En español | Many Vermonters are eligible to buy health insurance through Vermont Health Connect, the state’s Affordable Care Act (ACA) marketplace. And you might be able to save money on premiums, thanks to expanded federal tax credits in the March coronavirus relief bill. Because of the pandemic, Vermont Health Connect’s enrollment window is open through Oct. 1.
Most people already enrolled in ACA marketplace plans will also see their premiums go down this year because the recently enacted American Rescue Plan increases tax credits for insurance premiums and expands the number of households who qualify for them. Every household that pays more than 8.5 percent of their household income now qualifies for federal tax credits to help them afford health insurance. Prior to the new law, such tax credits were only available to people making up to 400 percent of the federal poverty level (around $51,000 for one person).
The average American with a marketplace plan can save $50 per month with the new assistance, the federal government says. As of now, this additional federal financial assistance will only be available in 2021 and 2022.
Who is eligible?
To buy health insurance through Vermont Health Connect, you must:
- Live in the U.S. and have a primary residence in Vermont.
- Be a U.S. citizen or national, or a noncitizen who is lawfully present in the U.S.
- Not be incarcerated.
You may also qualify for Green Mountain Care, the state’s Medicaid program, which offers free or low-cost coverage to low-income families and individuals.
When can I enroll?
- Anytime until Oct. 1
- Year-round enrollment is open to those who qualify for Green Mountain Care.
- After Oct. 1, special enrollment periods will be open to those who have a qualifying life event, such as the loss of employer-sponsored health insurance, the birth of a child, a divorce or a marriage, or a move to Vermont.
How do I sign up?
You apply for coverage and choose your plan at the same time. Once you’re approved for a plan, you’ll need to pay your first monthly premium for your coverage to begin. You can pay online, via phone or ask to receive a bill in the mail, which should arrive in one to three weeks.
To apply and enroll:
- Online: Go to Vermont Health Connect’s online portal to register. Here is a step-by-step guide to the registration process.
- By phone: Call Vermont Health Connect’s call center at 855-899-9600 between 8 a.m. and 4.30 p.m., Monday through Friday.
- In person: Use the Assister Directory to find the right type of in-person assistance you need. “Navigators” and “certified application counselors” can help you choose a health insurance plan at no cost to you. Licensed “brokers” help small businesses and individuals choose a health insurance plan but usually charge a fee.
- By mail: Download and print an application form, then mail the completed application to Vermont Health Connect, 280 State Drive, Waterbury, VT 05671-8100. Note that paper applications may take longer to process.
What is covered, and how much will it cost?
Coverage and cost depend on where you live, the type of plan you choose, your estimated household income, and the age and disability status of you and your family. If you qualify for Green Mountain Care, you will be able to get free or low-cost coverage and may not face premiums or copays, depending on your income level.
All Vermont Health Connect plans cover 10 “essential” benefits, including:
- Emergency services and hospitalization
- Pregnancy, maternity and newborn care
- Mental health services (including counseling)
- Chronic disease management and pediatric care
- Prescription drugs
Insurance companies cannot deny coverage because of preexisting conditions. When you apply, you can identify your medical needs and choose a plan that makes financial sense for you and your family.
Most Vermont Health Connect plans cover basic dental services for those under age 21. But adults who want dental coverage must add it to their policy. Deductibles and out-of-pocket costs vary between plans; enrolling in a family plan may cut costs.
What about new federal assistance for premiums?
Every eligible household that pays insurance premiums that exceed 8.5 percent of annual income now qualifies for federal tax credits for insurance premiums. For example, a single 64-year-old filer earning $51,000 per year could potentially save more than $8,000 with the new tax credits, according to the Kaiser Family Foundation.
Is there any other financial assistance available?
Yes. If you qualify for a premium tax credit, you may also qualify for a cost-sharing reduction that would help you pay for such out-of-pocket expenses as deductibles and copays. You must enroll in a Silver-level plan to get this assistance.
If you’ve collected unemployment benefits this year, even for just one week, you may qualify for an almost $0/month premium health coverage option, thanks to the American Rescue Plan. Call 855-899-9600 to notify Vermont Health Connect of your eligibility. This extra financial help will expire at the end of 2021.
What plans are available?
Vermont Health Connect plans are organized into five categories:
- Bronze plans have the lowest monthly premiums, the highest deductibles and copays, and cover roughly 60 percent of care costs. They’re designed to help you in case of serious illness or injury.
- Silver plans have moderate monthly premiums, deductibles and copays. They cover between 70 and 94 percent of care costs, depending on whether you qualify for a basic plan or an Enhanced Silver plan for lower-income households. They’re the only plans eligible for cost-sharing subsidies.
- Gold plans have higher monthly premiums, lower deductibles and copays, and cover roughly 80 percent of care costs.
- Platinum plans have the highest monthly premiums, the lowest deductibles and copays, and cover roughly 90 percent of care costs. These are for people who have significant health care needs and are willing to pay the highest premiums.
- Catastrophic plans have low premiums but minimal coverage. They are available only to those under 30 unless the applicants can prove they are eligible for a hardship exemption. People enrolled in these plans are not eligible for financial assistance.
Vermont Health Connect’s Plan Comparison Tool helps you estimate and compare costs and benefits of plans. It also gives you an estimate of your eligibility for financial assistance.
What if I already have health insurance?
If you already have coverage through your employer, you can switch to Vermont Health Connect, but you probably won’t qualify for financial help unless you can prove your employer’s insurance is inadequate or unaffordable.
If you already have a marketplace plan but want to change plans to take advantage of the new savings, you can switch through Aug. 15. Log in to your account or call 855-899-9600 to make a change. If you switch plans but stay with the same insurance company, any payments you’ve already made toward your deductible and out-of-pocket limits will transfer with you.
If you already have coverage directly with Blue Cross and Blue Shield of Vermont or MVP Health Care but want to move your plan into the marketplace in order to receive the new financial assistance, you can do so at any time. Any payment you’ve already made toward your deductible and out-of-pocket limits will transfer with you.
If you get coverage through the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) because you were terminated from a job or were put on reduced hours, you should be receiving a temporary COBRA premium subsidy that covers 100 percent of your monthly premium cost. This premium assistance, made possible through the American Rescue Plan, runs through the end of September or the end of your last month of COBRA eligibility, whichever comes first.
If you’re on COBRA, you may want to sign up for a marketplace plan that starts as soon as your COBRA coverage ends. Make sure to do so by Oct. 1 to avoid a coverage gap. If you’re not sure whether making this switch is right for you, you can seek help via the Assister Directory.
Visit Vermont Health Connect's American Rescue Plan Act FAQs for a full breakdown of what different categories of Vermonters can do.
Will I need to get a new doctor?
Probably not, if you stay with the same insurance provider. Blue Cross and Blue Shield of Vermont offers the same network of providers across its tiers of coverage and for both its on- and off-marketplace plans. MVP Health Care — the only other insurer in Vermont offering marketplace plans — does the same.
If you are looking to swap insurers, talk to your doctor or use the Plan Comparison Tool to see whether they will accept your plan.
Will my family members qualify for the same health plan that I do?
It depends. You can enroll as a family. In certain cases, however, some family members may also be eligible for subsidies or other programs, depending on age, income and disability, or caregiver status. Members of “mixed households,” in which family members are on different plans, may be able to see the same doctor or go to the same medical practice, as long as the provider is in both insurance networks, which is common in Vermont.