You might be able to change to a qualified health plan, even if you have job-based coverage now. However, if the job-based health plan is considered adequate or affordable, you won't qualify for financial help through Vermont Health Connect (VHC).
Here's how to find out. You need two pieces of information about your employer's health plan:
- Is the plan adequate? Does it meet the federal minimum value standard? Your employer can give you this information.
- Is the plan affordable? Affordability is how much of your income is needed to pay for the lowest cost plan. This is measured as a percentage. As long as the job-based plan is considered affordable you can't get financial help. If you would pay more, then you may be able to get financial help.
How do I calculate affordability of the job-based plan?
Ask your employer to fill out the Employer Coverage Tool for the plan year you’re looking for. Then use this information to fil out the online Affordable Employer Coverage Tool. This tool tells you if your job-based plan is affordable. Check out a list of affordability rates by year. You can find out if your employer's coverage is affordable under federal standards. The federal affordability standard changes each year.
If you prefer, you can also mail the completed Employer Coverage Tool with your application for health coverage, and we can figure out your plan's affordability for you.
Affordability for family plans
Starting with 2023 plans, families may qualify for new savings even if they weren't eligible before. There are two measures for employer plan affordability.
- For the employee, this uses your share of the lowest cost employee-only plan.
- For eligible family members, this uses your share of the lowest cost plan that covers all family members who have an offer of coverage.
You can apply for financial help paying for a Vermont Health Connect plan IF your plan is not affordable. EITHER with a Special Enrollment if you are transferring your job-based insurance OR during your next enrollment period.
Tips to help you decide
- Important! First, make the calculation with the online affordability estimator. The employee-only plan may be affordable, BUT the family plan may not be affordable. If this occurs, family members may be eligible for subsidies, even if the employee isn't.
- Consider these steps when deciding between job-based or VHC coverage.
- VHC uses Modified Adjusted Gross Income (MAGI) to determine your eligibility for health programs and possible financial savings.
- If your employer is offering coverage through Vermont Health Connect, you must use the cost of the lower cost bronze plan available to a single person.