Even if you work for a large employer, you may want to verify that your company's health plan meets the government’s definition of being adequate and affordable (see below). If it fails to meet one of these guidelines, you may be eligible to get insurance through Vermont Health Connect and qualify for financial help to pay for your monthly health premiums as well as your out-of-pocket costs.
In addition, if your situation changes in the future and you are no longer offered insurance by your employer, you can return to VermontHealthConnect.gov to select a plan that is right for you and apply for financial help.
In order for your employer-sponsored insurance to be considered “adequate,” it must cover at least 60% of the cost of medical expenses on average. In insurance terms, this is referred to as having an Actuarial Value (or AV) of 60%. To determine whether you have an offer of adequate coverage, ask your employer to fill out the Employer Coverage Tool (If necessary, your employer can also use a calculator from CMS (xls) to figure out whether the coverage you are offered meets minimum value standards).
If your employer-sponsored plan has an AV that is less than 60%, then you can visit VermontHealthConnect.gov or call toll-free 1-855-899-9600 to select a plan that is right for you and access financial help to pay for it.
According to the federal definition, a health plan is deemed unaffordable if your portion of the premium for single (self-only) coverage is more than 9.66% of your household income. To determine whether you have an offer of affordable coverage, see Vermont Health Connect's Affordability Calculator.
The lowest cost single premium available to the employee is used when making this calculation. The employer’s contribution is then deducted to determine what you would have to pay for this plan. If your portion is more than 9.66% of your household income, then your plan is deemed unaffordable. If you do not have an affordable offer of coverage, then you can visit VermontHealthConnect.gov or call toll-free 1-855-899-9600 to select a plan that is right for you and access financial help to pay for it.
Using Vermont Health Connect
Even if the coverage you are offered through work is adequate and affordable, you can choose to get health insurance on your own through Vermont Health Connect. However, it’s good to know that if you do, you won’t be eligible for any financial help.