Vermont Health Insurance: 2023 Coverage Guide

Vermont Affordable Healthcare Insurance

While the people in Vermont have several choices for health insurance plans it’s still important to compare rates carefully to make sure you’re getting the best value for the coverage you need. If you’re an individual or you’re buying coverage for a family, you can buy health insurance at the best prices available by comparing your options with SmartFinancial. Keep in mind that you may only enroll in a health plan during the open enrollment unless you are eligible for the Special Enrollment Period due to a qualifying event.

When Is Open Enrollment in Vermont?

November 1, 2022 – January 15, 2023

How to Get Health Insurance in Vermont

There are so many different types of plans and it can get confusing. The best way to start is to look at the previous year. Jot down how many times you saw your primary care doctor and how many times you saw a specialist. Consider how many prescription drugs you take too. All of these factors will determine which coverage will save you the most money. Sometimes, a higher premium plan will save you more in the long-run.

The smartest way to get the best rates for the coverage you need is to compare health insurance companies and health insurance quotes. You’ll get several health insurance rates, and we’ll connect you with a knowledgeable agent in your area so you can learn more about the plan you’re considering.

What Types of Health Insurance Are Available in Vermont?

Health Maintenance Organization (HMOs), Exclusive Provider Organizations (EPOs), Preferred Provider Organizations (PPOs) and Point of Service (POS) plans are available in Vermont. You can find health plans in all the metal tiers, bronze, silver, gold and platinum here but should consider all costs involved, including copays and coinsurance. Also important to note is how much of a deductible there is on the plan and whether or not you must pay all costs out-of-pocket until you reach that deductible (not true of HMOs).

Does Health Insurance Cover Pre-existing Conditions?

The Affordable Care Act made it illegal for marketplace health plans to deny anyone health insurance coverage based on pre-existing conditions.

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Do I Qualify for a Special Enrollment Period?

Common reasons people qualify for a special enrollment period:

• Lost or quit a job. Did you lose a job, change jobs or start your own business? You may qualify for the special enrollment period. If your new job does not offer health insurance, you qualify to buy health insurance outside the enrollment period.
• Turned 26. If you were on your parents’ health insurance plan but turned 26 after the enrollment period, you can enroll in an individual health plan.
• Moved out of state or out of the coverage area You may have had a health plan that was only valid in one state or region but you moved after the enrollment period. You can now sign up for a new health plan.
• Cobra coverage ended. If you extended your healthcare with Cobra and it expired, you can enroll in a new health plan.
• Divorce. If you shared coverage with your spouse but divorced, you can enroll in a new health plan outside the open enrollment period.
• Marriage. If you recently married, you may be able to get on your spouse’s policy or you can both start a new policy together.
• Birth or adoption of a child. If you had a baby outside the open enrollment date, you can still buy health insurance for that child.
• Death of spouse or partner. If you were covered under your spouse or partner’s health plan but that person passed away, you can take advantage of the special qualifying events exception to enroll in an individual plan.
• Spouse of partner loses coverage. If you previously had health insurance through a partner or spouse who lost his/her coverage for any qualifying reason, you are eligible to buy an individual plan or buy coverage with that spouse/partner again.

Is Health Insurance Required in Vermont?

No, only California, Massachusetts, New Jersey, Vermont, Rhode Island, and DC still require health insurance. Otherwise, there is a tax penalty. Even though it’s not required in every state, buying health insurance is necessary to avoid medical bankruptcy.

How Much Is Health Insurance in Vermont?

The average cost of health insurance in Vermont for a 40-year-old is about $554 a month. Health insurance is less expensive, the younger you are. Tobacco use increases health insurance rates.

How to Save on Health Insurance in Vermont

The best way to save on health insurance in Vermont is to compare rates based on the tier system. Beforehand, you’ll want to estimate your medical costs.

Medicare in Vermont

Medicare is health insurance coverage for Americans ages 65 years and older. The government also allows younger people with disabilities to enroll in the program. Individuals with End-Stage Renal Disease (a permanent kidney failure treated with dialysis or a transplant) can also sign up as can some individuals with severe mental health issues. Others who qualify for Medicare disability coverage are individuals with Amyotrophic Lateral Sclerosis (also called Lou Gehrig’s Disease). Most beneficiaries will receive Original Medicare (Parts A and B). Some people buy Medicare Advantage, which includes Part A and B as well as offering vision, dental and prescription drug coverage.

How Many People Are on Medicare in Vermont?

19% of the total population of Vermont is on Medicare. That’s just over 121,000.

How Much Is Medicare in Vermont?

If you do not qualify for Medicare, you can buy it for $471 a month for Part A in 2021/22 and a standard monthly premium for Medicare Part B was $148.50, or even higher depending on income.

Original Medicare vs Medicare Advantage: What’s the Difference?

Medicare is a government-subsidized health plan that is available to qualified Americans age 65 and older. Medicare Advantage is sold through private health insurance companies, but these policies are also regulated by the government. Medicare Advantage plans offer the same benefits as Medicare Parts A and B. Medicare Advantage plans also offer more coverage for dental, vision, hearing and prescription drugs. Medicare Advantage plans have a maximum out-of-pocket limit. For 2020, it was $6,700 but many plans set their maximums at a much lower cost. That is why it’s important to compare companies. People who opt for original Medicare can buy Medicare Supplements to help with out-of-pocket costs. You cannot buy both Medicare Advantage and Medicare Supplements. If you enroll in a Medicare Advantage Plan during the open enrollment, you will automatically be disenrolled from original Medicare.

How to Get Medicare Coverage in Vermont

If you receive social security payments, you may automatically enroll in Medicare, but you may have to sign up if you do not receive payments. The easiest way to enroll in Medicare is by working with a trusted insurance agent to get the coverages you want. Just enter your zip code and answer a few simple questions.

Types of Medicare Plans Available

Original Medicare, Medicare Advantage, Medicare Cost Plans (only offered in certain areas), Demonstration/Pilot Programs (also called Research Studies; only offered in certain areas) and Programs of All-Inclusive Care for the Elderly (PACE).

How Do I Qualify for Medicare?

To qualify for Medicare you must be a citizen of the U.S. or have been a legal resident for at least five years. If you are age 65 or older and you/your spouse have worked for at least 10 years (40 quarters) or you have a disability, Amyotrophic Lateral Sclerosis (ALS) or end-stage renal disease (ESRD), you most likely qualify for Medicare.

How Can I Save on Medicare in Vermont?

You can save on Medicare by signing up for Part B as soon as you’re eligible. People who enroll late must pay a penalty every year. If you’re interested in buying Medicare Advantage, you can shop and compare Medicare plans for the best value.

Vermont State Health System Ranking

Ever wonder how your state stacks up when it comes to quality healthcare? The Commonwealth Fund published a report in 2020 on State Health System Performance. They took into consideration the access to quality care, health outcomes, and disparities in all 50 states. The scores for the Vermont Health System are listed below:

• Vermont: Overall Ranking: 6 of 51
• Vermont: Overall Performance: Above U.S. Average
• Vermont: Access and Affordability: 4
• Vermont: Prevention and Treatment: 4
• Vermont: Avoidable Hospital Use and Cost: 15
• Vermont: Healthy Lives: 17
• Vermont: Health Care Disparities: 14

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Vermont Health Insurance Coverage

The people of the Green Mountain State have different kinds of health insurance while some Vermont residents are not insured at all. Vermont law requires health insurance companies to offer coverage for the following: prosthetic device, chiropractic services, maternity coverage, chemotherapy treatment, clinical trials for cancer patients, diabetes treatment, child vaccine benefits and home health care. See the breakdown for coverage below:

• Private coverage: 53%
• Medicaid: 25%
• Medicare: 19%
• Uninsured: 3%

Report: America's Health Insurance Plans

Vermont Health Insurance Companies

The following carriers offer health insurance and/or Medicare in Vermont.

• Blue Cross Blue Shield of Vermont
• MVP Healthcare
• UnitedHealthcare
• Cigna