ACA Marketplace. Generally, you must earn between 150% and 300% of the FPL to qualify.18
Check Vermont’s Plan Comparison Tool to see the total estimated cost of plans available to you and to find out if you can get help paying for coverage.
- Adults under age 65 who don’t get Medicare Parts A and B and whose household income is at or below 138% of the federal poverty level (FPL).
- Children under age 19 with household income below 317% of FPL and pregnant women with income below 213% of FPL. This part is called “Dr. Dynasaur” and is funded by the state’s Children’s Health Insurance Program (CHIP).
More than 155,000 Vermonters — or one in four — have Medicaid as of May 2020 (that’s 159,000, when including those who are enrolled in CHIP).20 You can apply online or by calling Vermont Health Connect at (855) 899-9600. Medicaid and Dr. Dynasaur enrollment is available all year long.21
Medicaid also provides free health coverage for those 65 or older, with disabilities or who are blind. This program is not offered through Vermont Health Connect, but through Green Mountain Care instead. To see if you’re eligible, print out the 205ALLMED application, fill it out, sign and date it, and return it to Green Mountain Care. If you need help applying, call (855) 899-9600.
Starting in January 2014, Vermont expanded access to Medicaid to cover more people, adding those between ages 19 and 64 with household incomes up to 138% of the federal poverty level.22 Before that, the state had been subsidizing health plans. Since the expansion, over 60,000 more residents have joined the state’s Medicaid rolls.23
Children’s Health Insurance Program (CHIP): Dr. Dynasaur
If your family earns too much money to qualify for Medicaid but has difficulty affording private insurance, you may qualify for the Children’s Health Insurance Program (CHIP), which in Vermont is called Dr. Dynasaur.
Children younger than 19 living in a household with an income under 317% of FPL and pregnant women earning less than 213% of FPL fall under the Dr. Dynasaur program. (If you qualify for Medicaid, you can’t also apply for benefits through Dr. Dynasaur.)24 Green Mountain Care administers these programs.
In May 2020, over 4,000 Vermont residents were covered under Dr. Dynasaur.25
What About Medicare for Vermont Seniors and People With Disabilities?
Medicare is a federal health insurance program that covers most seniors age 65 and over, younger adults with disabilities and those with a few very serious illnesses. As of 2018, more than 145,000 Vermonters—or one-quarter of the population—had Medicare Part A (hospital insurance) and Part B (medical insurance).26
More than nine in 10 Medicare enrollees in Vermont access their Part A and Part B coverage through the federal government’s Original Medicare program. The rest get these benefits through private Medicare Advantage (Part C) plans.27 Part C plans bundle in other benefits, including Part D prescription drug coverage.
If you get your Part A and Part B coverage through Original Medicare, you may also want to buy an individual Part D prescription drug plan from a private insurer. In 2018, more than 84,000 Vermont residents had a standalone Part D plan.28
The federal government sets the benefits for each standardized plan, so the basic benefits for each type of plan are the same no matter where you buy it. But since the insurance company can charge what it wants for its policies, premiums can vary depending on who you buy it from.
Any questions you may have about Medicare insurance, including about Medicare Part D prescription drug plans, can be answered with a call to the state’s Senior HelpLine at (800) 642-5119.29 Some state programs, including Medicaid, might also help you reduce the cost of Medicare if you qualify. Green Mountain Care can help you with that.
Can I Buy Short-Term Insurance in Vermont?
Vermont does allow short-term, limited-duration plans (not all states do). These are limited to a three-month term and you can’t renew your policy within 12 months. These temporary coverage plans are designed to be used only to fill a temporary gap between full-coverage, long-term plans.30
In Vermont, insurance companies aren’t allowed to deny coverage to people with preexisting conditions and the state requires that short-term plans include many of the same benefits that ACA plans do. For these reasons, the cost of offering short-term coverage is much higher for insurance companies and none are currently offering these policies in the state.