Green Mountain Care Board releases insurance plans for exchange, shoots down dental proposal

The Green Mountain Care Board on Tuesday shot down a proposal to require adult dental coverage on the Vermont health benefits exchange and approved six insurance plans, which will lay the foundation for the future health insurance market.

But this new marketplace carries caveats. The board is concerned that two of the six plans will leave Vermont’s low-income residents with high health care costs in times of greatest need.

“It is going to be a rugged undertaking if you have a bronze plan and you get sick,” said board member Al Gobeille. “I don’t want that sugarcoated. Everybody should know what is going on.”

As stipulated in the Affordable Care Act, Vermont’s exchange is slated to go into effect on Jan. 1, 2014. When it does, low-income health insurance programs like the Vermont Health Access Program and Catamount Health will cease to exist. As Lindsey Tucker, deputy commissioner of the Health Benefit Exchange put it, low-income Vermonters will either qualify for Medicaid or they will enter the exchange.

The two Bronze plans Gobeille referred to fall at the bottom of the state insurance hierarchy. Patients on these plans would pay the highest copays and receive the lowest coverage. Annual out-of-pocket expenses, which don’t include premiums, would tap out at $6,250 for medical services and $1,250 for pharmaceuticals. That amount is termed the “out-of-pocket maximum,” or OOPM, and according to Tucker is double for families, regardless of size.

Above those bronze plans are two silver plans, a gold plan and a platinum plan, which present patients with lower maximums and better coverage. State officials expect that plans with better coverage will have higher premiums. (See the chart above for a plan-by-plan comparison.)

The premiums for each of these plans, however, won’t be determined until the summer of 2013, when insurance companies submit their proposals to the Green Mountain Care Board, which is responsible for approving them. Premiums will fluctuate in price between individual and family plans, said Tucker.

According to the Green Mountain Care Board’s calculations, roughly 80,000 Vermonters will purchase health insurance via the exchange. That number represents those Vermonters who purchase insurance individually or are part of a small business with 50 or fewer employees.

In addition to this set of state-constructed plans, insurance companies will be able to propose several “choice plans” that are created within state guidelines. Those plans will be released at a later date.

Anya Rader Wallack, chair of the Green Mountain Care Board, doesn’t think the health benefits exchange will reduce the cost of health care for Vermonters.

“I think this particular decision has very little to do with restraining health care costs,” she said. “I think other activities we’re working on will do that, but this is just about how you structure insurance coverage in the market. It’s not about changing the health care system fundamentally.”

When asked about the bronze plans, she said that they are worrisome.

“I think all of us (on the board) have expressed some concern about the cost-sharing exposure at those levels,” she said. “If you’re someone who has extraordinary medical expenses, you can be insured and still have to pay for a lot of those expenses out of your own pocket.”

Wallack said that the Shumlin administration pressured the Legislature to draw up legislation preventing bronze plans. But business interests triumphed.

“Representatives of the business community argued that they wanted them to be available,” she said. “And they ended up prevailing in the Legislature and (the state is) keeping the bronze plans as part of the Vermont scheme.”

No adult dental benefits

In spite of 1,500 written comments calling on the Green Mountain Care Board to make adult dental benefits an essential health benefit on the exchange, the board decided in a 3-2 vote not to. Voting to make adult dental coverage an essential health benefit would have included dental coverage in all health insurance plans sold on the marketplace.

This split marked the first time the board did not unanimously agree on an issue. Con Hogan and Karen Hein were the two board members in support of providing dental benefits, while the other three members — Wallack, Gobeille and Allan Ramsay — did not. Dental and vision benefits for children are, however, essential health benefits.

Although all of the board members agreed that adult dental health is a crucial element of overall health care, the prevailing opinion was that they didn’t have enough information to determine what level of dental care was appropriate to put in adult plans on the exchange. Depending on the level of care, said Ramsay, this proposition could cost the state anywhere from $17 million to $87 million.

“I don’t think there’s anyone else on the board who has seen … the effect of dental care on a person’s quality of life more than me,” said Ramsay, who is a primary care physician. “I also saw the (positive) effect of opening a dental clinic at the community health center in Burlington when I was on the board. … That being said, I believe that when we reform and improve the health care system, we do so in a series of steps.”

“To make that system of exchange … work well I just can’t reconcile how we can add an additional financial burden to (Vermonters) at this point, at this step, in the process we’re trying to achieve. As painful as that is for me, I just can’t reconcile that issue.”

At the end of the meeting, Gobeille proposed that the board hire a professional to analyze current access to dental care, how it is financed and how it is organized. All board members supported this notion, and by Nov. 15, board director Georgia Maheras is tasked with drawing up a project outline.

Donna Sutton Fay, policy director of the Vermont Campaign for Health Care Security Education Fund, said she was glad the board plans to study the issue but wishes they would have spent more time analyzing funding.

“I’m really happy to hear that the board gets how important dental care is,” she said. “But I’m really disappointed that there was no discussion about funding. … One place funding could come from is the sugar-sweetened beverage tax.”

The soda tax floated by state officials in previous years was estimated to generate roughly $27 million for the state.

Clarification: Dental benefits can be included in health care plans and as stand alone plans on Vermont’s exchange. Adult dental benefits, however, are not essential benefits.

Andrew Stein

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32 Comments on "Green Mountain Care Board releases insurance plans for exchange, shoots down dental proposal"


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Anna Carey MD
4 years 3 months ago
The financial burden of adding dental care to the Health Care exchange is real because the exchange is only a MASQUERADE of insurance companies to keep profiting from selling some very lousy health care plans (i.e., the Bronze plan), not reducing the costs of care. And yet, Karen Hein MD and Con Hogan, the two members of the Green Mountain Care Board who do champion dental health are to be applauded. Dental health, just like mental and ‘physical’ health provides essential and life-saving means for nutrition, growth, sustenance and last but not least toothy delightful smiles. Alternative revenues such as… Read more »
Craig Powers
4 years 3 months ago

Your insistence that the bronze plans are lousy is an incorrect statement. They are excellent plans for some people to keep costs down. They are not “lousy” plans for everyone.

Paula Schramm
4 years 3 months ago

Bronze plans are certainly “excellent” if you can’t afford any other option.

Jesus Ortiz
4 years 3 months ago
With all due respect, when did we become so blind to reality that we think a health insurance plan that only covers 50% of an individual’s costs (or 90% for that matter) is ever ok? One bad accident or chronic health problem will bankrupt most people “covered” under any one of these plans. Try to imagine a $500,000 hospital bill and then try to imagine coming up with $50,000 (%10 of the total) or, for that matter, $250,000 (50%) in out-of-pocket costs. Healthcare is a human right and no one should face financial ruin just from getting sick. Second, if… Read more »
William Koch
4 years 3 months ago
Jesse, you misunderstand how these plans are structured. Yes, there is a lower co-pay for certain categories of service, but the out-of pocket costs are capped. The catastrophic medical event (cancer, organ transplant, severe trauma, etc.) would require $7,500 annually from the subscriber, with the rest of the costs covered by the insurer. Most insurance plans work this way now. Please remember that many individuals have HSA’s and Flex Plan monies available to help cover out-of-pocket expenses, and many businesses and employee groups have endorsed the combination of higher deductible, lower premium plans that are supplemented with these co-pay tools.… Read more »
Paula Schramm
4 years 3 months ago
In response to William Koch – I appreciate your effort to clearly define “rights” in jurisprudence, a helpful clarification. On the other hand we speak, ( famously in our Declaration of Independence), of having certain unalienable rights, including life, liberty and the pursuit of happiness, and of forming a government that “promotes the general welfare”. FDR was pushing an “Economic Bill of Rights” which talked about people’s rights to food, shelter, health, and work adequate to live in dignity. ( If only he had lived a bit longer ! ) If we constrain our concepts of “rights” to your description,… Read more »
walter carpenter
4 years 3 months ago

If you want pay for insurance and not be able to use it in case you get sick or not mind paying the first $6,000 and change out of your own pocket then the bronze might just the plan. High deductibles are great for the insurance company because, while one pays the premiums, they cannot use the insurance without fear of medical debt.

William Koch
4 years 3 months ago
Walt, I have had a high deductible plan for many years, and I love it. Not everyone is broke, and some individuals choose to self-insure for the first few thousand because they have resources to do so. Health care utilization rises dramatically when there is no buy-in from the consumer, and these “bronze” plans suit certain individuals. Universal access to medical insurance is a great thing; providing limited or no choices in those plans is not. Insurance is meant to be a hedge against catastrophe, not a guarantee that every event– whether it be a fender-bender, a lightning strike to… Read more »
Paula Schramm
4 years 3 months ago
“Health care utilization rises dramatically when there is no buy-in from the consumer”…. William Koch-you explain why the bronze plan suits you : you have the resources to pay the deductible, and I’m guessing, you feel healthy enough that it seems like a sensible gamble. But the flip side of your phrase above is that for those who have the high-deductible insurance,( not because they are “broke” as you put it, but because they are working but can’t afford anything better ), their health care utilization drops dramatically. Why ? Because they can’t afford to get the care they need,… Read more »
rosemarie jackowski
4 years 3 months ago

Dr.Carey…Thank you. The exclusion of dental care will have disastrous consequences. How about instead to save money we fire those 3 members of the GMCB, fire the insurance companies,and cap the salaries of hospital CEOs. There is not a shortage of money – just a shortage of politicians willing to spend it in the right way.

Many others pretend that Vermont is heading toward Single Payer. That will never happen until the insurance companies are out of VT.

In the meantime, can I trade my obstetrical care for dental care. I’m 75 years old.

cate bell
3 years 11 months ago

you are so right

Ann Raynolds
4 years 3 months ago

And it is true that healthy people can pay a penalty and have no insurance. Important always to state that creating these Exchanges is NOT the Single Payer Healthcare System which the GMCB is still tasked to design and present. Within THAT system, free of administrative profit-making by the Insurance companies, we will defnitely have to include a dental plan. I thank the supporters of dental care, am one of them and say: We won’t go away.

Robert Roper
4 years 3 months ago

But, if the cost of the dental plan causes the total cost of healthcare in Vermont to exceed what it is today, then the governor promises he will “take his marbles and go home,” and scrap single payer entirely. No? This, at least according to Shumlin, is primarily about cost control.

Ethan Parke
4 years 3 months ago
Thank you to Con Hogan and Karen Hein for their principled dissent. Although the Exchange is only supposed to mirror the current insurance marketplace, the process of deciding what will be offered in the Exchange presented an opportunity for the Board to suggest a creative approach for adult dental care–which some employers now offer, and others do not. That the Board ran out of time, or chose to be cautious, is understandable, but unfortunate. I agree with Ann Raynolds that the next forum for a discussion on dental benefits will be in the single payer benefits and financing debate. Carry… Read more »
Lester French
4 years 3 months ago

Insurance is a shell game where many pay into a pool to provide support for the fewer number who need it. Administrative expenses and profits are taken off the top. Dental insurance would better be served by individual medical accounts paid into pre-tax than by paying an insurance company to administer the program. Preventive care is normally covered by insurance at an additional cost to the consumer. This cost would be avoided by a medical accounts program.

Bruce Post
4 years 3 months ago
I appreciate all the work the Board has put into this, and it will be interesting to see what the price structure will be. As my wife and I have studied Medicare (I’m 65 today!), it is has been eye-opening to recognize that, just as in the exchanges, individuals essentially will have to do their own medical underwriting or risk analysis. In the exchange, someone can get a bronze plan, with its relative lower costs, and do just fine. This is similar to paying for Medicare Part B, the medical program apart from Part A, the hospital program. Medicare recipients… Read more »
Kristin Sohlstrom
4 years 3 months ago

Be very, very careful about buying into the argument that the exchange is a soft and fuzzy portal through which to buy health insurance. Remember that other types of sites that are being used for comparison such as are sites you enter of your own free market will. That’s not going to happen with the health exchanges.

Eric Davis
4 years 3 months ago
Are the Green Mountain Care Board’s responsibilities policy-making, regulatory, administrative, or a combination of all three? It seems to me that the decision about whether or not to include adult dental health services in the exchange verges close to policy-making and is different in kind from the GMCB’s decision to ask some hospitals to resubmit their budgets because the original proposals were too high in comparison to the guidelines established by the Legislature. In the case of the hospital budgets, the Legislature established policy and charged the GMCB with regulating its implementation. The Legislature did make certain policy decisions about… Read more »
Paula Schramm
4 years 3 months ago

Eric Davis, in answer to your question, here is an official summary of what the GMC Board has to do :

Vermont’s Health Reform law, Act 48, charges The Green Mountain Care Board (GMCB) with controlling the rate of growth in health care costs and improving the health of Vermonters. The GMCB approves hospital budgets, major health care capital investments, health insurer rates increases, all-payer rates for all providers, and minimum health benefit requirements. The Board encourages Vermonters seeking to share their views to visit the GMCB website ( or to call (802) 828-2177.

Jay Davis
4 years 3 months ago
These plans seem to me on surface out rageous. All western countries have a single payer HC system. Our neighbor north, Canada has such a system/ The crying and outrageous issue here is profits and Insurance companies as well as heath care provider excess treatments and out right frauds. We all should get basic healthcare as the Canadians do for no out of pocket payments. The whole concept is just making the day one year more, the system fails entirely. Younger people generally, outside, of some chronic illness just don’t need a full coverage, unless some medical emergency takes place.… Read more »
John Greenberg
4 years 3 months ago
I’m not sure that I’m understanding the chart correctly. The top line show maximum out-of-pocket expenditures, but then other lines show less than 100% coverage. So if a patient has a $30,000 procedure in the hospital, for example, how much does he or she pay under each plan? Does the 50-90% coverage shown kick out and become 100% after the “out-of-pocket maximum” in each case, or is the patient left with a substantial bill to pay? I’m guessing that these are all zero deductible plans: that is, with the variables shown in the chart, they begin paying at the first… Read more »
William Koch
4 years 3 months ago
John, These plans appear to mimic what is currently available in the marketplace today. All of them have some form of deductible, but there are differences in deductible depending on what service is rendered. As an example, there is a greater co-pay for name brand vs. generic drugs. That said, there are aggregate annual maximums that limit out-of-pocket costs. The plans attempt to combine smart consumer spending with cost sharing, as dollar-one, 100% coverage plans are ridiculously expensive and do not discourage wasteful patient choices (e.g., if it costs the same, many patients would always opt for the name-brand drug,… Read more »
4 years 3 months ago

What are the implications of healthcare reform on dental care?

Len Vignola
4 years 3 months ago

My wife & I have been on Medicare A & B, VT Blue 65 (medicare supplement) & Blue Medicare RX for years and are very pleased with the coverage and costs. I have one question that no one has been able to answer; Can we continue to maintain these plans ?

Dave Bellini
4 years 3 months ago
Excluding dental care is just a preview of coming attractions. All the altruistic song and dance of the past few years is fading away and AFTER THE ELECTIONS a new reality will become clear: This isn’t going to be as wonderful as advertised. Vermonters will still struggle to have medical care needs met, like dental. Will the new plans cover hearing aids, eye glasses, orthodontics, durable medical goods, etc? What happens when the economy tanks again? If we’re going to have a socialist takeover, let’s at least do it all the way and cover what is needed. BAD, AMORAL, DECISION… Read more »
Christopher French
4 years 3 months ago

i think it’s really sad to not include dental for adults. at a minimum, 2 cleanings a year could help many people. i’m fortunate to have both dental and health through my partner. but i know many people won’t even be able to afford this.

Anita Kelman
4 years 3 months ago
Both VHAP and Catamount are excellent insurance programs. I wonder why the new Exchange Plans are not more closely modeled on these, especially as Medicaid dollars help support VHAP at present, and would I gather also do so in the future after the Exchange takes effect. I also wonder why teeth are not considered part of the body for medical purposes? Given that it is well known that the health of the gums and teeth play major roles in overall health, let alone the ability of people to eat a healthy diet, just what do we save by leaving out… Read more »
Jim Barrett
4 years 3 months ago

It is always nice to have plans with no costs published by the very person who is pushing this farce….Shumlin! Just a note: the state doesn’t p[ay for my healthcare, I do. So when Shumlin claims the STATE is paying 5 billion a year now he is full of it………many take the responsibility of paying for their own insurance and I don’t rely on handouts from Shumlin!

Paula Schramm
4 years 3 months ago

Jim Barrett – my understanding from what Shumlin et. al. say, is that we all are now paying 5 billion a year for health care in this state…..counting the way that everyone pays for their health care, whether as part of a state program, or through a private plan. Does that make more sense to you ?

walter carpenter
4 years 3 months ago

“is that we all are now paying 5 billion a year for health care in this state…..counting the way that everyone pays for their health care,”

Paula, yep. It is $5 billion for the whole tab — public, private, public-private, and rising by a million or so a day. I am curious to know what insurance Jim is on if he pays for it by himself, since so few can, and the ones I know who are paying for it by themselves are getting crushed by it.

Lisa McCormick
4 years 3 months ago
This does not look like great coverage to me, especially for the folks who choose the bronze plan. I will assume such folks are probably the working poor who don’t qualify for Medicaid. They’re out of pocket max is over $6,000; their family max is over $12,000. Would the $1,250 Rx max be in addition to that? Considering that many poor people have chronic health conditions and need monthly prescriptions, they may have to shell out a big portion of their monthly income before the $5 copays kick in. I’m curious to see what the premiums will look like. Most… Read more »
4 years 3 months ago

Why cannot we have, as part of our plan, a form of cafeteria plan~~i.e. not have obstetrical (I am 78) and replace with dental? It seems to me that if we could have some choices within a plan, this would be far more acceptable to more folks…..

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