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Vermont Health Insurance

Vermont Medical Insurance Overview

As one of the healthiest states in the country, Vermont is already in good shape in terms of overall health.  The portion of the population of Vermont that lacks health insurance is quite low, and the state is ranked number one in a number of health care factors.  However, there are still some Vermont residents lacking health insurance, and even a state as healthy as Vermont could show some improvements after initiatives of the Patient Protection and Affordable Care Act are implemented.

The Affordable Care Act was passed in 2010, and its various provisions are set to go into effect, gradually, through 2020.  The Act will hopefully make health insurance more accessible to Americans across the country.  A lack of health insurance in the general population is a significant problem in the United States, and as of 2011, 16% of the entire population lacked insurance.  Current efforts at health care reform are intended to improve health care and increase health insurance availability in Vermont and in every state.

Vermont’s Health Care Issues
Vermont came in first place in a 2012 comparison of overall health in all 50 states by the United Health Foundation, but has since dropped to second place as of 2014.  Vermont exhibits much strength in health care and has few weaknesses.  However, there are a small number of areas in which Vermont’s health situation lags slightly behind. The state of Vermont consistently ranks high in comparison with the other states on a consistent basis.

Below are some of the main health strengths and weaknesses of the state of Vermont:

Low percentage of uninsured population
Low violent crime rate
Low infant mortality rate
Large disparity in health status by education level
High prevalence of excessive drinking
High incidence of pertussis

Understanding Vermont’s Uninsured Population
The Henry J. Kaiser Family Foundation reveals that 6% of people are not covered under insurance in the state of Vermont as of 2014.  This translates to 35,600 people in the state overall and it is quite a significant figure, despite the state’s positive health status.

The uninsured rate has seen a drop from 8% in the year 2013.  This means that even though Vermont is a relatively healthy state, there are people who reside there without insurance coverage.

The information below is comprised of statistics regarding Vermont’s uninsured population:

  • No children under 18 are without insurance coverage
  • 8% of people aged 19 to 64 are without insurance
  • 5% of the total uninsured population earns over 400% of the Federal Poverty Level

Group Health Plans
As in all states, group health plans are the most widely recognized type of health insurance in the state of Vermont. In Vermont, 52% of the populace appreciates health benefits through an employer-supported plan.  The best source of information on group insurance for an employed person is the HR office of his or her organization.  While employer-supported health insurance programs for the most part include premiums that plan members must pay, these premiums are significantly lower than other plan types because of the level of employer contribution.

In the state of Vermont, the Department of Banking, Insurance, Securities and Health Care Administration oversees and regulates the activities of health insurance providers.

Signing Up
Through an open enrollment period, you should be able to sign up for medical benefits under your employer’s group plan.  If your company does not offer such coverage, you may wish to check with a local trade union to determine if similar coverage is available.  The person in charge of Human Resources at your company should be able to advise you on enrollment periods and whether or not the employer offers benefits to their workers.

Before joining an employer-sponsored group plan, consider the following items of interest:
Cost: Is the group plan an affordable option for you?  If not, you may need to look elsewhere for coverage.
Coverage: Does the plan offer a good deal of coverage for services?  You need to ensure coverage is available if you fall ill in the future.
Dependents: Do you have a spouse or children that need to be enrolled?  Consider the costs associated with covering an entire family along with your ability to obtain a group plan that covers dependents.

Pre-Existing Condition Exclusion Periods 
If you have a pre-existing condition in Vermont, you cannot be turned down for insurance under a group benefits plan.  However, you may have to sit through an exclusionary period of time in this situation.  For Vermont, the exclusionary period cannot last longer than a year and does not apply to dependents under age 19.  During an exclusion period, you are not required to pay premiums and coverage is not available.

Also applicable to group plan participants is a look back period of six months for insurance providers to determine whether or not you have a pre-existing medical condition.

Affiliation or Waiting Periods 
Waiting periods apply to everyone enrolling in a group benefits plan and are usually limited to two months.  However, for late enrollees, waiting periods may extend to a period of three months before you can use your coverage.

If an exclusion period is applied to your policy, you will not have to wait through the waiting period in addition to the exclusion period – as these will both run simultaneously.

Individual Health Plans 
If you need individual insurance coverage in Vermont because of self-employment or employment through a company that doesn’t offer group benefits, you will run into issues.  Insurance coverage of this type is so expensive that it makes residents of this state think twice before making a policy purchase.  The Foundation for Health Coverage Education has revealed that a healthy young person in Vermont can receive insurance benefits under an individual policy for nearly $300 every month.

Individual policies do offer comprehensive benefits to participants and an upside is that these plans are not subject to medical underwriting.  For anyone purchasing an individual policy in the state of Vermont, you may be subject to exclusionary and look back periods of up to twelve months.  In Vermont, seven percent of the population enjoys health insurance using individual insurance contracts.

Continuation Coverage 
Under the terms of the Consolidated Omnibus Budget Reconciliation Act (COBRA), people who have lost insurance benefits can obtain continuation coverage for a period of 18 months following the termination of the person’s previous group health insurance plan.  A drawback to obtaining COBRA coverage is that the employee must pay the portion that was previously paid by the company that originally offered the group plan.  To qualify, the company that offered the plan’s benefits must employ over 20 workers.

Vermont Health Benefit Marketplace 
In 2010, the state of Vermont received a federal grant of $1 million to research the creation and implementation of a statewide benefits exchange.  Later, Vermont received another grant for $44 million that was part of an Early Innovator Grant to develop exchange technology for use in a state-based benefits marketplace.

To comply with the requirements placed on the state under the Affordable Care Act, the state established its marketplace called the Vermont Health Connect.  Using this website, residents of the state of Vermont can access their coverage options, compare plans and buy an affordable policy during its open enrollment periods.

The benefits exchange is part of the Department of Vermont Health Access and is monitored by the Green Mountain Care Board.  The Dept. of Vermont Health Access has a wealth of information on the benefits exchange as well as the Henry J. Kaiser Family Foundation’s website.

Vermont State Insurance Programs 
In the state of Vermont, publicly funded programs offer insurance coverage to individuals and families that earn low incomes.  Qualifications for any of these programs are varied and based on factors such as age, gender, income and health condition.

Among the programs offered are the Pre-Existing Condition Insurance Plan, Medicaid, the Vermont Health Access Plan, Dr. Dynasaur, WIC, Ladies First, the Catamount Health and Catamount Health with Premium Assistance Program, Medicare, the State Health Insurance Assistance Program, the Health Coverage Tax Credit, the VA Medical Benefits Package, the Partnership for Prescription Assistance and the NAMI Helpline.

Information on these programs is provided below:

Pre-Existing Condition Insurance Plan (PCIP) 
PCIP exists to give coverage choices to individuals who are prevented from otherwise securing coverage because of a pre-existing condition. PCIP in Vermont covers services like primary and specialty care, hospital care services and prescription drugs.  Costs for participation can range between $148 and $635 every month.

For low income earners in Vermont, the Medicaid program offers many services.  As long as income guidelines are met, participants can enjoy doctors’ visits, hospital care, dental care, vision care, prescription medications and more.  Co-payments for participation are typically free, but may require a certain contribution based on your income.

Vermont Health Access Plan (VHAP) 
This program covers prescription drugs, visits for specialist’s care, mental health costs and hospital care services to those who qualify.  Income is a determining factor and can cause your monthly premiums to vary between free and under $50.

Dr. Dynasaur 
Children who are part of low income households and pregnant women who are in need of medical insurance can utilize services provided by Dr. Dynasaur as long as income requirements are met.  If you are pregnant and earn below 200 percent of the federal poverty line, you can apply for coverage.  Children under the age of 19 are also covered if they are part of a household whose income is under 300 percent of the federal poverty level.

Women- Infants-Children (WIC) 
This program is managed by the USDA Food and Nutrition Service and endeavors to create healthy living situations for all of its participants.  The program offers pregnant women and new mothers informational guidance and support on the subject of breastfeeding.  It also covers low cost supplemental food items for participants to enjoy.

Ladies First 
Women can get screened for various cancers under the Ladies First Program.  Income guidelines require the applicant to earn an annual salary that is under 250 percent of the federal poverty level.  Certain restrictions may be applied and there are no fees to be paid toward premiums.

Catamount Health and Catamount Health with Premium Assistance (CHAP) 
CHAP covers uninsured adults who don’t qualify for VHAP and haven’t had insurance for a period of a year’s time.  Other eligibility requirements may apply and participants may have to pay premiums between $453 and $512 every month.

Medicare and the Medicare Prescription Drug Program
Medicare and the Medicare Prescription Drug Program provides the disabled and seniors with health insurance benefits.  Medicare is comprised of parts –plans A, B, C, and D and members can receive adequate medical coverage to meet their medical needs.  Qualification is based on age, disability status, health condition and work history.  Persons suffering from renal disease can obtain guaranteed coverage, but a senior must be over the age of 65 and have worked in a job that was covered by Medicare for at least ten years.

State Health Insurance Assistance Program (SHIP)
SHIP offers counseling services to persons interested in coverage under the Medicare program.

Health Coverage Tax Credit 
Those affected by trade dislocation can receive this tax credit for services like inpatient and outpatient care, preventive medicines and prescription drugs.  Eligibility is based on whether or not you are receiving pension benefits or Trade Adjustment Assistance.

VA Medical Benefits Package 
For veterans who have served 24 continuous months in any branch of the armed services, the VA has put together a comprehensive benefits package.  Coverage is guaranteed only in the event that you have received an honorable discharge from the service.

Partnership for Prescription Assistance 
Consumers who are without insurance coverage for prescription drugs can utilize the free services from the Partnership for Prescription Assistance to get financial assistance for prescription costs.  The program connects you with 475 programs that can offer help.

The NAMI Helpline
The NAMI helpline was created to dispense quality information and resources to people dealing with the mentally ill and their family members.

The Health Insurance Portability and Accountability Act 
HIPAA laws that were put into effect in 1996 that factor in the ability of insurance companies to deny, delay or limit coverage to new policyholders, especially in cases involving employer-sponsored group plans.

If you are looking for health insurance coverage, you want to make yourself completely aware of how HIPAA affects you and your ability to obtain coverage through private insurance providers.