Vermont has some of the lowest rates of uninsured residents in the entire country – but that doesn’t mean it’s okay for anyone to go without. If you’re struggling to figure out how to cover your health care needs in Vermont, then you’ve come to the right place. We can help you choose between a major medical plan from the Vermont Health Connect state exchange, a health share plan, fixed indemnity plans, and more. And if you still have questions by the time you’re done reading this, We encourage you to reach out and contact us for more info.
Major Medical Insurance in Vermont
The Patient Protection and Affordable Care Act was passed back in 2010, but Vermont has been passing laws and regulations to help people get qualifying coverage since many years before its inception. That’s part of the reason why Vermont has some of the highest rates of insured residents in the country. Vermont is unique in that it has its own state-run health exchange where you apply for your coverage as opposed to going to the federal Exchange and applying for coverage through HealthCare.gov.
When you are ready to enroll during Open Enrollment (which starts on November 1st), you as a Vermont resident will go to Vermont Health Connect instead of HealthCare.gov. The site has many helpful informational videos, blog posts, and tools you can use to figure out which insurance plan will save you the most money on your health care needs. Enrollment for 2020 plans ended on December 15th of 2019, but you may be eligible for a special enrollment period if you have a significant life change to report, such as the birth of a child or a move, for example.
The insurance sold on the Vermont state exchange is what’s known as a guaranteed issue. Guaranteed issue insurance has been popular in Vermont for many years now, even before the passage of the ACA. But if you’re unfamiliar with the term, it means that you cannot be rejected for coverage nor can you be charged more for your monthly premiums based on pre-existing conditions. The only factors that can really influence how high or low your monthly premiums are, include the following four factors:
- Your age
- Your location
- Your use of tobacco products
- Whether you are applying for an individual policy or a family policy
Something that might be newer for health insurance consumers, however, are the 10 guaranteed Essential Health Benefits that every major medical policy on the Vermont exchange offers. Without all of these benefits, health experts agree that it would be harder for individuals and families to get the preventative care they need in order to keep their health care costs minimal over the long term:
- Ambulatory/outpatient services
- Emergency services
- maternity/newborn care
- Mental health and substance abuse
- Prescription drugs
- hab/rehab services and devices
- Lab tests
- Preventive and wellness services and chronic disease management
- Pediatrics (including oral and vision)
The truth is that it does cost health insurance companies a little bit more to offer all of these benefits along with guaranteed issue health insurance. But that’s where federal and state subsidies come in. Vermont has some slightly different rules, but in general, as long as you make at least 138% of the federal poverty limit, you can qualify for some sort of financial aid in order to lower your monthly premiums. But this is based on a combination of your total income and your household size. Go ahead and take a look at the chart below to see whether you fall above or below this poverty limit.
|Household Size||Annual Income (138% of FPL)|
Since Vermont was an early adopter of the Medicaid expansion program, which was part and parcel of the ACA legislation, anyone making less than 138% of the federal poverty limit might want to think about applying for Medicaid. You can do so through the Vermont Health Connect website, and you can also visit this page for more information on Medicaid in Vermont. Vermont has fewer qualifications than most other states, and qualifying for the program is largely based on income.
Short Term Health Insurance in Vermont
Technically, short-term health insurance is not illegal in Vermont. But it is closely regulated by the state government to the point where plan durations are only allowed for a maximum of three months. Because of this, unfortunately, there aren’t any health insurance companies who are willing to provide short-term health insurance in the state.
Short-term health insurance is similar to major medical coverage, but with some important differences. Most of the time, these Insurance products require medical underwriting and are the opposite of guaranteed issue. This means you could be rejected for coverage or charged astronomically high monthly premiums if you have a pre-existing condition. They typically pay out a smaller total percentage of your medical costs, and they usually have maximum limits (called “caps”) on both your annual and lifetime medical benefits. But if you don’t qualify for a subsidy or Medicaid in Vermont, they could potentially cost around 33% less per month than major medical coverage through the Exchange. However, until short-term health insurance companies start offering their services in Vermont again, it can be difficult to know whether or not such a plan would benefit you.
Christian Health Plans/Health Share Plans in Vermont
Recent legislative changes have removed the individual mandate on the federal level – in response to this, Vermont legislators have passed new legislation on the state level that will bring back the individual mandate for Vermont residents starting in tax year 2020. This means you will have a grace period on your 2019 taxes where you won’t have to pay a federal penalty for not having insurance – but if you don’t act quickly and get qualifying major medical coverage soon, It may cost you big on next year’s taxes. Or you could sign up for a Christian health plan in order to receive a religious exemption to the individual mandate.
But you should be aware of the fact that there are several major differences between a health share plan and qualifying major medical coverage. The only real reason these plans give you an exemption to the individual mandate is because of the religious, nonprofit status of your health share plan provider. In reality, here’s where Christian health plans fall short at meeting the ACA establish mandates that private insurance companies have to follow in order to be available for sale in Vermont:
- These plans are NOT guaranteed issue
- They will likely have unlimited out-of-pocket costs
- Almost all plans come with lifetime and annual benefit caps
- These plans do not include all of the guaranteed Essential Health Benefits
Still, these plans could be of significant value – the price you pay for monthly premiums could be as much as 33% less than an unsubsidized Vermont Health Connect plan – and you won’t have to pay an annual tax penalty for having insufficient coverage. But there are a few things you should know before you run out to sign up for one of these plans. The lingo is a little bit different, and requires you to pay a “monthly share amount” instead of a monthly premium as well as an “unshared amount” or a “personal responsibility amount” in the place of co-pays, deductibles, and coinsurance). Because these plans are offered by religious organizations, the government cannot get involved and you cannot take them to court if you find yourself in an intractable dispute with your plan provider. You may also need to pledge to follow certain participation guidelines like attending church more frequently at a specific location, declaring a specific faith, or immediately stopping all tobacco use (among other things) in order to stay in good standing with your plan provider. These health plans can get a little complicated if you aren’t careful, but if you are a person of faith and if a health share plan is a better financial deal for you, then it could benefit you to take a look at what is available in your area.
Fixed Indemnity Plans in Vermont
Fixed indemnity plans are lower on this list up health care options because they offer significantly less coverage compared to the options we’ve already discussed. Whereas major medical plans will pay out a fixed percentage of your total medical costs, fixed indemnity plans will pay out a fixed amount per claim of your medical costs. So if you go to the doctor and it costs you $300, major medical insurance may payout 80% per claim whereas a fixed indemnity plan might only pay out $80 per claim. These claims are paid out on a per day, per week, per month, per incident, or per event basis.
There are some good things about fixed indemnity plans that make them worth considering. For one, they aren’t limited to specific medical networks. They make a great form of supplemental insurance if you have a particularly restrictive HMO or PPO network associated with your major medical coverage. This allows you to get out-of-network care for at the very least a discounted price. But fixed indemnity plans come with all the pitfalls of most other insurance products outside of the Health Insurance Marketplace – including fewer benefits, caps on your lifetime and annual benefits, medical underwriting, and the like. But if you have a lot of out-of-pocket costs with your current form of coverage, supplementing with a fixed indemnity plan could end up saving you money in the long run.
Discount Cards in Vermont
Another great way to supplement your medical costs is with a medical discount card in Vermont. But be careful when you’re shopping around, because not all card providers are created equal. There are free options you can consider like GoodRx or the Vermont Rx Card which are free of charge and can help you save money on your prescriptions. There may also be medical discount cards in your area that can connect you to pharmacies, doctors, dentists, and more for discounted medical products and services. All you have to do is pay a membership fee, receive your card in the mail, and use it whenever you get medical care or purchase medical products. You get a discount right there at the register and you don’t have to worry about filing claims or getting reimbursed.
But do keep in mind that medical discount cards are not insurance, and they are far from an adequate replacement for insurance. They’re also not very closely regulated, so it’s easy to run across a scam. Just make sure you avoid companies that are trying to advertise their medical discount card as a replacement for major medical insurance (because it’s not). Also, you might want to look into the discounts they promised and the providers they promised you can get these discounts from. It’s not unheard of for companies to exaggerate these claims in order to attract business. But if you find a reputable provider who’s willing to offer you more savings and discounts than you pay for your membership fee, these cards can help reduce your out-of-pocket costs and save you money on your medical expenses.