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If you’re looking for health insurance coverage in Vermont, you’ve got plenty of options to consider. You can join an employer-sponsored plan, enroll in Medicaid or Medicare, or purchase an individual or family plan through an insurance company.
This guide reviews these options in detail to help you make an informed decision.
Vermont is one of 14 states with its own Health Insurance Marketplace. To enroll in coverage through the Affordable Care Act, you can visit healthconnect.vermont.gov and create an account. This process is straightforward and requires you to enter your contact information, select a password, and set your security questions. Once you’ve set up an account, you can apply for health insurance coverage.
Make sure you have the full name, birth date, and Social Security number available for each person you intend to cover with your plan. When you apply for coverage, the website automatically checks to see if you qualify for the Advanced Premium Tax Credit, Green Mountain Care (Medicaid), and other financial assistance programs. The application requires you to answer the following questions:
After you fill out the application, you can shop for insurance plans on the exchange. You can compare plans side-by-side to compare annual deductibles, coinsurance requirements, and monthly premiums. Once you find the plan that you like, you can complete your enrollment on the site.
The following insurance companies offer health insurance plans both on and off the Health Insurance Marketplace in Vermont:
Enrolling for individual coverage isn’t any different than enrolling in a family plan, but there are extra considerations needed when you’re shopping for a family policy. You need to take into account individual or family deductibles, your preferred plan type, the coinsurance requirement, and how much your plan will cost each month.
If you’re shopping for yourself, it’s fairly simple to find affordable health insurance that meets your needs. Assuming you’re healthy, you can save a lot of money by enrolling in a plan with a higher deductible and copayment. Remember you’ll need to meet your deductible before you receive coverage, and a higher coinsurance requirement means you have greater out-of-pocket expenses if you need medical treatment.
There are different types of plans you can choose from:
It’s a little more complicated to shop for family coverage because you need to balance the needs of every person you intend to cover on your plan with the cost of your policy against the benefits you’ll receive. You could be in perfect health, but your spouse or child may suffer from a condition that requires regular doctor appointments and state-of-the-art treatments.
Study your options carefully to discover what the copayment is for each service and determine what deductible you can afford to pay before receiving your policy’s benefits. You may think that a lower monthly premium is the way to go for affordable health insurance, but paying more per month may be worth it if you’re saving money each time you require medical care.
Consider whether you really need a PPO plan and whether an HMO or POS could save you money. Before committing to either, review the plan’s network to confirm whether you’re going to have access to the types of doctors and specialists that your family needs to see regularly. If you feel you’ll be happy with the network, you might not need to pay more per month for the right to see out-of-network doctors.
When you log in to the Health Insurance Marketplace, you’ll going to see four different tiers of coverage: bronze, silver, gold, and platinum. The tiers grade insurance plans based on factors such as annual deductibles, copayment requirements, and monthly premiums. It’s common to lean toward the plan that costs the least every month, however, your goal should be to lower the total cost of your health care. Cheap health insurance plans won’t necessarily be the best fit for you.
|Average premiums in Vermont||2018||2019||2020||2021|
|Most affordable bronze Plan||$422||$426||$476||$491|
|Most affordable silver Plan||$474||$598||$645||$666|
|Most affordable gold Plan||$569||$584||$652||$674|
If you live in Vermont, there are two programs available for low-income residents in need of health insurance. The first is Green Mountain Care, which is Vermont’s Medicaid program. You can also enroll your children in the CHIP program, which provides coverage to minor children and pregnant women.
Green Mountain Care is available to Vermonters who are blind, disabled, over the age of 65, pregnant, or caring for children under the age of 18. You might qualify if you’re providing care for someone with a disability. Green Mountain Care offers coverage for preventive care:
To qualify for Green Mountain Care, your income needs to remain under the threshold that corresponds with your household size. For example, if you’re applying as an individual, you can’t earn more than $17,171 per year to qualify for Medicaid services. If you’re living in a household of three, your total household income limit rises to $29,207 and increases to $41,284 for a household of five.
Vermont’s Green Mountain Care may also provide coverage if you’re over the age of 18 and require ongoing care at a nursing home or assisted care center. To apply for Green Mountain Care, you can visit the member portal and follow the prompts shown on the website. You can also apply for Medicaid services through the Vermont Health Connect website or by calling 855-899-9600.
Even if you don’t qualify for Green Mountain Care, you may be able to enroll in the Vermont Dr. Dynasaur program if you’re unable to afford insurance coverage for your children. This program insures children under the age of 19 and pregnant women. It covers:
To learn if you qualify, visit the Vermont Health Connect website or call 855-899-9600.
Vermont has several Medicare options available for residents within the state.
If you’re worried about your ability to cover your annual deductible and copayments, you can purchase a Medicare Supplement plan. These plans cover those out-of-pocket expenses after you meet a separate deductible.
To qualify for Medicare, you must be at least 65 years old or have a qualifying disability. In most cases, a qualifying disability is a condition that makes you eligible for at least 24 months of payments from the Social Security Disability Insurance program or Railroad Retirement Board. You may be able to qualify sooner if you have end-stage renal disease or amyotrophic lateral sclerosis (Lou Gehrig’s disease).
If you start receiving your Social Security or Railroad Retirement Board benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:
If you need assistance or have questions regarding Medicare enrollment, you can contact the Vermont Association of Area Agencies on Aging by calling 800-642-5119.
Short-term insurance is provided to those who need to cover a gap in insurance coverage until finding a more permanent solution.
While short-term plans aren’t illegal in Vermont, no insurance companies offer them due to the strict laws that the state has enacted, which heavily regulate temporary policies.
If you reside in Vermont, you’re not required to purchase health insurance. While the Affordable Care Act mandated coverage for all U.S citizens, it no longer carries a financial penalty.
In Vermont, you don’t have to use the marketplace. However, the Health Insurance Marketplace is the only place you’re able to take advantage of the Advanced Premium Tax Credit to reduce the cost of your health coverage. If you’re not interested in the credit or don’t qualify, you can purchase a policy from an individual provider without penalty.
The most popular form of cost-sharing plans are faith-based plans. In a faith-based plan, members share health care costs with other members. You don’t need to be a member of a particular denomination (or even religious), to participate in a plan. While these plans can be relatively low-cost, most faith-based plans don’t conform to ACA standards and don’t cover pre-existing conditions, mental health care, or pregnancy.
You should still have health coverage even if you choose to set up a health savings account or flexible savings account. These savings accounts are designed to help you plan for potential medical expenses should you be injured or diagnosed with a serious medical condition. You’d need to save a lot of money to cover the entire cost of medical treatment. Health insurance covers the majority of your medical bills, while an HSA or FSA prepares you for the out-of-pocket expenses your insurance doesn’t cover.
Short-term disability coverage is a supplemental form of insurance that helps you afford to pay your bills while you’re out of work. It’s not an adequate replacement for health insurance because it’s only meant to cover expenses your insurance won’t.
Long-term disability coverage works in the same manner as short-term disability insurance. It’s an excellent supplement to have with a health insurance plan. Keep in mind that you still need health coverage to pay for your doctor visits, state-of-the-art therapy, and medical procedures while you’re unable to return to work.