Vermont Health Insurance

Health insurance in Vermont

● Vermont operates a state-run health insurance exchange, Vermont Health Connect.

● Two insurers offer plans in Vermont's individual market; the average rate increase for 2021 is around 3.5%.

● Vermont's individual and small-group markets merge.

● The open registration for the 2021 plans is from 1 to 15 December 2020.

● Vermont law allows the sale of short-term health plans with a duration of up to three months, but there are no insurers offering short-term plans in the state.

● More than 42,000 Vermont residents have coverage under the small business plans.

● In 2019, only 4.5% of Vermont residents were un insured.

● Vermont implemented guaranteed issuance and community scoring many years before the ACA.

This page is dedicated to helping consumers quickly find health insurance resources in the state of Vermont. We've included information about Vermont Health Connect, the state health insurance exchange, and the open enrollment period that applies to health plans purchased by individuals and families in Vermont. We also summarized the state's approach to Medicaid expansion and included an overview of Medicare in Vermont. You'll also find various other health insurance resources for Vermont residents.

Vermont's health insurance marketplace

Vermont has a state-run health insurance marketplace, Vermont Health Connect. The market offers coverage for individuals and families who need to purchase their own health insurance policies. This includes people who have retired before Medicare eligibility, people who are self-employed, and people who are employed in a small business that does not provide health benefits. Financial assistance (to offset premium costs and out-of-pocket medical expenses) is available through Vermont Health Connect, depending on the applicant's family income.

Vermont has long been a pioneer of health care reform. The state had planned to convert to a single payment system in 2017, but abandoned that plan at the end of 2014. Lawmakers in the state legislature recently renewed the push for a single payment system, with H.129, introduced in 2019, and H.860, introduced in 2020, though neither bill has come out of committee.

Vermont's individual health insurance marketplace -- despite being small -- is more stable than markets in many other states, largely because Vermont has united its individual and small-group markets into a single insurance pool. This option is available to all states, but most have rejected it.

Vermont has an individual mandate to from 2020, which requires residents to maintain minimum coverage of essential health insurance. But the state has not yet established any kind of penalty for non-compliance (so the mandate is essentially the same as the federal individual mandate, which no longer has a penalty for non-compliance).

As of early 2020, there were 33,982 people enrolled in Vermont's individual health insurance marketplace, including stock market enrollment and carrier-directed enrollment. In addition, there were 42,520 people with small-group coverage sponsored by the employer in the state.

Open enrollment period and dates in Vermont

Open enrollment in Vermont follows the federal program from November 1 to December 15 (Vermont generally sticks to this program and doesn't tend to offer extensions with the frequency of other state-run exchanges). The open enrollment period is an opportunity for individuals and families to recently enroll in health coverage or renew or modify an existing policy. Subscribers with coverage through Vermont Health Connect should also update their financial information that is on file with the exchange, to ensure premium subsidies are accurate over the next year.

Registration outside of open registration requires a qualifying event. This is true both on the stock exchange and through the state's "full-cost direct enrollment path," which refers to enrollments made directly through insurance companies.

Medicaid enrollment continues year-round, and eligible enrollees don't need a qualifying event.

Vermont Health Insurance Companies and Premiums

Two insurers offer plans in Vermont's individual market: MVP and Vermont's Blue Cross Blue Shield. Both insurers also offer plans that can be purchased directly, rather than through the health insurance marketplace, for people who are not eligible for premium subsidies (subsidies are only available if the plan is purchased through the market).

For 2021, average premiums in Vermont's individual health insurance marketplace are rising by about 3.5%, before premium subsidies are applied.

Plans for all-payer system

Vermont had initially planned to implement a single-payer system, but those plans were abandoned in late 2014 amid cost issues. But the Green Mountain Care Board voted in 2016 to sign the All-Payer model agreement.

This agreement between the State of Vermont and the Centers for Medicare and Medicaid Services is designed to move the state's health plans away from paid reimbursement and incentivize doctors who keep people healthy -- something former Governor Peter Shumlin said made Vermont the first in America to do so.

In 2017, the state began piloting the all-payer model, OneCare, with 2,000 providers and 30,000 Medicaid insured patients. In 2018, the paid model was expanded to include nine of the state's 14 hospitals (some participate only partially, only with Medicaid patients), and OneCare provided care to about 120,000 patients in 2018. By 2019, that number had grown to 175,000 Vermonters. Details and updates on the state's all-payer program can be found here; the first annual report for the All-Payer model, for 2018, is available here.

Medicaid expansion in Vermont

The use of federal funds to expand Medicaid eligibility to 138% of the poverty line played a role in the success of Obamacare in Vermont. But the state has been working to implement accurate eligibility redetermination processes since 2016, to ensure that people are enrolled in the correct coverage.

As a result, total Enrollment in Medicaid/CHIP in Vermont was 7% lower at the end of 2019 than at the end of 2013 (as a result of an average 26% increase nationwide). But there was a nationwide increase in Medicaid enrollment due to job losses caused by the coronavirus pandemic, and by May 2020, Enrollment in Medicaid/CHIP in Vermont was only 1% lower than in 2013.

Short-term health insurance in Vermont

Although Vermont does not ban short-term health insurance plans, the state's benefit mandates and requirement that the plans cover pre-exist conditions make Vermont's short-term market not attractive to insurers. As a result, no insurer is currently selling short-term health insurance plans in the state.

How did Obamacare help Vermont residents?

In 2013, about 7.2% of Vermont residents did not have medical insurance -- well below the national average and the fourth lowest rate in the country.

By 2016, with only 3.7% of its population uninsured, Vermont had cut its already low uninsured rate by nearly half. The uninsured rate slid a little higher in 2017, to 4.6 percent (nationally, there was also a slight rise in the uninsured rate in 2017, after President Trump took office), but fell to 4 percent by 2018 (nationally, the uninsured rate rose again in 2018 , but Vermont countered this trend). In 2019, however, it grew to 4.5%. But that was still less than half the average uninsured national rate.

Vermont and the Affordable Care Act

The Vermont congressional delegation is fully supportive of the ACA. Senators Patrick Leahy and Representative Peter Welch are both Democrats, and although Senator Bernie Sanders is an independent, he caucuses with Democrats and has long been in favor of expanding the ACA with a Medicare for All proposal (during both of his presidential campaigns, Sanders officially became a Democrat).

Former Governor Peter Shumlin not only supported the ACA, but was also the first governor in the country to actively pursue the clause in the law that allows states to go one step further and eventually implement a single, state-based payment system. Green Mountain Care was supposed to start as early as 2017, but the state abandoned its progress toward a single payment system at the end of 2014 – however, it still has its supporters and the legislation was introduced in 2019 and 2020 to revive the idea.

In 2016, with limited shumlin, a new governor was elected. Phil Scott, a Republican, was among a group of nine bipartisan governors who signed a letter in 2017 calling on Congress to abandon the Graham-Cassidy ACA repeal measure that was then under consideration, and instead focus on bipartisan efforts to stabilize the individual health insurance marketplace. Scott was re-elected in 2018.

Vermont implemented health care reform well before the ACA

Prior to the ACA, Vermont was one of the few states where individual health insurance was not medically underwritten; that's been the case since 1992. This means that medical history has not been used to determine suitability for coverage. In addition to guaranteed issuance policies, the state also used community assessment, so premiums were no higher for older policyholders (this is still the case; Vermont and New York are the only states where insurers can't charge older applicants more than they charge younger applicants.

Although these are good measures to protect consumers, they are not necessarily beneficial for health insurance carriers seeking to make a profit, so the market had significantly destabilised by 2006. The legislature passed a measure that year contained a variety of reforms, and the ACA later strongly supported what Vermont was already doing.

Because Vermont had a law requiring all policies to be guaranteed, there was no need for a state-run high-risk pool before the ACA, but the law still provided PCIP coverage in Vermont starting in 2010.

Medicare coverage and enrollment in Vermont

As of August 2020, there were 151,195 Vermont residents with Medicare coverage. That's about 24 percent of the state's population -- the national average is about 19 percent, but Vermont's population is older than the national average.

In Vermont, 16% of Medicare beneficiaries are under the age of 65 and are eligible for Medicare because of a disability. The other 84% are at least 65 years old and are entitled to Medicare because of their age.

Vermont Health Insurance Resources

● Vermont Health Connect — Health insurance marketplace/exchange. Individuals and families use the market to obtain health coverage, with income-based financial assistance.

● Filing an insurance claim in Vermont

● Vermont State Health Insurance Program - A local service that provides enrollment advice and assistance for Medicare beneficiaries

● Medicare Rights Center - A service that can provide assistance with questions and issues related to Medicare. Includes a website and call center.

Vermont Health Reform Legislation

Vermont's proactive approach to health care reform means there's a lot of health insurance-related legislation in the state. Scroll to the end of this page for a summary of recent Vermont invoices.