Having health coverage helps us stay healthy. Understanding how health insurance works and what is covered helps you get the most from your plan. There are different types of health insurance. The type of plan that works for you depends on many factors, including:
- Size of your tax household
- Where you live
- Benefits from you employer
- Life events
Health Insurance in Vermont
Vermont Health Connect (VHC) is Vermont’s health insurance marketplace. It was created after the Affordable Care Act in 2010. Vermont Health Connect offers qualified health plans to all Vermonters, and offers financial help for people who qualify. Vermonters who qualify can also get Medicaid for Children and Adults, including Dr. Dynasaur.
Vermonter who earn too much money to get financial help often sign up for health insurance directly with a health insurance company.
Qualified Health Plans
What is a qualified health plan, or QHP? A QHP is an insurance plan certified by Vermont Health Connect. It provides essential health benefits, follow limits on cost-sharing (like deductibles, copayments, and maximum out-of-pocket amounts). All QHPs meet the Affordable Care Act requirement for having health coverage, known as "minimum essential coverage."
Eligible Vermonters enrolled in a qualified health plan through VHC can get financial help. Financial help can be for premium tax credits and enhanced silver plans with cost-sharing reductions
If things in your life change, report these changes to VHC. Changes can be your income or the household size. These changes can affect your financial help or you could be eligible for financial help for the first time.
Before you compare plans, here is some information to consider:
- All health plans offered on the marketplace cover the ten essential health benefits.
- Your total costs for health care. This is for your health insurance bill and for your out-of-pocket costs. You pay a monthly bill for health insurance, even if you don't use medical services. You pay out-of-pocket costs, including a deductible, when you get care. Think about both kids of costs when looking at plans.
- The "metal" categories. Metal levels show how much you pay and how much your insurance pays, It has nothing to do with the quality of care.
- The three stages of a qualified health plan.
Want to compare plans and prices now? The Plan Comparison Tool shows plans available to you.
Medicaid and Dr. Dynasaur
Vermont Health Connect also manages Medicaid for Children and Adults (MCA) which includes:
- Medicaid for Adults
- Dr. Dynasaur for Children
- Dr. Dynasaur for Pregnant Women
Other Medicaid programs in Vermont, such as Medicaid for the Aged, Blind and Disabled (MABD), are administered by Green Mountain Care.
Medicaid programs may have cost-sharing, such as co-pays when you go to the doctor. Some have monthly premiums you pay.
The Medicaid programs work differently than qualified health plans:
- Eligible Vermonters can enroll in Medicaid at any time of year.
- Vermont Health Connect checks your eligibility for Medicaid every 12 months. If you can no longer be on Medicaid, you may get a Special Enrollment Period to enroll in a qualified health plan.
- You can apply for coverage that starts up to three months before the month when you applied for Medicaid.
- If you earn too much money to qualify for Medicaid, you could become eligible through a process called a “spenddown”. Learn more about Medicaid spenddowns here.