Vermont's Health Insurance Exchange

Vermont's Health Insurance Exchange will start January 1, 2014.  The Exchange will be run by the state. It will be a web site where Vermonters and small businesses buy private insurance from standardized health insurance plans.  There will likely be several plans to choose from. The benefits offered by these plans will be largely the same.  The plans will offer different levels of premiums and vary in cost sharing (deductibles, copayments, coinsurance).   The Exchange will administer Medicaid and Dr. Dynasaur, and the federal subsidies for low and middle income Vermonters. To read or download a copy of our overview materials on the Health Insurance Exchange, click here.

Who Will Be Able to Buy Insurance in the Exchange?

Those who can buy insurance through the Exchange include: the uninsured, those with individual (nongroup) plans, including Catamount Health, small businesses can buy insurance for its employees, and legal immigrants.

How Will the Exchange Affect Medicaid, VHAP, and Catamount Health?

The Exchange means many changes for  Medicaid, VHAP and Catamount Health.  (We expect Dr. Dynasaur to remain the same as it is now.)  Starting in 2014, more Vermonters will be eligible for Medicaid.  Medicaid eligibility will expand from about 100% of the Federal Poverty Level  up to 133% of the Federal Poverty Level.  This means some people who are now in VHAP and Catamount Health will be eligible for Medicaid.

VHAP and Catamount Health will not exist as they do now.  People in VHAP and Catamount Health with premium assistance whose income is too high for Medicaid will buy their insurance through the Exchange and will receive federal subsidies to help make the cost more affordable.  We are very concerned that the federal subsidies will not be high enough and people currently in VHAP and Catamount Health will be required to pay significantly higher premiums and out-of-pocket costs.  See the chart below for some examples.

What Key Decisions will the Vermont Legislature Make in 2012?

We are waiting for the federal government to provide a great deal of information about the operation of the Exchange, so there is a lot that we don't know yet.  We do know that the Vermont Legislature will make some very important decisions in 2012.

Covered Services

The Vermont Legislature will have to decide if the plans in the Exchange must cover all of Vermont's current mandated benefits.  We will know which benefits the federal government will mandate be covered early 2012, but it is likely they will not include all the Vermont mandated benefits.  Vermont currently mandates coverage of many necessary services like chiropractic care, naturopathic care, mammograms and colonoscopies, mental health parity, diabetes treatment, chemotherapy, tobacco cessation programs.   We need to work  to make sure all Vermont's mandates continue to be covered.

Premium and Cost-Sharing Subsidies for low and middle income Vermonters

The federal subsidies will not be enough to help keep coverage affordable for Vermonters. We need the Legislature to add additional state subsidies to help Vermonters who are in VHAP and Catamount Health keep affordable coverage.

Size of Small Businesses

The Legislature will decide if a small business will be defined as having up to 50 or up to 100 employees.  Only small businesses can buy insurance for its employees in the Exchange in 2014.

For more information or to learn how you can help, click here