Health Insurance Basics

Table of Contents

Protect Your Health and Your Wallet | Stay Well with Preventive Care | Get the Most from Your Plan | Find Programs to Help You Stay Healthy | We're Here to Help

Learn how health insurance can work for you and get familiar with insurance lingo.  Download a PDF of "HEALTH INSURANCE: Why It’s Important & What You Need to Know."


No one plans to get sick or hurt, but most people need to see a doctor or get a prescription filled at some point. Health insurance not only protects your physical health, but also provides important financial protection to help you pay for care.

Worry Less: Protect Your Health & Your Wallet

Unexpected health costs can add up if you don’t protect yourself. Having health insurance gives you peace of mind because you know you are prepared for an unexpected health issue or accident.

If you don’t have health insurance:

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Be Healthy & Stay Well

Health insurance coverage can help you stay healthy by covering preventive health services like flu shots, routine check-ups, and blood pressure screenings—and with insurance through Vermont Health Connect, many of these services are free! Having health insurance can also help you avoid health issues before they become major problems.

All insurance plans offer the same essential health benefits, so you know the essentials are covered. In addition to free preventive services, some of these benefits include:

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How Health Insurance Works

Getting health coverage is just the first step to staying healthy. Understanding how health insurance works—and what services are covered — can help you get the most from your plan.

Some Vermonters qualify for public health insurance programs that are free. Other plans—both public and private—require you to pay a monthly premium to help cover the cost of your insurance.

Most people with private health insurance have to pay a deductible, and either a co-pay, or co-insurance each time they visit a health care provider.

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Most health insurance plans provide you with a network of doctors and other health care providers. If you see a doctor in your network, the insurance company will pay for their share of the cost.

If you see a doctor outside of your network and it isn’t an emergency, you usually have to pay most (or all) of the cost yourself. Click here for links to your insurance carrier’s Provider Networks.

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For Vermonters with Medicaid, most services, other than emergency services, are only covered in Vermont. Other plans may cover medical services when you travel.

Visit our Glossary of Terms for more words or phrases that you’re likely to hear when you’re shopping for a health care plan.

Vermont’s Health Insurance Marketplace

Vermont Health Connect is for you if you fit into one of these categories:

  • You do not get health insurance through your job
  • You are a college or university student
  • You are a sole proprietor of a business and purchase health insurance on your own

For those who qualify, the Vermont Health Connect marketplace is the only place to enroll in Dr. Dynasaur and Medicaid (based on income). The marketplace is also the only place to get financial help to lower the cost of private health insurance plans.

Vermont Health Connect is probably NOT for you if you are eligible for Medicare or military benefits (such as TRICARE), you have disability health benefits, or if you are offered another type of insurance that meets minimum essential coverage standards.

Not Sure If You Can Get Covered?

Even if Open Enrollment has ended, you may still be able to get coverage if you qualify for a Special Enrollment Period. Click to learn more about qualifying events . Give us a call—toll-free—at 1-855-899-9600 or meet with an in-person Assister near you. If it turns out that you qualify for coverage, we can help you compare plans and choose the one that best meets your needs and budget.

Other Programs to Help You Stay Healthy

You may also qualify for other programs that help Vermonters stay healthy.


Helps individuals and families stretch their food budgets so they can put three healthy meals on their tables every day.

Essential Person Program

Helps older and disabled Vermonters stay in their own homes by contributing to the cost of having someone live with them and provide essential care.

Ladies First

A health screening program for eligible Vermont women. Ladies First removes financial barriers that prevent many women from being screened for breast and cervical cancer and heart disease and can help pay for out of pocket expenses related to diagnostic testing. Ladies First also pays for Weight Watchers.  


Provides the tools and support to help Vermonters quit smoking.

Click here for more information and a complete list of programs.

Having Insurance Saves You Money

When you add up the benefits (like free screenings, immunizations, and other preventive services), health insurance is a smart investment.

And now there’s help to make it more affordable. In fact, most Vermonters qualify for financial help to lower the cost of their health plan—and thousands of people will have absolutely no upfront costs!Find out how much financial help is available to you Most americans who do not have health insurance will have to pay a shared responsibility fee when they file their federal taxes.

We’re Here to Help!

Still have questions? Call our toll-free hotline at 1-855-899-9600 or get in-person help from a Vermont Health Connect Assister in your area. We are here to help you understand your options and find the plan that’s right for you!