Vermont took its first step toward publicly funded, single-payer health insurance in May 2011, when Gov. Peter Shumlin signed Act 48. The bill created Green Mountain Care, which by 2017 is intended to the sole health insurance coverage option for all Vermonters.
The bill was prompted by the federal Patient Protection and Affordable Care Act signed into law by President Barack Obama in 2010. That bill, designed, among other things, to remove obstacles to insurance coverage for many Americans (for example, the lack of coverage for pre-existing conditions) required that each state participate in a federal health care exchange or create its own version. Vermont chose the latter and on Oct. 1, Vermont Health Connect was launched to serve individuals and those employed by companies with 50 or fewer employees.
At its most basic level, Vermont Health Connect is a state-run, Web-based marketplace where Vermonters can compare and buy health insurance plans.
Vermont Health Connect is the state’s response to the federal Affordable Care Act, or Obamacare, which requires states to have online health insurance markets. Vermont is the only state in the nation that has made participation in the exchange mandatory. All individuals and all businesses with 50 or fewer workers must buy into the state’s exchange. The law, Act 171, will affect about 100,000 Vermont residents.
Businesses with more than 50 employees can purchase plans outside of Vermont Health Connect. In 2016, all businesses with 100 or fewer employees will be required to buy health insurance on the Vermont Health Exchange.
The exchange is not to be confused with Gov. Peter Shumlin’s proposal for a single-payer, publicly financed health care system, which would be administered by one insurer. Vermont Health Connect offers plans through two competing insurers: MVP Health Care and Blue Cross Blue Shield of Vermont.
Vermont Health Connect opened to the public at healthconnect.vermont.gov on Oct. 1, and from the beginning, the market has been hampered by technical glitches and delays. More than a month after Vermont Health Connect officially began accepting customers, the site’s payment mechanism for purchasing insurance is not yet ready.
Earlier this month, the Shumlin administration developed a contingency plan to ensure that Vermonters don’t lose health care coverage as a result of the logistical problems with the exchange system.
Even without the technical issues associated with the exchange website, Vermont Health Connect presents Vermonters with a range of tough decisions, and shifting policies have muddied an already complicated landscape.
VTDigger has created this user’s guide to help Vermonters learn more about the market, employer and employee obligations, navigators, the state’s contingency plan, the range of subsidies available, information about changes for Medicaid, Dr. Dynasaur, Catamount and VHAP beneficiaries, tax implications and penalties for individuals and businesses.
How to use this guide
Employer Explainer: Companies with 50 or fewer employees must decide whether to offer health insurance to their workers through Vermont Health Connect or send those employees to the state’s online marketplace as individuals.
Employees: First, find out what your employer intends to do. There are tax benefits if your employer offers you insurance through the exchange, and there are subsidies available to offset the cost of your premiums if the employer doesn’t.
Contingency Plan Options: Technical problems that accompanied the rollout of the state’s new health insurance market led officials to allow insurers to extend their current plans through March 31.
Subsidy Explainer: In its effort to encourage everyone to buy health insurance, the government is offering subsidies to help offset the cost of premiums. This assistance is based on family size and household income.
Penalties and Taxes: To go along with the carrot of subsidizing health insurance premiums for many Americans, the law also contains the stick of penalties for those who refuse coverage.
Medicaid: A change in the calculation used to determine eligibility and the elimination of the Catamount and VHAP insurance programs, mean thousands more people may qualify for Medicaid benefits.
Premiums in context: The state has the fifth-highest premium rates in the country among health care exchanges.
Finding a navigator: Use this map to find assistance in your area.
What insurers will participate and what plans are available?
Blue Cross Blue Shield of Vermont and MVP Health Care are the only two health insurers selling plans on the market.
Each insurer will offer nine plans: six standard plans created by the state and three choice plans created by each insurer. The 18 plans cover the same benefits, but range in coverage levels, from bronze plans, with low premiums and high out-of-pocket liability, to platinum plans, with high premiums and greater coverage.
How do I enroll?
There are three main ways to enroll in new plans. The first is to use the state’s website for the market, which is healthconnect.vermont.gov.
The second option is to call one of two hotlines to ask questions and enroll.
Individuals can call 855-899-9600, and employers and their employees can call the small business line at 855-499-9800.
Businesses can enroll in new plans directly through Blue Cross and MVP.
What resources are available to help me understand my options?
The state has spent $2 million on more than 200 “navigators” who can provide free one-on-one assistance to Vermonters and businesses that need help understanding the new market. Insurance brokers can also help residents and businesses choose plans. Brokers can also charge a fixed-cost rate of $20 per person, per month for their services.
On Jan. 1, a Vermont law will make it illegal for health insurance companies in Vermont to bake broker fees into their premiums.
How much does Vermont Health Connect cost?
The exact dollar amount is a moving target. The federal government has given the state roughly $170 million for the state’s exchange.
In 2015, the administration estimates the market will cost the state $18.4 million a year to operate and maintain.
An independent review of the state’s upcoming health information technology projects estimates that they will cost the state $427.5 million over five years. The estimated cost for the market portion is $224 million.
Why is the state creating its own market?
Vermont is one of 17 states, along with the District of Columbia, that is creating its own market. The state wanted its own subsidy programs so that it could design the plans for the market and manage consumer assistance and maintain other controls.