Updated: 2021-05-17 by
It's not too late! Affordable Care Act (Obamacare) enrollment is OPEN in Vermont until October 1.
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 October 1, 2021. This is a bit longer than the special enrollment period announced by the Biden administration, allowing Vermonters a generous amount of time to get covered.
Also, a new federal law, The American Rescue Plan Act of 2021 (ARPA), increases premium subsidies, provides free health insurance if you’re unemployed in 2021, and waives excess subsidy payments for the 2020 tax year. If you qualify for new financial benefits, you can go to Vermont Health Connect to sign up.
This website provides information about the new programs available under ARPA as well as other facts 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. You can use the COVID special enrollment period to get covered under the Affordable Care Act, even though open enrollment is over.
Because of the COVID-19 pandemic, Vermont Health Connect will be open for new Obamacare signups until October 1, 2021. This extension of the state's usual open enrollment period allows all Vermont residents to get health coverage and benefit from new financial assistance programs.
To learn more about enrollment, see How To Sign Up for Obamacare in Vermont.
2. You may qualify for new health insurance premium subsidies.
On March 11, 2021, President Biden signed the American Rescue Plan Act. The law provides $1.9 trillion of federal aid to Americans still struggling with the COVID-19 pandemic. The relief measures include additional premium subsidies for those who purchase health insurance under the Affordable Care Act. Also, Vermont offers state financial assistance to lower-income residents. Here's a quick summary of the programs that may be available to you:
Federal tax credits. Until the passage of ARPA, the ACA provided premium subsidies only for those whose income fell between 100% and 400% of the federal poverty level. (For example, the cutoff for a family of four in Vermont was $104,800. For an individual, it was $51,040.)
Now, no individual or family will have to pay more than 8.5% of their household income for a mid-level “silver” plan purchased from Vermont Health Connect. Even though the amount of the subsidy is based on a silver plan, you can apply the subsidy to any marketplace plan, including bronze, gold, or platinum plans. The subsidies are tax credits, but you can choose to have them automatically deducted from the cost of your monthly premiums when you purchase a plan through Vermont Health Connect.
Even though Vermont is allowing only uninsured people to enroll during the COVID-related enrollment window, you should still be able to switch to a silver plan at Vermont Health Connect. That's because becoming eligible for new subsidies is a qualifying event that will allow you to buy or change plans outside of open enrollment. Keep in mind, however, that you have only 60 days to act after you become newly eligible.
These enhanced subsidies are retroactive to the start of 2021, but they're also temporary. They will last only through 2022 unless Congress enacts legislation to extend them.
Cost-sharing subsidies. More than half of the people who purchase coverage through a health insurance exchange receive "cost-sharing reductions" (CSRs). These subsidies automatically reduce your premiums and lower your costs when you use your insurance benefits—for example, when you go to the doctor, get lab work, or have to stay in the hospital. CSRs are available to people who make between 100% and 250% of the federal poverty level. (For 2021 health plans, that means a family of four in Vermont can't earn more than $65,500 and an individual not more than $25,520.) Keep in mind that cost-sharing subsidies are available only on silver plans. 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.
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.
3. If you are unemployed in 2021, you qualify for free health insurance.
If you receive unemployment benefits for at least one week in 2021, the American Rescue Plan guarantees that you can receive a mid-level silver plan for 2021 at no cost to you. This is because the law will disregard any income you earn over 133% of the federal poverty level. And that, in turn, will lock in the highest level of premium assistance for you. If you get a job, your eligibility will change. You’ll be able to apply for this benefit when you purchase an insurance plan through Vermont Health Connect. Be prepared to prove that you are receiving or have received unemployment compensation this year.
As an alternative, from April through September of 2021, ARPA provides for 100% free coverage under COBRA for those who have been laid off or subject to a reduction of hours great enough to trigger COBRA eligibility. Speak to your former employer about this benefit; for more information about COBRA, see the U.S. Department of Labor website.
4. If you owed excess premium subsidies for 2020, you don’t have to pay.
Did you expect to owe the IRS for excess health insurance premium subsidies you received last year? The American Rescue Plan Act says you don’t have to pay back the money.
If your subsidy assistance fell short of your eligibility, you can still claim the additional amount owed to you when you file your taxes. But if your subsidy amount was too large, you get a free pass this year—and only this year. In other words, don’t underestimate your income when you purchase a 2021 plan because you hope for a similar break next year.
Because this rule is new and tax season is upon us, you may need to call your tax preparer for help. It’s not yet clear, for example, what you should do if you’ve already filed your 2020 tax return and repaid your excess tax credit. If you’re not sure what to do, you can always request an extension to file your taxes, giving you until October 15 to sort it out.
5. 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.
6. For 2021, Vermont 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.
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.
8. You can get help signing up if you need it.
A couple of years back, the Trump administration drastically cut funding for programs that provide help with health insurance enrollment. But the Biden administration is expected to quickly reverse that trend, making it much easier to get the information you need to get covered. To connect with local support resources, 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