Overview of Vermont’s Health Insurance Exchange
The federal healthcare law—the Affordable Care Act—was passed in 2010, and permits individual states to build their own health insurance marketplaces. Vermont’s marketplace, or exchange, is called Vermont Health Connect. The exchange offers 18 different plans, including two low-cost, catastrophic options for people under age 30. The two providers of individual plans for the Vermont exchange are Blue Cross Blue Shield of Vermont and MVP Health Care.
Plans are available for shopping and purchase as of October 1, 2013. Open enrollment lasts until March 1, 2014. Your plan will be effective on January 1, 2014. Trained “assisters”—who include navigators, certified application counselors, and brokers—are available to help both individual Vermont residents and small businesses choose the best plan for their needs and income. You can find an assister in your area via this link.
Per the Affordable Care Act, all plans must offer the following essential services:
- Ambulatory patient services (doctor visits)
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices (Habilitative services are for people with disabilities who need speech, occupational, or physical therapy.)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
Standalone dental benefits for adults will be offered on Vermont Health Connect. Pediatric dental and vision coverage are included in all of the medical plans. Vermont Health Connect is also offering “choice” plans that provide incentives for and reward wellness, preventive care, and mental health care.
There are four basic plans available with varying levels of coverage: Bronze (60 percent of expenses paid by plan), Silver (70 percent), Gold (80 percent), and Platinum (90 percent). Lower plans have lower premiums, but higher out-of-pocket costs. A catastrophic plan is available for folks under the age of 30. This plan has a high deductible.
Adults living at or below 133 percent of the poverty level (also known as the FPL, which is $11,490 a year in wages for one person and $23,550 a year in wages for a family of four), and pregnant women living at or below 208 percent of the FPL, can qualify for Medicaid in Vermont, based on eligibility guidelines that take effect January 1, 2014.
Additional federal financial protections will start in 2015 that include a maximum annual out-of-pocket cost of $6,350 for individuals and $12,700 for families. Capping out-of-pocket costs will help consumers pay medical bills that aren’t covered by insurance, reducing the chances of bankruptcy.
Tax credits are based on the Silver Plan, so you can easily determine what your additional out-of-pocket costs will be if you elect a higher or lower plan compared to the Silver Plan. The Affordable Care Act (ACA) was designed so the Silver Plan would be affordable to people who had to buy their own insurance, regardless of how expensive the healthcare rates may be where they live.
The average monthly cost of a Silver Plan offered on Vermont Health Connect is $418.
The plan designs, summaries of benefits and coverage, and monthly premium rates are available here.
Individuals and families with incomes between 100 percent and 400 percent of the federal poverty level (and who are covered by an exchange plan) are eligible for healthcare tax credits. The payment of credits will begin in 2014.
People want to how much their subsidies are, but the real question is how much will you pay? Once you figure out what the maximum healthcare percentage is for your income, you then know that's the most you'll have to pay for a Silver Plan (you may pay less). For example, if your income is $32,500 a year (283 percent of the poverty level), the most you’ll have to pay for health insurance is nine percent of your income, which amounts to $2,926 a year, or $244 a month. The challenge is to look at the costs of Bronze, Silver, Gold, and Platinum, and decide which plan offers the best value for you.
Information on Subsidies
Vermonters can learn more online, via the toll-free call center, or by meeting with an assister in person.
Vermont Health Connect also provides a few calculators for customers to estimate their potential tax credits. The Individual Subsidy Calculator estimates the amount of tax credits that you may be able to use to help pay your premiums. The Small Employer Estimator helps businesses determine if they are eligible to use Vermont Health Connect, and it also helps employers estimate the cost of offering insurance for employees.
To learn more about Vermont Health Connect, please visit http://www.vermonthealthconnect.gov or call 1-855-899-9600 (individuals) or 1-855-499-9800 (small businesses). The site also has contact forms for questions from individuals, questions from employers, and general site feedback.