How to Sign Up for ACA Health Insurance in Vermont

Posted on 10/21/22 by Emily Paulin, Natalie Missakian

En español | Many Vermonters are eligible to buy health insurance through Vermont Health Connect, the state’s Affordable Care Act (ACA) marketplace, during open enrollment, which runs from Nov. 1, 2022, through Jan. 15, 2023. 
 
Residents who experience a qualifying life event, such as a marriage, divorce, the birth of a child, a move or lost health insurance, may be eligible to buy or change coverage outside the open enrollment period.

Most people already enrolled in ACA marketplace plans have seen their premiums go down because the 2021 American Rescue Plan Act (ARPA) increased tax credits for insurance premiums and expanded the number of households who qualify for them. Every household that pays more than 8.5 percent of their household income now qualifies for federal tax credits to help them afford health insurance. These enhanced subsidies are now available through 2025. 

Prior to the 2021 law, such tax credits were only available to people earning less than a certain salary ($54,360 for one person). Most Americans with a marketplace plan can save an average of about $800 per year, according to the federal government.

To buy health insurance through Vermont Health Connect, you must:

  • Live in the U.S. and have a primary residence in Vermont.
  • Be a U.S. citizen or national, or a noncitizen who is lawfully present in the U.S.
  • Not be incarcerated.

You may also qualify for Green Mountain Care, the state’s Medicaid program, which offers free or low-cost coverage to low-income families and individuals.

  • During open enrollment, which begins on Nov. 1, 2022, and runs through Jan. 15, 2023.
  • You can enroll outside of open enrollment if you experience a qualifying life event, such as the loss of employer-sponsored health insurance, the birth of a child, a divorce or a marriage, or a move to Vermont. You generally have only 60 days from that event to enroll. 
  • Year-round enrollment is open to those who qualify for Green Mountain Care. 
  • You may also qualify for a special enrollment period and sign up year-round if your household income is no more than 200 percent of the federal poverty level ($25,760 for one person or $34,840 for a couple).

You apply for coverage and choose your plan at the same time. Once you’re approved for a plan, you’ll need to pay your first monthly premium for your coverage to begin. You can pay online, via phone or ask to receive a bill in the mail, which should arrive in one to three weeks.
To apply and enroll: 

  • By phone: Call Vermont Health Connect’s call center at 855-899-9600 between 8 a.m. and 4.30 p.m., Monday through Friday.
  • In person: Use the Assister Directory to find the right type of in-person assistance you need. “Navigators” and “certified application counselors” can help you choose a health insurance plan at no cost to you. Licensed “brokers” help small businesses and individuals choose a health insurance plan but usually charge a fee.    
  • By mail: Download and print an application form, then mail the completed application to Vermont Health Connect, 280 State Drive, Waterbury, VT 05671-8100. Note that paper applications may take longer to process.

Coverage and cost depend on where you live, the type of plan you choose, your estimated household income, and the age and disability status of you and your family. If you qualify for Green Mountain Care, you will be able to get free or low-cost coverage and may not face premiums or copays, depending on your income level. 

All Vermont Health Connect plans cover 10 “essential” benefits, including: 

  • Emergency services and hospitalization 
  • Pregnancy, maternity and newborn care 
  • Mental health services (including counseling) 
  • Chronic disease management and pediatric care 
  • Prescription drugs 

Insurance companies cannot deny coverage because of preexisting conditions. When you apply, you can identify your medical needs and choose a plan that makes financial sense for you and your family. 

Most Vermont Health Connect plans cover basic dental services for those under age 21. But adults who want dental coverage must add it to their policy. Deductibles and out-of-pocket costs vary between plans; enrolling in a family plan may cut costs.

Every eligible household that pays insurance premiums that exceed 8.5 percent of annual income qualifies for federal tax credits for insurance premiums through 2025. According to Megan O’Reilly, AARP vice president of government affairs for health and family, subsidy recipients ages 50 to 64 have already seen average annual savings of over $950. 

Yes. If you qualify for a premium tax credit, you may also qualify for a cost-sharing reduction that would help you pay for such out-of-pocket expenses as deductibles and copays. You must enroll in a Silver-level plan to get this assistance. 

Vermont Health Connect plans are organized into five categories: 

  • Bronze plans have the lowest monthly premiums, the highest deductibles and copays, and cover roughly 60 percent of care costs. They’re designed to help you in case of serious illness or injury. 
  • Silver plans have moderate monthly premiums, deductibles and copays. They cover between 70 and 94 percent of care costs, depending on whether you qualify for a basic plan or an Enhanced Silver plan for lower-income households. They’re the only plans eligible for cost-sharing subsidies. 
  • Gold plans have higher monthly premiums, lower deductibles and copays, and cover roughly 80 percent of care costs. 
  • Platinum plans have the highest monthly premiums, the lowest deductibles and copays, and cover roughly 90 percent of care costs. These are for people who have significant health care needs and are willing to pay the highest premiums. 
  • Catastrophic plans have low premiums but minimal coverage. They are available only to those under 30 unless the applicants can prove they are eligible for a hardship exemption. People enrolled in these plans are not eligible for financial assistance.

Vermont Health Connect’s Plan Comparison Tool helps you estimate and compare costs and benefits of plans. It also gives you an estimate of your eligibility for financial assistance.  

If you already have coverage through your employer, you can switch to a marketplace plan, but you probably won’t qualify for the federal financial help unless you can prove your employer’s insurance is inadequate or unaffordable. In 2022, premiums would need to be more than 9.12 percent of your household income for individual coverage to be unaffordable. 

If you already have a marketplace plan but want to change plans to take advantage of the financial assistance, you’ll need to wait until open enrollment to do so unless you experience a qualifying life event or qualify for Vermont's income-based special enrollment period.
 
If you already have coverage directly with Blue Cross and Blue Shield of Vermont or MVP Health Care but want to move your plan into the marketplace in order to receive the  financial assistance, you can do so at any time. Any payment you’ve already made toward your deductible and out-of-pocket limits will transfer with you. 

Visit Vermont Health Connect's American Rescue Plan Act FAQs for a full breakdown of what different categories of Vermonters can do.

Probably not, if you stay with the same insurance provider. Blue Cross and Blue Shield of Vermont offers the same network of providers across its tiers of coverage and for both its on- and off-marketplace plans. MVP Health Care — the only other insurer in Vermont offering marketplace plans — does the same.

If you are looking to swap insurers, talk to your doctor or use the Plan Comparison Tool to see whether they will accept your plan. 

It depends. You can enroll as a family. In certain cases, however, some family members may also be eligible for subsidies or other programs, depending on age, income and disability, or caregiver status. Members of “mixed households,” in which family members are on different plans, may be able to see the same doctor or go to the same medical practice, as long as the provider is in both insurance networks, which is common in Vermont.

This guide was updated on Oct. 21, 2022 with new information about a special enrollment period for people with lower incomes. 

This story is provided by AARP Vermont. Visit the AARP Vermont page for more news, events, and programs affecting retirement, health care, and more.

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