Vermont’s largest commercial health insurer wants to offer a new suite of cheaper plans, but the state’s primary healthcare regulator is casting doubt on whether that would actually yield any real savings.
When expanded federal subsidies for people buying health insurance ended at the end of 2025, the number of Vermonters receiving that assistance dropped by more than 9,000. The number of people buying any insurance at all on Vermont’s marketplace fell by more than 2,000, too.
Since, BlueCross BlueShield of Vermont has looked for ways to offer less expensive plans.
“We went hunting,” Andrew Garland, BCBS’s vice president of client relations and external affairs, told the Green Mountain Care Board in a May 6 hearing outlining a new suite of lower-premium, higher-deductible healthcare plans the insurer is hoping to offer Vermonters next year.
But the insurer first needs the care board’s approval — and that might be a big ask.
The Green Mountain Care Board has postponed its decision on the plans to August, which BlueCross BlueShield says jeopardizes its ability to prepare the plans. Without earlier approval, BlueCross “would likely strongly consider” pulling the option altogether, Kristina Massari, a spokesperson for the insurer, told VTDigger.
Some on the care board question whether the plans offer genuine savings or merely shift costs to the detriment of Vermonters — trading lower premiums for higher out-of-pocket bills and more limited access to care.
BlueCross estimates that premiums on the proposed plans, called Vermont Basic, would be somewhere between 5-9% lower than the current cheapest plans on Vermont Health Connect.
But, the deductible for the Basic plans would be markedly higher. For a bronze Basic plan, the deductible could be $11,800, according to BlueCross. By comparison, the deductible for a bronze version of BlueCross’s existing cheapest plan on the marketplace is $9,000.
BlueCross knows that the high-deductible Basic plans are not for everyone, Garland said. The plans are not meant to replace the existing Vermont Select, Vermont Preferred or standard plans, which BlueCross intends to continue offering on the marketplace.
“These plans were offered simply to put more affordable options on the market right now,” Garland told the care board last month. “We know that consumers in the marketplaces are really struggling with (the) price of healthcare.”
This higher deductible is responsible for most of the savings behind the lower premiums, Garland said.
In addition, the Basic plans have a narrower network. They would only cover care from providers in Vermont and contiguous New York, Massachusetts and New Hampshire counties, including Dartmouth Hitchcock Medical Center. Emergency care would still be covered in out-of-state settings, but any other specialty care beyond the local network would be subject to prior authorization, Garland said.
BlueCross BlueShield currently waives the deductible for certain “wellness” drugs that manage conditions like high blood pressure and asthma, which it would no longer do for the Basic plans.
Before an insurance plan hits the marketplace, it needs to clear a trio of approvals and certification from the Vermont Department of Financial Regulation, the Green Mountain Care Board and finally the Department of Vermont Health Access, which manages the healthcare marketplace.
In the May 6 meeting, the care board voted to defer its approval of the Vermont Basic proposal to August, contingent on whether BlueCross can meet a series of demands, including providing more information about the standards it would use to grant out-of-network coverage and a clear messaging campaign about the Basic plans’ prices and network restrictions.
Most significantly, the care board wants to see proof that narrowing the network can yield premiums at least 3% lower than those of existing plans.
But, BlueCross says that the care board’s asks reach beyond the regulator’s statutory obligations and leave the insurer “between a rock and a hard place,” according to a May 18 letter they sent the care board. Without approval by June 19, the insurer wrote, they may withdraw the plan from consideration.
The care board approves both what new marketplace plans cover and how much they cost Vermonters, which happens every summer. BlueCross maintains that those should be separate processes.
The deliberation gets at the heart of the fine balancing act between healthcare affordability and access.
“This particular approach offers an illusion of affordability,” Thom Walsh, a member of the five-person board, said last month.
He worried about the tendency for people with high deductibles to forgo care despite having insurance. The result, he said, could be less preventative care and more costly emergency care down the line.
And yet, other board members maintained that for some people — young and healthy and short on cash, say — the Basic plans could be a solid option in an expensive market.
“It’s about whether or not we support choice in the market. For many people it might make sense,” said Dr. David Murman, another member of the care board, during its May meeting. “I think this is the best we can do with what we have. There is good to adding more options.”
