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.

What to know about insurance in Vermont

  • Marketplace plans: In Vermont, you’re able to purchase an individual insurance policy even if you’re enrolled in an employer health plan. This is useful if your employer-sponsored coverage doesn’t meet your needs.
  • Open enrollment: Vermont’s 2022 open enrollment period runs from November 1, 2021 to January 15, 2022. If you don’t sign up during an open enrollment period, you might need to wait until the next year before you’re able to buy insurance through the exchange again.
  • Special enrollment: Special enrollment periods allow you to enroll in a health insurance plan if you qualify because of special life events such as, getting married, having children, switching jobs, or a recent move.
  • Vermont Health Connect: Vermont has its own health insurance marketplace called Vermont Health Connect. If you want to receive the Advanced Premium Tax Credit to reduce your cost of health coverage, you must enroll through the Health Insurance Marketplace and meet certain eligibility requirements.
  • Premium tax credit: If you don’t need or qualify for the Advanced Premium Tax Credit, you’re not required to purchase insurance through the exchange. You won’t be penalized for buying insurance directly from an insurance company.
  • Coverage types: Roughly 48.4% of Vermonters receive health insurance through an employer. About 4.8% are enrolled in individual plans. Just under 24% are covered under Medicaid, while an additional 17.5% are enrolled in Medicare. Just 4.4% of the state is uninsured.

How do I enroll in Vermont’s health insurance marketplace?

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:

  • What is your total household income?
  • What is your marital status?
  • Would you like to apply for financial assistance?
  • How many people do you claim as dependents on your taxes?

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:

  • Blue Cross Blue Shield of Vermont
  • MVP

How do I enroll in Vermont individual and family insurance?

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.

Insurance for individuals in Vermont 

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:

  • A Health Maintenance Organization plan (HMO) offers the best choice if you don’t make many visits to a doctor or a specialist or require prescriptions. It has lower monthly premiums and higher deductibles. HMO plans are the least expensive plans. However, there are restrictions with an HMO plan. You’ll need to get a referral if you want to see a specialist, you’ll need to name a primary care physician, and you’re limited to using the HMO plan’s in-network medical providers.
  • A Preferred Provider Organization (PPO) plan is a better idea if you regularly visit doctors or specialists. You’ll have more flexibility with a PPO plan, although you’ll pay more for it. You aren’t limited to in-network providers, you don’t need to name a primary care physician, and you’ll never need to obtain a referral to see a specialist.
  • A Point of Service Plan (POS) is a hybrid of an HMO and a PPO. You can use out-of-network providers, but any time you want to see a specialist, you’ll need to get a referral.

Insurance for families in Vermont 

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.

How much does health insurance cost in Vermont?

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

  • Bronze plans offer the cheapest health insurance, but also provide the lowest level of coverage. Bronze plans have higher annual deductibles and copayment requirements. With a bronze plan, your financial responsibility after meeting your deductible is 40% of the cost of your medical care. The most affordable bronze plan in Vermont costs $491 per month in 2021.
  • Silver plans cost a little more per month than bronze plans but provide lower deductibles and coinsurance requirements. Once you meet your deductible, you’re responsible for 30% of your medical expenses. Some residents may qualify for financial assistance that can lower the cost of silver plans. In many cases, you can enroll in a silver plan for less money than a bronze plan. The least expensive silver plan in Vermont costs $666 per month in 2021.
  • Gold and platinum plans are the most comprehensive plans that you can purchase but are also the most expensive. The copayment requirement with a gold plan is only 20%, while a platinum plan only requires a 10% copayment. If one or more members of your household have a chronic health condition, a gold or platinum plan may save you money even though it comes with a higher monthly premium. The most affordable gold plan in Vermont costs $674 per month in 2021.

What kind of low-income health insurance is available in Vermont?

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.

Medicaid in Vermont 

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:

  • Hospital stays
  • Diagnostic testing
  • Outpatient services
  • Chiropractic care
  • Mental health services
  • Dental visits.

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.

Vermont Dr. Dynasaur Program 

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:

  • Prenatal care
  • Routine medical appointments
  • Medications
  • Immunizations
  • Emergency care
  • Vision
  • Dental
  • Mental health care
  • Outpatient procedures

To learn if you qualify, visit the Vermont Health Connect website or call 855-899-9600.

What are Vermont’s Medicare options for seniors and people with disabilities?

Vermont has several Medicare options available for residents within the state.

  • Original Medicare is composed of Medicare Part A and B. Part A covers inpatient care that includes hospital stays, nursing care, home health care, and hospice care. Medicare Part B covers preventive care, annual physical examinations, medical transportation, outpatient procedures, diagnostic testing, medical devices, and medical supplies.
  • Medicare Advantage Plans are sold by insurance companies and subsidized by the government to reduce your cost. An Advantage plan must cover everything provided by Medicare Parts A and B, but you can add coverage for dental, vision, and more. Not all Advantage plans offer prescription drug coverage, but you can enroll in Medicare Part D if you require this benefit.

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.

Eligibility

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).

Enrollment

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:

  • Initial enrollment: Your initial enrollment period starts three months before your 65th birthday and ends three months after your 65th birthday. If you’ve never had Medicare, you can enroll during this period. If you started receiving Medicare when you were younger, you can also make changes to your plan.
  • General enrollment: Choose this enrollment period if you missed your initial enrollment period. The Medicare general enrollment period is January 1 to March 31. You can choose Original Medicare, Medicare Advantage, Medigap, or Part D.
  • Medicare Advantage open enrollment: You can make changes to your Medicare Part C, also known as Medicare Advantage, from January 1 to March 31.
  • Open enrollment: You can join, switch plans, or drop your coverage from October 15 to December 7 each year.
  • Special enrollment periods: You may qualify for a special enrollment period if you lose your coverage or have changes to your eligibility outside the regular enrollment periods.

Medicare Resources 

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.

Are there short-term health insurance plan options in Vermont?

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.

Vermont Insurance FAQs

Does Vermont require health insurance?

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.

Do I have to use the Health Insurance Marketplace in Vermont?

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.

What types of alternative health insurance plans are available in Vermont?

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.

Do I need health insurance if I have HSA/FSA?

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.

Do I need short-term disability coverage in Vermont if I have health insurance?

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.

Do I need long-term disability coverage in Vermont if I have health insurance?

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.

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Insurance and healthcare consultant

Tammy Burns is an experienced health insurance advisor. She is ACA-certified for health insurance and other ancillary, life, and annuity products.

She’s always been driven by a desire to help people, spending more than 25 years as a practicing nurse in hospitals, private doctors’ offices, home health, and hospice. As a nurse, Burns supported patients filing insurance claims with Medicare, Medicaid, and private insurance companies, as well as responding to billing questions from confused patients.

Seeing firsthand how unsuspecting patients are frequently confused by an overly complex system they don’t understand led Burns to become an insurance agent and healthcare consultant, now helping people understand the medical system. Since becoming an agent, she has worked with some of the largest and most reputable insurance carriers and agencies in the nation, and she has built a large and loyal clientele by way of her commitment to transparency and personalized service.

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