Updated: 2020-07-16 by
The Affordable Care Act, also known as Obamacare, has not been struck down or repealed.
The news has been full of uncertainty about the future of the Affordable Care Act (Obamacare) as the law once again sits before the U.S. Supreme Court. However, a ruling on that case is still months away, and changes under the incoming Biden administration could end the case before the court decides it.
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:
1. Open enrollment has ended for 2021 health care plans, but you can still get health insurance if you qualify for a special enrollment period.
In Vermont, the ACA open enrollment period ended on December 15, 2020. This means that, unless you qualify for an exception, you won't be able to get health insurance through Vermont Health Connect until the 2022 open enrollment period begins in the fall of 2021.
If you’ve lost your job or significant income in the past 60 days, whether due to the COVID-19 crisis or for any other reason, you might qualify for a special enrollment period that will allow you to sign up for a new health insurance plan or to change your current plan.
To learn whether you qualify for a special enrollment period, see What Happens If I Missed the Vermont Obamacare Enrollment Deadline?
2. You won’t face a tax penalty for going without health insurance in 2021—but there are big downsides to being uninsured.
Obamacare’s tax penalty went away in 2019. That means that if you didn’t have health insurance coverage in 2020, you won’t have to pay a penalty when you file your taxes this year.
However, even though there's no more tax penalty, think hard 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 the 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.) Even if you missed open enrollment for 2021, special circumstances may allow you to obtain coverage.
3. Your health insurance marketplace is located at Vermont Health Connect.
During open enrollment, or whenever you qualify for a special enrollment period, you can use Vermont Health Connect to choose your health insurance plan, apply for cost-saving tax credits, and get other help you need.
To learn more about enrollment, see How Do I Sign Up for Obamacare in Vermont?
4. For 2021, insurers are sticking with the marketplace and average premium costs are going up -- but way less than last year.
Two insurance companies sell plans through Vermont Health Connect: Blue Cross Blue Shield of Vermont and MVP. Average premium increases for Blue Shield plans will be 4.2%. For MVP, average increases are 2.7%. (This is an improvement over last year's increases of more than 10%.) Both companies had initially proposed rate increases about twice as high, but the Green Mountain Care Board kept them down.
5. Vermont offers additional premium subsidies to save you money.
In addition to the existing federal premium subsidies provided under the Affordable Care Act, Vermont offers state-based financial assistance to help those with low incomes get covered.
Federal tax credits. The federal government provides help with premium payments for those whose incomes fall between 100% and 400% of the federal poverty level. For example, for 2021 health plans, a family of four in Vermont earning as much as $104,800 can qualify for subsidies, as can an individual who earns up to $51,040. Though the subsidies are tax credits, they are automatically deducted from the cost of your premiums each month, as long as you purchase your plan through Vermont Health Connect.
Vermont cost-sharing reductions and premium subsidies. In addition to the federal subsidies provided under the Affordable Care Act, Vermont offers help with premiums and out-of-pocket costs to those earning up to 300% of the federal poverty level. At Vermont Health Connect, you can find a detailed chart to help you figure out if you are eligible for these benefits in 2021. To qualify for some types of assistance, you must purchase a silver plan through Vermont Health Connect.
Medicaid. If your income is very low, you may qualify for free or low-cost coverage through Green Mountain Care in Vermont.
For more information, see Ways to Save Money on Obamacare in Vermont.
6. Vermont passed a law requiring state residents to have health insurance but lawmakers never agreed on a penalty.
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. Technically, Vermont's law requires you have health insurance beginning January 1, 2020. But because state lawmakers never agreed on a penalty, the law has no teeth.
That said, even if the law doesn't force you to do it, 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 2022 to get it.
7. Vermont limits "short-term insurance plans" to fewer than three months.
In 2018, the Trump administration made it easier to purchase short-term insurance plans. These plans don't have to cover preexisting conditions or the essential health benefits provided by Obamacare plans. The new federal rules say that short-term plans can last for as long as three years. In Vermont, however, short-term plans must last fewer than three months and they cannot be automatically renewed. Vermont plans must also cover pre-existing conditions. (Vermont's Department of Financial Regulation publishes these rules.)
If you’re genuinely caught without health insurance and need it for a few months to cover a new health condition, you might want to consider a short-term plan to get you through to the next open enrollment period. Otherwise, be careful of plans that don’t meet the requirements of the Affordable Care Act. Shop around to look for coverage that truly meets your needs.
Remember, if your income is very low, you may qualify for free or low-cost coverage through Medicaid in Vermont.
You may also be interested in:
Where to go in Vermont to get health plans under the Affordable Care Act (Obamacare) and how to get help with the application process.
Learn whether you must have health coverage under the Affordable Care Act (Obamacare) in Vermont.
Learn the five factors that determine what residents of Vermont will pay for health insurance under the Affordable Care Act