State officials are making a push to enroll eligible Vermonters that delayed signing up for health insurance through Vermont Health Connect before the end of open enrollment. And the online payment system is up and running just in time.
But for many low-income Vermonters formerly covered by state subsidized health plans, who did not qualify for Medicaid under the Affordable Care Act expansion, the ability to pay online and how easy it is to navigate the website may be irrelevant.
While premiums are cheaper in some cases and more expensive in others, the out-of-pocket costs for Vermonters enrolled VHAP or Catamount will increase if they choose to purchase coverage through Vermont Health Connect.
“Most people understand the need for coverage, but they’re just faced with the financial reality of what they can afford,” said Donna Sutton Fay, policy director for the Vermonter Campaign for Health Care Security education fund.
Fay’s organization provides direct outreach to low-income Vermonters, and she said many of the people they hear from say even the low-cost plans on the exchange are prohibitively expensive.
“It is mostly the out-of-pocket costs that people are concerned about, not the premiums,” Fay said. “The out-of-pocket costs are generally significantly higher, especially for people who were on VHAP.”
People on VHAP had no out-of-pocket limit and no deductible, and very low co-payments were the only out-of-pocket costs, while those on Catamount had an out-of-pocket maximum of $1,500 with a deductible of $500 for individuals. Those amounts were doubled for couples.
The out-of-pocket limit is the maximum amount someone could pay on top of a monthly premium. A deductible is the amount paid before insurance kicks in.
For silver plans, the lowest cost options available on the exchange, the out-of-pocket limits and the deductibles are higher than those for Catamount.
A person making between $23,000 and $29,000 annually the deductible is between $1,250 and $1,500 and their maximum out-of-pocket cost would range from $3,750 to $4,500 – or between 16 and 20 percent of their income – according to figures compiled by the Vermont Campaign for Health Care Security education fund.
That calculation does not include the $91 to $157 that person would pay in premiums.
For a family of four in the equivalent income range – between $47,000 and $60,000 – they could end up spending as much as 8 percent to 10 percent of their annual income on health care, again excluding the $188 to $321 they would need to pay in premiums.
Figures from the state show that several thousand additional low-income Vermonters qualify for Medicaid.
In December of last year there were 51,011 Vermonters on VHAP or Catamount. Nearly 66 percent, or 33,549, were automatically transitioned to Medicaid, according to figures from the Department of Vermont Health Access.
The remaining 17,642 were allowed to stay on VHAP and Catamount until April, when those programs will cease to exist.
In that time, 10,868 low-income Vermonters have applied for coverage through Vermont Health Connect and 3,406 discovered they were eligible for Medicaid, according to the latest figures available from the state, complied on Feb. 23.
But for the more than 6,000 who weren’t Medicaid eligible and for others who have yet to apply, even the subsidized coverage on Vermont Health Connect could be out of reach.
Because their current coverage disappears at the end of open enrollment, Vermonters on VHAP and Catamount have an additional 60 days to weigh their options after March 31, Fay said.
The state is trying to reach VHAP and Catamount patients who have not yet enrolled through direct mail, calls and emails.
VTDigger requested a copy of the template used for that direct outreach, but did not receive a copy prior to deadline.
After they make their first payment, there is a three-month grace period for Vermonters who qualified for subsidies to make their premium payments.
The premiums continue to accumulate during that period, but Fay said for people with a temporary cash-flow problem, the grace period could allow them to catch up.
A far greater concern is Vermonters who might be signing up for coverage they can’t afford, Fay said. Once they miss a payment and the grace period is done, they can be kicked off their insurance for the rest of the year.
VHAP and Catamount allowed Vermonters to cycle on-and-off those plans monthly. Often, if a person couldn’t afford their premium one month, they would get it back the next.
Many of the people counted as uninsured in Vermont are actually part of the churn on and off VHAP and Catamount, Fay said.
The ranks of the uninsured could swell because income insecure Vermonters, who may have trouble planning their budget from month to month, are having difficulty deciding now whether they’ll be able to afford their health care coverage for the rest of the year.
