With most of the Affordable Care Act’s major provisions now in effect, the nation’s health insurance marketplace has undergone a significant transformation. Obamacare impacts individuals, families and small business owners alike. Most Americans are required to have minimum essential coverage unless they qualify for an exemption; however, the law is designed to make health insurance more accessible and affordable with income-based financial assistance and one-stop shopping via state-based and federally facilitated exchanges. Meanwhile, the private marketplace remains a place to shop for quality, affordable health insurance plans that meet ACA requirements.
The following guide offers a glimpse at the various types of ACA-compliant health insurance in Vermont, including individual and family health plans, small group health plans, coverage for high-risk applicants, mini-COBRA continuation coverage, Medicaid, and CHIP.
Health and healthcare in Vermont
Vermont placed 2nd in United Health Foundation’s 2014 America’s Health Rankings.1 Its strengths include a low rate of drug deaths, a high rate of high school graduation, and few poor mental and physical health days per month. North Dakota’s biggest health challenges include a high prevalence of binge drinking, a high prevalence of obesity, and a high rate of occupational fatalities.
Vermont individual and family health insurance
Under the Affordable Care Act, Vermont decided to create a state-based health insurance exchange, which launched Oct. 1, 2013. Vermont Health Connect provides a portal through which individuals and families can shop and apply for private health insurance coverage. Use HealthCare.com’s tax subsidy calculator to see if you are eligible for an Obamacare tax credit when buying private health insurance from Vermont Health Connect.
The U.S. Department of Health and Human Services reported that 31,619 individuals in Vermont selected a marketplace plan through the exchange from Oct. 1, 2013, through April 19, 2014.2 In 2015, the number of individuals in Vermont enrolled in a marketplace plan increased to 38,048 during the open enrollment period.3
|Vermont’s health insurance exchange:||vermonthealthconnect.gov|
|Vermont department of insurance:||dfr.vermont.gov/insurance/home|
Vermont small group health insurance plans
In Vermont, small businesses with 50 or fewer employees are able to purchase small group health insurance plans through the Vermont Health Connect exchange. Small businesses that use the state-based marketplace and have 25 or fewer employees may qualify for a Small Business Healthcare Tax Credit.
Self-employed individuals with no employees must apply for an individual health insurance plan through Vermont Health Connect or face a tax penalty.
Vermont state COBRA variations for small groups
The Consolidated Omnibus Reconciliation Act (COBRA) allows those employed by businesses with 20 or more employees to continue their group health insurance plan for a limited time should they lose coverage due to qualifying events such as termination of employment due to reasons other than gross misconduct, a reduction in work hours, divorce or legal separation, and loss of dependency status. To learn more about the federal COBRA program, visit dol.gov/ebsa/cobra.html.
In some states, those who work for a small business and lose health insurance coverage due to a qualifying event may be eligible for health insurance continuation through mini-COBRA or a similar state continuation program. In a few states, these programs may also be extended to those who work for larger companies and exhaust their federal COBRA continuation coverage limit. Mini-COBRA generally works like the federal COBRA continuation coverage, but its terms may vary.
Details from Vermont’s small group COBRA continuation law include the following4:
|Eligible group sizes||2–19; other private employers who sponsor a group health plan but are not eligible for COBRA|
|Maximum continuation period – standard||18 months|
|Maximum premium Increase||102 percent – full group premium cost, plus a 2 percent administrative charge|
|State legislation reference||Vermont Continuation of Coverage|
|More information||800-964-1784 – Vermont Department of Financial Regulation consumer service specialist|
|Additional notes||Covered employees and their covered family members are eligible.Qualifying events include layoff, reduction of hours, divorce, civil union dissolution, legal separation, a child no longer qualifying as a dependent under the plan rules, or death of the covered employee.|
Vermont high-risk pools
It used to be that health insurance companies could deny applicants or charge them more based on health history and preexisting conditions. When the Affordable Care Act was passed in 2010, many states created federally funded preexisting condition insurance programs or accepted federal funding to assist with similar high-risk pool programs they already operated.5
The Affordable Care Act prohibits this practice for health insurance plans considered minimum essential coverage with effective dates beginning Jan. 1, 2014, and later. As such, the PCIPs and state high-risk pools created to provide health insurance for those once considered uninsurable are being phased out.
Medicaid is a state health insurance program for low-income individuals under age 65, pregnant women, children, disabled individuals, and seniors over age 65; it is partially funded by the federal government. In 2014, states were given the option to accept additional federal funding and expand their Medicaid program eligibility to those who make up to 133 percent of the federal poverty level (effectively 138 percent due to how it is calculated, according to HealthCare.gov).6
Vermont expanded its Medicaid program to low-income adults on Jan. 1, 2014.7 Medicaid/CHIP open enrollment take place year-round.
The information below is specific to Medicaid in Vermont, which is part of the state’s Green Mountain Care family of low-cost and free health coverage programs:
|Governing agency||Centers for Medicare & Medicaid|
|Administrator||Department of Vermont Health Access|
|Where to apply||vermonthealthconnect.gov / greenmountaincare.org/application_forms.html|
|Open-enrollment period||Year-round in all states|
|Eligibility||Low-income adults under age 65For information on Vermont Medicaid for the Aged, Blind or Disabled, visit dcf.vermont.gov/esd/MABD.|
The Children’s Health Insurance Program is a partnership between the states and federal government. CHIP provides health insurance to uninsured children who meet certain eligibility guidelines.
The information below is specific to Dr. Dynasaur, Vermont’s health insurance program for low-income children, which falls under the Green Mountain Care family of low-cost and free health coverage programs:
|Program name||Dr. Dynasaur|
|How to apply||vermonthealthconnect.gov / greenmountaincare.org/application_forms.html|
|Eligibility||Children under age 19 and pregnant women|
1 United Health Foundation. 2014 America’s Health Rankings Annual Edition. “Annual State Health Rankings.” http://www.americashealthrankings.org
2 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2014/.
3 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2015/.
4 National Conference of State Legislators. Coverage of Uninsurable Pre-Existing Conditions: State and Federal High-Risk Pools. Updated April 2014. http://www.ncsl.org/research/health/high-risk-pools-for-health-coverage.aspx.
5 Pre-Existing Condition Health Insurance Plan. “PCIP Coverage Ended April 30.” N.D. https://www.pcip.gov.
6 Centers for Medicare & Medicaid Services. “Medicaid Expansion & What It Means for You.” HealthCare.gov. N.D. https://www.healthcare.gov/what-if-my-state-is-not-expanding-medicaid/.
7 Centers for Medicare & Medicaid Services. “North Dakota.” http://www.medicaid.gov/medicaid-chip-program-information/by-state/north-dakota.html.