What if my employer offers coverage, but I can’t afford it?

Under Vermont Health Connect, employer-sponsored health coverage is considered “unaffordable” if the employee's share of the premium of Single (self-only) coverage for the least expensive plan the employer offers is more than 9.56% of household income (for 2018). If your coverage meets this definition of "unaffordable"; you may be eligible to find an alternative plan through Vermont Health Connect that works better for your budget.  The coverage your employer offers must also meet minimum value standards, meaning it covers at least 60% of your medical costs. Employers can check to see if the coverage they offer meets the minimum value standard by using the federal government's Minimum Value Calculator.


My employer does not offer health insurance. Can I get health coverage through Vermont Health Connect?

Yes! If your employer does not offer health coverage, you will be able to get health insurance through Vermont Health Connect. You can use Vermont Health Connect to compare plans and select the one that fits your needs and budget. On the Vermont Health Connect website, you can find out if you are eligible for Medicaid or financial assistance to help you pay for private plans.


If I voluntarily drop my COBRA after open enrollment, will I qualify for a special enrollment period and be eligible for subsidies?

No. If you have COBRA coverage and wish to enroll in a Vermont Health Connect plan, your options are to either A) drop your COBRA coverage during an open enrollment period ,or B) wait for it to expire.

During open enrollment, you can voluntarily drop COBRA and get a Vermont Health Connect plan instead, even if your COBRA hasn't expired. You may also be determined eligible for financial help in the form of Advanced Premium Tax Credits (APTC) and cost-sharing reductions (CSR).

Outside of open enrollment, if your COBRA expires, you would qualify for a special enrollment period and may be eligible for financial help. 


I am eligible for Medicaid; do I have to take my employer’s insurance coverage?
No, if you are eligible for Medicaid, you do not have to take your employer’s insurance. Alternatively, if you want to have both Medicaid and your employer's coverage, you can do so.


What income should I enter into the application?  What will tax subsidies be based on?  

Under the Affordable Care Act, eligibility for financial help to get health insurance is calculated using a household’s Modified Adjusted Gross Income (MAGI). It's important to note, however, that you don't need to calculate your MAGI yourself.  The application will ask you about various types of income and then calculate your MAGI for you.

Your household's MAGI will determine whether you are eligible for Medicaid, Advanced Premium Tax Credits (APTC), and/or cost-sharing reductions (CSR).

If you qualify for APTC, your tax credits will ultimately be based on your full income for the coverage year. You can choose, however, to take some or all of this payment in advance to offset the monthly cost of your health insurance premium.  Because you may not know your future income, you will be asked to report your current income.  You'll also be asked if you expect that to change over the course of the year. If your income does change, you should call Vermont Health Connect to report the change as soon as possible. When you file your taxes in the following year, the IRS will reconcile what you received as APTC with what you actually are eligible for.  If you under or over reported your income, you would end up owing taxes or receiving a credit for the difference (read more here).


If a business does not offer health insurance and its employees buy health plans through Vermont Health Connect on their own, can the business still contribute to an HSA?

Yes. Both Blue Cross Blue Shield of VT (BCBSVT) and MVP Health Care offer high deductible health plans (HDHP) through Vermont Health Connect that may be paired with HSAs. The BCBSVT HDHPs, also known as consumer-directed health plans (CDHP), have "integrated HSAs" with a company called Health Equity (read more here). For more details on HSAs, FSAs, and HRAs, please visit Vermont Health Connect's Tax-Favored Accounts Fact Sheet.