What Vermont Residents Need to Know About Obamacare for 2020
UPDATE: Due to the coronavirus (COVID-19) outbreak, Vermont Health Connect is OPEN until April 17 for new health insurance signups.
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. 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.
2. Open enrollment has ended for 2020 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, 2019. This means that, unless you qualify for an exception, you won't be able obtain health insurance through Vermont Health Connect until the 2021 open enrollment period begins in the fall of 2020.
To learn whether you qualify for an exception that will let you get covered, see What Happens If I Missed the Vermont Obamacare Enrollment Deadline?
3. Your health insurance marketplace is located at Vermont Health Connect.
During open enrollment, or whenever you qualify for an exception, you can use the website 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. Many Vermonters will face premium increases in 2020.
In Vermont, both insurers in the marketplace will remain in place for 2020. That's the good news. The bad news is that prices for most individual marketplace plans will take a steeper jump than they did last year. For MVP, the average rate increase will be 10.1%. For Blue Cross Blue Shield of Vermont, the average increase will be 12.4%. Ouch. These increases are slightly less than what insurers asked for but the Green Mountain Care Board said it needed to take care of the financial needs of the insurance companies. It's hard to sympathize.
5. Premium subsidies are available to save you money.
Several forms of financial assistance can help you lower your health insurance premiums.
Fedral 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 2020, for example, a family of four earning as much as $103,000 can qualify for subsidies, as can an individual who earns up to $49,960. 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.
Cost sharing reductions. More than half of the people who purchase coverage through a health insurance exchange receive "cost-sharing reductions" (CSRs). Originally, these were payments the federal government made to insurance companies that allowed them to reduce deductibles and co-payments for lower-income Americans. In 2017, the Trump administration stopped paying for CSRs, but insurers and many state regulators found a creative way keep the program alive—adding the costs to silver marketplace plans through a practice called “silver loading”—so CSR benefits remain available for 2020 insurance plans.
Keep in mind that cost-sharing subsidies are available only on silver plans. They will automatically reduce your premium if your income as no more than 250% of the federal poverty level. (For 2020, that means a family of four can't earn more than $64,375 and an individual not more than $24,980.) If you think you may qualify, look carefully at costs for the silver plans available at Vermont Health Connect while you are shopping for coverage.
Medicaid. If your income is very low, you may qualify for free or low-cost coverage through Medicaid in Vermont.
For more information, see Ways to Save Money on Obamacare in Vermont.
6. 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.
7. You can get help signing up if you need it.
A couple years back, the Trump administration drastically cut funding for the programs that provide enrollment assistance. It also killed the budget for promoting the federal health insurance exchange. The good news is that Vermont doesn't rely on federal funding for its outreach and enrollment assistance programs so you still plenty of ways to get free help.
An insurance agent or broker may be the best bet for sorting out your options. To find one or to learn about other support resources available to you, see How To Sign Up for Obamacare 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