Vermont Health Insurance Consumer Guide

To be eligible to enroll in private health coverage through Vermont Health Connect, you must:

• Be a resident of Vermont and lawfully residing in the United States
• Not be incarcerated
• Not be enrolled in Medicare

So most people in Vermont are eligible to enroll in a health plan through Vermont Health Connect. But there are some additional parameters must be met in order to qualify for state and federal subsidies through Vermont Health Connect. 

To qualify for income-based federal Advance Premium Tax Credits (APTC), federal cost-sharing reductions (CSR), or Vermont’s state-funded financial assistance you must:

• Not have access to an affordable plan offered by an employer. If you are eligible to sign up for an employer’s plan and aren’t sure whether it’s considered affordable, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies via beWellnm. 
• Not be eligible for Vermont Medicaid or Dr. Dynasaur coverage.
• If you receive premium subsidies, you must file a tax return for the year the coverage is in effect (must be a joint return if married).⁸ 

In addition to those basic parameters, Vermont Health Connect premium subsidy eligibility will depend on your household’s income and how it compares with the premium for the second-lowest-cost Silver plan in your area (unlike most states, premiums do not vary by age or location within the state of Vermont). 

The open enrollment period in Vermont begins November 1 and continues through January 15.⁹ 

Enrollments must be completed by December 15 in order to have coverage effective January 1. Enrollments completed between December 16 and January 15 will have a February 1 effective date.¹⁰

Outside of the annual open enrollment period, you may still be able to enroll or make a plan change if you experience a qualifying life event, such as giving birth or losing other health coverage. 

Some people can enroll year-round even without a specific qualifying life event. This includes the low-income special enrollment period, which is available to Vermont applicants with household income up to 200% of the poverty level.¹¹ (The household income cutoff for this SEP is 150% in most states.) 

Enrollment in Vermont Medicaid and Dr. Dynasaur is available year-round for eligible applicants.

To enroll in an ACA Marketplace/exchange plan in Vermont, you can: 

• Visit Vermont Health Connect – the state’s health insurance exchange/Marketplace – to compare the health plans that are available in your area, determine whether you’re eligible for financial assistance, and enroll in coverage during open enrollment or during a special enrollment period. You can reach Vermont Health Connect’s call center at 855-899-9600. 
• Enroll in a Vermont Health Connect plan with the help of an insurance agent or broker, or a certified enrollment assister.¹²
  

You may find that you’re eligible for financial assistance through Vermont Health Connect, which can make your coverage and medical care more affordable. And the assistance may be more robust than it is in many other states, as both federal and state subsidy programs are available in Vermont.

The Affordable Care Act (ACA) created federal premium subsidies (advance premium tax credits, or APTC), which are available depending on your income. Nearly nine out of ten Vermont Health Connect enrollees were receiving APTC as of early 2023. These subsidies covered an average of $620/month, reducing the average enrollee’s premium to about $175/month.¹³

Vermont also offers state-funded premium subsidies for applicants with household income up to 300% of the federal poverty level. The additional subsidies stack on top of the federal APTC, and reduce (by 1.5 percentage points) the percentage of income that applicants have to pay to purchase the second-lowest-cost Silver plan.¹⁴

Federal cost-sharing reductions (CSR) are available to applicants with household income up to 250% of the poverty level, and Vermont offers additional cost-sharing reductions to bring eligibility for this program up to 300% of the poverty level in Vermont.¹⁵

Cost-sharing reductions reduce the deductible and other out-of-pocket expenses for Silver-level plans. More than a quarter of Vermont Health Connect enrollees were receiving CSR benefits as of 2023.¹³

Depending on your income and circumstances, you may be able to enroll in free or low cost health coverage through Vermont Medicaid or Dr. Dynasaur. Learn more about whether you might be eligible for these programs in Vermont.

Source: CMS.gov¹⁶

Two insurance companies offer 2023 health plans through Vermont Health Connect:

• Blue Cross Blue Shield of Vermont
• MVP

The following table highlights Vermont’s Marketplace insurers’ approved rate changes for 2024 individual/family health plans. (Note that in both cases, the approved rate increase is a little smaller than the insurer had initially proposed).¹⁷ 

Source: HealthCare.gov¹⁷

It’s important to note that average rate changes apply to full-price premiums, and most enrollees do not pay full price. Eighty-eight percent of Vermont Health Connect enrollees were receiving federal premium subsidies in 2023.¹³

During the open enrollment period for 2023 coverage, 25,664 people selected private plans through Vermont Health Connect.¹³

Source: 2014,¹⁸ 2015,¹⁹ 2016,²⁰ 2017,²¹ 2018,²² 2019,²³ 2020,²⁴ 2021,²⁵ 2022,²⁶ 2023,²⁷ 2024²⁸

Vermont Health Connect
The state-run health insurance Marketplace/exchange. Individuals and families use the Marketplace to obtain health coverage, with financial assistance based on income. Vermont Health Connect can also be used to enroll in Medicaid and Dr. Dynasaur.

Vermont Insurance Division
Consumer assistance with insurance questions and complaints.

Green Mountain Care Board
An independent five-member board, created by Vermont’s 2011 health care reform legislation and tasked with improving health care transparency, advancing innovation in health care payment and delivery, and regulating various aspects of health care in the state. The Green Mountain Care Board is also responsible for reviewing and approving health insurance rates.

Vermont State Health Insurance Program
A local service that provides enrollment counseling and assistance for Medicare beneficiaries.

Vermont Medicaid and Dr. Dynasaur
Health coverage for low-income Vermont residents.