What Vermont Residents Need to Know About Obamacare for 2021
It's not too late! Affordable Care Act (Obamacare) enrollment will be OPEN in Connecticut from February 16 to May 14.
Vermont has announced a special enrollment period (SEP) for health plan signups under the Affordable Care Act (Obamacare). This COVID-related enrollment period will run from February 16 to May 14. It mirrors the federal special enrollment period announced by the Biden administration, but Vermont's SEP applies only to those who are currently uninsured.
This website provides information about getting health insurance under the Affordable Care Act (ACA), including:
- whether you must get health insurance
- what the available plans cover
- how much coverage will cost
- how to sign up for a plan
- how to get help if you need it.
To begin, keep in mind these key points about health insurance in Vermont:
How To Sign Up for Obamacare in Vermont
It's not too late to sign up for 2021 health coverage under the Affordable Care Act (Obamacare). Due to the COVID-19 pandemic, Vermont is reopening health plan enrollment from February 16 to May 14, 2021.
To get covered, you can go directly to the online health insurance marketplace for Vermont. If you need personalized help, you can reach out to an enrollment assistant. Most enrollment helpers are working remotely during the COVID crisis.
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 Personalized 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 help from an enrollment assistant or from a licensed health care agent or broker.
An enrollment assistant 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.
To find a Vermont certified assistant, see Finding Help With Coverage at Vermont Health Connect. You can then search for helpers near you.
Private insurance agents or brokers can also help you understand your health care coverage options under Obamacare. Unlike government trained assistants, they are allowed to suggest the best plan for you.
How Much Does Obamacare Cost in Vermont?
This article explains the costs of health care plans offered under the Affordable Care Act (commonly called Obamacare) for individuals or families who are currently uninsured or not covered by a job-based health plan.
What you'll pay for an Obamacare plan depends on five things:
- The level of coverage you choose
- Whether you qualify for a subsidy
- Where you live in Vermont
- Your age
- Whether you smoke
Read on to learn more about each of these factors.
1. The Level of Coverage You Choose
Obamacare insurance plans offer four levels of coverage:
Platinum -- covers approximately 90% of health care costs
Gold -- covers approximately 80% of health care costs
Silver -- covers approximately 70% of health care costs
Bronze –- covers approximately 60% of health care costs
Do I Have to Get Health Insurance in Vermont?
Yes -- but no. Techincally, Vermont law requires you to have health insurance beginning in 2020. Vermont lawmakers intended this law to replace the federal penalty for going without health insurance, which disappeared in 2019.
That said, lawmakers were unable to agree on a plan for the penalty. 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 (currently toothless) 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?
Ways to Save Money on Obamacare in Vermont
There are three primary ways to reduce the cost of health plans under the Affordable Care Act in Vermont.
- You may be able to lower the cost of monthly premiums when you sign up for a private health insurance plan. Your savings will come in the form of a federal tax credit.
- You may be able to reduce your out-of-pocket costs -- including copayments, deductibles, and coinsurance -- with cost-sharing subsidies paid for by insurers.
- You may qualify for free or low-cost coverage through Medicaid in Vermont, or your children may be able to obtain coverage through the Children’s Health Insurance Program (CHIP).
Each of these forms of assistance depends on your income and family size.
Vermont Medicaid Expansion: Do I Qualify for Medicaid Under the ACA?
The Affordable Care Act (Obamacare) expanded Medicaid eligibility to include more people who couldn’t otherwise obtain health insurance. As written, the ACA would extend Medicaid to all adults with incomes at or below 138% of the federal poverty level. (For a single person in Vermont in 2020, that’s $17,609. For a family of four, it’s $36,156.)
However, the U.S. Supreme Court later ruled that it was up to individual states to decide whether to expand Medicaid. As of August 2020, 12 states have not expanded their programs.
Vermont Has Expanded Medicaid
Because Vermont did decide to expand its Medicaid program, residents can qualify for Medicaid more easily today than in years past.
What to Do If You're Frustrated or Fed Up With Vermont Health Connect
As Obamacare enters its open enrollment period for 2018 health plans, those seeking coverage face more chaos than ever. For many Americans, affordable coverage and streamlined enrollment still seem like faraway goals.
Below are a couple of strategies to help you get your health insurance needs met.
Common Complaints from Health Insurance Applicants
Understanding Obamacare's Preventive Health Care Benefits
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.
Know the difference between “preventive” and “diagnostic.” Doctors can use screening tests for either preventive or diagnostic reasons. For example, having a routine mammogram every year or two is preventive care for women over 40. But if you schedule a mammogram because you feel a lump or have breast pain, that’s diagnostic. Likewise, a routine colonoscopy is recommended for adults over 50, but if your doctor schedules a colonoscopy to investigate a problem like blood in your stool, it becomes a diagnostic procedure. Preventative services are free; diagnostic procedures are not. (If the timing is right -- say, you go to the doctor because you find a lump in your breast but you also happen to be due for an annual mammogram -- your doctor may bill the diagnostic procedure as preventive, but that’s not something you can count on.)
Obamacare for Self-Employed Vermont Residents
Many self-employed people will be quick to tell you that getting and paying for health insurance is one of the biggest challenges they face. For some, however, the Affordable Care Act (Obamacare) may make things easier by providing 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 the Affordable Care Act thinks you're self-employed.
The ACA 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.) If you are self-employed, you can use Vermont Health Connect to compare health insurance plans and sign up for the one that works best for you.
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. You will be connected with a registered SHOP (Small Business Health Options) agent or broker who can help you understand your coverage options.
If you aren’t sure whether the people who work for you are independent contractors or employees, read "Independent Contractor (Self-Employed) or Employee?" on the IRS website.
What the Affordable Care Act (Obamacare) Means for Self-Employed People in Vermont
Here are seven things self-employed people should know about the Affordable Care Act:
Get Help Finding a Health Insurance Plan in Vermont
Get Help From Vermont's Health Insurance Exchange
The following links and telephone numbers take you to the official help resources for Vermont Health Connect, the health insurance marketplace for Vermont.
Get help by phone: 855-899-9600 (TTY: 888-834-7898)
Get help in person: To find a certified navigator (called an "assister" in Vermont), see the Help Center at Vermont Health Connect.
Get Help From a Licensed Insurance Broker
To directly connect with a Vermont insurance broker who can help you evaluate insurance plans and choose a plan that's appropriate for your situation, call 800-943-6832. (We receive advertising income from the licensed brokers who offer their services through this telephone number.)
For more detailed information, see How Do I Sign Up for Obamacare in Vermont?
How Obamacare Affects Unemployed Vermont Residents
During this time of record unemployment, many people have lost not only their jobs, but health insurance, too. (Between February and May of 2020, an estimated 5.4 million people became uninsured because of job losses during the coronavirus pandemic.)
If you've suffered the dual blow of losing employment and your insurance, the Affordable Care Act (Obamacare) may offer relief in the form of readily available, affordable coverage. Usually, you must sign up during an open enrollment period. But leaving your job and losing job-based health insurance makes you eligible for special enrollment; you'll have 60 days to sign up for a new health plan.
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, because you're not working, you'll probably qualify for significant cost-saving subsidies.
When you sign up for a health plan under the ACA, your coverage can start within a few weeks.
Vermont Has Its Own Health Insurance Requirement
The Affordable Care Act tax penalty for going without health insurance ended in 2019, but a handful of states, including Vermont, have enacted their own laws to replace it. Vermont law requires you to have health insurance beginning January 1, 2020, but here's the twist:
That means you’ll have to report whether you have 2020 health coverage when you file your Vermont tax return in 2021, but you won’t have to pay anything for being uninsured unless officials change the current rules.
To read the Vermont law requiring health insurance coverage, see Title 32, Chapter 244 of the Vermont Statutes.
To find out how to obtain coverage, see How to Sign Up for Obamacare in Vermont.
For information about costs, see How Much Does Obamacare Cost in Vermont?
What Domestic Partners Need to Know About Applying for Health Insurance Under Obamacare
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.)
Vermont Obamacare Scams: What They Are & How to Avoid Them
If someone calls you on the phone in Vermont offering you discount health insurance for $29 a month, hang up and report them to the Vermont Department of Financial Regulation.
Worthless insurance is one of many scams that unscrupulous people are trying to sell to consumers confused by Obamacare. To satisfy the requirements of the new law, you must have a qualified insurance plan. If you don't, not only will you miss out on cost-saving insurance subsidies, you will probably be subject to a tax penalty.
Beware of scammers who may try to persuade to you buy insurance outside of Vermont Health Connect. Below is a list of common types of scams.
Obamacare and Seniors
If you’re over the age of 65, your health insurance options under the Affordable Care Act (Obamacare) 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 an ACA health insurance marketplace.
The Affordable Care Act does enhance your existing Medicare coverage by providing additional preventive care benefits, such as cancer screenings and an annual wellness visit.
For more information on Medicare coverage, go to Medicare.gov.
Obamacare and Students
Under Obamacare, students who are U.S. citizens or legal residents have several options for getting covered under the Affordable Care Act (Obamacare).
1. Stay on your parents health insurance. If you’re under the age of 26, your parents may be able to add you as dependent to a health insurance plan purchased through the marketplace at Vermont Health Connect.
2. Stay on your college or university’s health coverage. Because insurance plans offered by colleges and universities vary widely, you should talk to your school's health plan office to make sure its plan meets Obamacare rules.
Can I Use a Paper Application to Get Obamacare?
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-school 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.
How an Insurance Agent or Broker Can Help You Sign Up for Obamacare in Vermont
If you’re confused by your health care choices under the Affordable Care Act (Obamacare) -- or if you’re having a difficult time completing an application -- there are many ways to get help. For example, you can call the Vermont health insurance exchange for telephone support or obtain free, in-person guidance from trained enrollment counselor. You can also seek help from a licensed insurance agent or broker.
Given the technical flaws in many online health care marketplaces, getting help from an agent or broker has become an attractive option for many people. Agents and brokers, while grappling with most of the same delays and hassles faced by individuals, can make the process easier in several important ways, including:
- determining whether you qualify for subsidies
- helping you compare plan prices and coverage details, while explaining any complicated features or terms
- recommending plans that would be best for you (government enrollment assistants are not permitted to suggest specific plans), and
- walking you through the application process.
When Are You Legally Required to Report “Life Changes” to the Vermont Health Insurance Exchange?
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.
What Happens If I Missed the Vermont Obamacare Enrollment Deadline for 2021?
In most states, open enrollment has closed for 2021 health plans. After open enrollment ends, you won't be able to use Vermont Health Connect to purchase a health insurance plan unless you qualify for an exception, called a "special enrollment period."
COVID-19 Special Enrollment Periods
This year, a significant exception exists for many people. The Biden administration has announced a special enrollment period due to the COVID pandemic. It opens a three-month window from February 15 to May 15, 2021, for those using the federal health exchange to get covered. Many state-run exchanges are doing the same. To learn more about COVID special enrollment in your state, see How To Sign Up for Obamacare in Vermont.
You Can Still Enroll If You Qualify for a Special Enrollment Period
Certain life events make you eligible to sign up for health insurance outside of open enrollment. The circumstances under which you may qualify for special enrollment include:
About This Website
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 here, 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.