What if my employer offers coverage, but I can’t afford it?
My employer doesn’t offer health coverage. Can I get a plan through Vermont Health Connect?
I lost my job and was offered COBRA. Do I have to take COBRA?
Can I drop my COBRA plan and get coverage through Vermont Health Connect instead?
I’m eligible for Medicaid. Do I have to take my employer’s health coverage?
What if my employer offers coverage, but I can’t afford it?
During an enrollment period, any eligible Vermonter can enroll in a qualified health plan through Vermont Health Connect. Eligible Vermonters can also get financial help paying for their coverage. However, Vermonters who have an offer of insurance through a job can’t get financial help unless they can prove that coverage is not adequate, or not affordable.
To prove your employer’s plan is not adequate, you must find out if it meets the federal government’s minimum value standard. The easiest way to do this is to ask your employer to fill out the Employer Coverage Tool.
To prove your employer’s plan is not affordable, you must find out the cost of your share of the payment as a percentage of your household income. You can use our affordability worksheet or the new online tool to find out if your employer’s plan meets federal government affordability standards.
If you can prove your employer’s coverage is either not adequate, or not affordable, you may be eligible to get financial help when you enroll in a qualified health plan through Vermont Health Connect.
My employer doesn’t offer health coverage. Can I get a plan through Vermont Health Connect?
Yes! If your employer does not offer health coverage you can get health insurance through Vermont Health Connect during an enrollment period. Eligible Vermonters can also get financial help paying for their Vermont Health Connect plan.
To sign up for a qualified health plan, you must have an enrollment period:
- Open Enrollment is the time when any eligible Vermonter can sign up for coverage through Vermont Health Connect. Vermonters who already have coverage can change plans during Open Enrollment. Open enrollment usually starts November 1 every year.
- Outside of Open Enrollment, you can’t sign up for a qualified health plan unless you have a major life event. When this happens, you can get a 60-day Special Enrollment Period to sign up for a health plan.
- Vermonters who are eligible for Medicaid can enroll in Medicaid at any time.
I lost my job and was offered COBRA. Do I have to take COBRA?
No, you do not have to take COBRA. If you lose your health insurance, you will get a 60-day Special Enrollment Period to sign up for a qualified health plan through Vermont Health Connect. Eligible Vermonters can also get financial help paying for their coverage.
Most employers must allow you to continue your health insurance for 18 months after your job ends. This coverage is called COBRA. If you take COBRA coverage, you may have to pay up to 102% of the cost of your employer’s health plan. Before you take COBRA, you can compare costs with Vermont Health Connect plans to make sure you’re making the best choice for your budget.
If you enroll in COBRA coverage, you won’t be able to enroll in a Vermont Health Connect plan until the next Open Enrollment period, which typically starts in November every year. Most of the time, if you decide to end your COBRA coverage before it expires at the end of 18 months, you won’t get a Special Enrollment Period to get a Vermont Health Connect qualified health plan.
If you’re trying to decide if you want to take COBRA coverage, Vermont Health Connect’s Plan Comparison Tool can help. This tool will give you an estimate of the financial help you could get from Vermont Health Connect. It will also show you the costs and coverage for each plan you can buy. This can help you decide whether COBRA is your most affordable health insurance option.
Can I drop my COBRA plan and get coverage through Vermont Health Connect instead?
Most of the time, if you decide to drop your COBRA plan before it expires at the end of 18 months, you won’t get a Special Enrollment Period to enroll in Vermont Health Connect coverage. However, if you have been getting financial help through your employer or a government subsidy to help pay for COBRA coverage, and this help stops, OR if you have another major life event, you may also be eligible for a Special Enrollment Period. You can enroll in Vermont Health Connect coverage during Open Enrollment which generally starts on November 1 every year.
When COBRA coverage expires after 18 months, you will be eligible for a 60-day Special Enrollment Period when you can enroll in a Vermont Health Connect plan.
Vermonters who are eligible for Medicaid can enroll in Medicaid at any time.
I’m eligible for Medicaid. Do I have to take my employer’s health coverage?
No. If you’re eligible for Medicaid, you don’t have to take your employer’s coverage. You can have Medicaid and your employer’s coverage if you want both.
My employer offers a Health Reimbursement Arrangement (HRA). Can I use the HRA to pay for a health plan through VHC?
It depends. If your HRA is affordable, you must enroll in a full price plan without advance premium tax credits (APTC) and use your HRA to help pay for the cost.
If your HRA is not affordable and you qualify for advance premium tax credits, you can enroll and use the tax credits to help pay your monthly premium, but you must opt out of the HRA. You cannot have an HRA and get financial help from Vermont Health Connect.
To find out if your 2024 HRA is affordable, use our 2024 HRA Affordability Worksheet. You can enroll in a plan during Open Enrollment. If you are offered a new HRA, you may qualify for a Special Enrollment Period at that time.