To begin, keep in mind these key points about health insurance in Vermont:
1. Vermont law requires you to have health insurance.
The federal tax penalty for going without health insurance went away in 2019. In response, a handful of states, including Vermont, passed their own health insurance requirements. Under Vermont's new law, state residents are required to have health insurance as of January 1, 2020. Unfortunately, that's where the clarity ends. The state created a "working group" to determine what the actual penalty will be, but so far Vermont lawmakers have not agreed on the details.
Even if the Vermont tax penalty is as yet without teeth, think carefully about whether it makes sense to forego health insurance. A medical crisis could knock the financial wind from your sails and do more damage than any penalty would. (A study published in 2019 showed that a lapse in health insurance coverage can double a person's chances of ending up in bankruptcy.) And if you miss open enrollment and find yourself needing coverage mid-year, you’ll have to wait until 2021 to get it.
To sign up for a health plan under the Affordable Care Act (Obamacare) you can go directly to the online health insurance marketplace for Vermont -- or you can get help in person or over the phone.
For 2020 health plans, Vermont open enrollment ended on December 15, 2019. However, you may still be able to purchase health insurance for this year if you qualify for a special enrollment period; see What Happens If I Missed the Enrollment Deadline for 2020?
Where's the Vermont Health Care Exchange?
You can find the health insurance exchange for Vermont at Vermont Health Connect. This is where you can learn about the various health insurance options available to you under Obamacare. If you see a plan you like, you'll be guided through the enrollment process online.
Getting In-Person Help with Enrollment
In Vermont, if you need help understanding your options for coverage under Obamacare or signing up for a plan, you can get free assistance from a navigator (often called an "assister" in Vermont) or from a licensed health care agent or broker.
Navigators can explain your options, answer your questions, and help you apply for the plan you choose -- but they can’t legally recommend a specific plan for you.
Private insurance agents or brokers can also help you understand your health care coverage options under Obamacare. Unlike government-trained navigators, they are allowed to suggest the best plan for you.
The short answer is yes -- beginning January 1, 2020, Vermont law requires you to have health insurance. Since the federal penalty for going without health insurance went away in 2019, a handful of states -- including Vermont -- have passed their own health insurance requirements. That said, Vermont is not yet imposing a financial penalty for ignoring the law.
Vermont lawmakers were charged with determining what the new tax penalty should be, but they were unable to agree on a plan. That means you'll have to report whether you had 2020 coverage when you file your Vermont tax return in 2021 but, unless lawmakers change the current rules, you won't have to pay anything if you were uninsured.
To meet the requirements of Vermont's individual insurance mandate, you must have what's called "minimum essential coverage." In Vermont, minimum essential coverage is the same for purposes of state law as it is under the federal Affordable Care Act.
What Qualifies as Minimum Essential Coverage in Vermont?
Get a colonoscopy, mammogram, vaccinations, and other essential services for free
The Affordable Care Act requires health insurance plans to offer certain preventive care services free of charge -- or more accurately, for nothing more than the cost of your monthly insurance premiums. This rule applies to most plans sold directly by insurance companies and all plans sold through Vermont Health Connect, the health care marketplace for Vermont. Covered preventive services are available for free (meaning no co-pay or other out-of-pocket charges) whether or not you’ve met your plan’s annual deductible.
Tips for Using Your Preventive Care Benefits – And Avoiding Unexpected Charges
Below, you’ll find a list of free preventive benefits -- screening tests, counseling services, and vaccinations -- for adults, women, and kids. But first, here are some pointers to help you avoid an unexpected bill for services you thought were preventive.
Use a network provider. To get a preventive service for free, you must use a health care provider in your insurance plan’s network.
Many self-employed people will be quick to tell you that getting and paying for health insurance is one of the biggest hassles they face. But this may change for the better under Obamacare, which provides new coverage options for the self-employed.
Are You Self-Employed or an Employer?
Before you start evaluating your options for health coverage, you need understand whether you are in fact considered self-employed under Obamacare.
The law says you are self-employed if you are an independent contractor or a sole proprietor without employees. (If you hire other independent contractors to do some work for you, you probably still qualify as self-employed.) Self-employed people can use the new health care marketplace to purchase individual health insurance plans.
If you have employees – usually, workers whose income you report on a W-2 at the end of the year -- you’re considered an employer. In that case, you can learn about purchasing health insurance for yourself and your employees through the SHOP Marketplace.
The difficulties of unemployment are often compounded by the lack or loss of health insurance. But millions of Americans who are currently without both a job and health coverage may find relief under Obamacare. That's because low-cost coverage options may be available to you through Vermont Health Connect, the health insurance marketplace serving Vermont.
All plans available through the marketplace offer essential medical benefits, including preventive care, emergency services, and prescription drug coverage. You can't be turned away if you have a pre-existing medical condition and, as an unemployed person, you probably qualify for significant cost-saving subsidies.
When you sign up for a marketplace health plan, your coverage can start within a few weeks. Usually, you must sign up during an open enrollment period. But leaving your job and losing job-based health insurance makes you eligible for a special enrollment period. That means you'll have 60 days to sign up for a new health plan.
When registered domestic partners or civil union partners apply for coverage at an Affordable Care Act health insurance marketplace, there’s one question that almost always arises: Do we apply based on our separate incomes, or must we include all the income we make as a couple?
The answer depends on the state where you live.
States other than California, Nevada, or Washington. In almost all states, registered domestic partners or civil union partners who apply for insurance via the state’s health insurance exchange must do so separately. Each partner includes only his or her separate income, and this amount determines health plan costs and eligibility for cost-saving subsidies. It works this way because domestic partners are not considered married for federal tax purposes. (If you registered first and got legally married later, this article doesn't apply to you. You must apply as a married person and report your combined income.)
If you’re over the age of 65, your health insurance options under the Affordable Care Act depend on whether or not you’re covered by Medicare or another insurance plan. To find out what, if anything, you need to do, find the situation below that applies to you.
You have Medicare. If you’re already enrolled in Medicare, you’re considered covered under the ACA, and you don’t have to do anything. In fact, it’s illegal for someone who knows you have Medicare to try to sell you a plan through a health care marketplace.
The Affordable Care Act enhances your existing Medicare coverage in a couple of important ways:
When Obamacare first launched, the federal and state health insurance marketplaces (also called “exchanges”) were plagued by technical troubles. Many people who tried to sign up for new health insurance plans online in the early days were unable to complete their applications.
Because of these difficulties, some individuals and application assistants turned to the old-fashioned way of getting health insurance -- paper applications.
Applying on Paper May Not Be Better or Faster
When facing a slow or broken online health insurance exchange, using a paper application may seem tempting -- at least it would provide the feeling of getting something done. However, paper forms may not speed up the process at all. On the contrary, they could slow down your application even more.
The worker who reviews your paper application must manually enter the information from your forms into the same system you would use online at your state’s exchange. It won’t work any faster for them than it does for you. Plus, using a paper application opens up more opportunity for error by putting more people between you and your goal of getting insurance.
It’s still best to apply online if you can. That said, if you feel that you’re unlikely to come back and apply for health insurance later, you may want to go ahead and complete a paper application now.
To get a paper application, call the Vermont Health Connect customer service center and let them know you want to apply on paper. They'll point you to a downloadable application or send you one in the mail. For detailed Vermont Health Connect contact information, see How To Sign Up for Obamacare in Vermont.
Are you planning to get married, change jobs, or move to a new state? If so, you might have to share your big news with Vermont Health Connect.
Which Changes Must You Report?
If you buy a health insurance plan through the Vermont marketplace, the Affordable Care Act requires you to report changes that may affect your insurance coverage. These changes include:
moving to a new state or insurance coverage area
significant changes in income
getting new health coverage through a job
signing up for Medicare or Medicaid
getting married or divorced
becoming pregnant, having a child, adopting a child, or placing a child for adoption
losing or gaining a dependent
becoming disabled, and
other changes that affect your income or household size.
We built this website to get people the answers they need about the Affordable Care Act (Obamacare). Our goal is to guide you to reliable, local information about your new health insurance options.
When you choose your state or enter your zip code above, you will quickly learn:
whether or not you're required to get health insurance
what the available plans cover
how much coverage will cost, and
how to sign up in your state.
For those concerned about cost, we show you how to determine whether you qualify for subsidies. We also explain the rules about expanded Medicaid eligibility.
