Vermont is known for maple syrup, as the state is amongst its major producer. Besides this, the state is also popular for its natural landscape and forested terrain. Residents can explore thousands of acres of mountain terrain by hiking trails and skiing slopes. Vermont is one of the smallest state in terms of area and and ranks lower in total population. However, its natural landscape has kept its residents active and healthy due to which it is considered as one of the fittest states in America. Even though the state ranks high in terms of health but still residents of this state should make effort to either improve or maintain this status. The best way to take care of their health is by being active and by having apt health insurance coverage to have proper protection in case of medical emergency. Residents of this state should be aware of its health insurance exchange along with all the health insurance options available in their state in order to take sound and decisive decision pertaining to their health. Vermont has a state-operated health insurance exchange called Vermont Health Connect. Individual health insurance market of Vermont is small and stable compared to health insurance market of other states, mainly because the state has combined individual and small group markets into one. As of 2020, Vermont has an individual mandate and require residents to maintain minimum essential coverage.
Highlights & Updates
- Vermont has a state-run health insurance exchange, Vermont Health Connect using which residents can enroll in health insurance plan.
- Open enrollment for 2020 coverage in Vermont just like other states ended on December 15, 2019. However, residents with qualifying events can still enroll.
- The next open enrollment window for health plans effective in 2021 will open on November 1, 2020.
- Vermont has highly stable health insurance market because its individual and small group markets are merged.
- In Vermont’s individual health market, only two insurance carriers are offering health plans.
- Vermont long back even before ACA implemented guaranteed issue and community rating.
- The sale of short-term plans with duration up to three months are allowed in Vermont but no insurance carrier is willing to offer short-term plan in the state.
- From 2020 residents of Vermont will require to have health insurance or else they would have to pay penalty.
Individual & Family Health Insurance
Residents of Vermont has plenty of options as far as individual and family health plans are concerned, which can be purchased from the participating private health insurers offering plans through Vermont Health Connect, the state-run exchange. Individuals who don’t have affordable and qualifying health insurance coverage from their employers can buy healthcare coverage for themselves and their families either through the state exchange or through participating private insurance carriers. All the individuals and family qualifying plans available in Vermont must offer ten standardized essential benefits and the state has also included some additional mandated benefits that every plan has to include.
Some of the Individual and Family Plans available in Vermont include:
Preferred Provider Organization – PPO is the most popular individual plan in Vermont in the individual and family market that allow insured to visit any in-network physician or healthcare provider of their choice without requiring a referral from their primary care physician. Members of PPO plan can visit any doctor from the insurance company’s network of doctors and they don’t even need to choose a primary care physician. The PPO plans mostly suit to individuals who prefer flexibility of choosing almost any medical facility or doctor for their healthcare needs. Individuals enrolled in the PPO plans probably have to pay an annual deductible and co-payment before start receiving coverage for their medical bills from the insurance company. A PPO is a network of medical professionals and facilities, hospitals and other healthcare professionals having contract with the insurance carriers to provide healthcare services to subscribed members at an agreed-upon reduced rare. PPO plans come with higher premiums because these plans are costly to administer and manage but offer more flexibility compared to alternative plans.
Health Maintenance Organization – HMO health insurance plans provide coverage through a network of physicians and other healthcare providers having contract with the HMO for a monthly or annual fee. The members of the HMO plans are required to first receive medical care services from the primary care physician. The medical entities having contract with HMO are paid an agree-upon fee to render a range of healthcare services to the members of the plans. Due to the agreed-upon fee, HMO plans have lower premiums compared to other types of health insurance plans while offering a high quality of care from its network. members of the HMO plans pay a monthly or annual premium to access healthcare services from the plan’s network of providers. Though, members have access to only in-network doctors and hospitals but some out-of-network services like emergency care and dialysis are covered under the HMO. The members of the HMO plans need to live or work in the plan’s network area to become eligible for the coverage.
Point-of-Service Plans – A POS plan is a managed care health plan offering healthcare benefits to the insured. The level of benefits depend upon whether the insured have used in-network or out-of-network healthcare providers. This plan comes with the combined features of both HMO and PPO plans. Just like HMO plans, POS plans policyholders also require to choose a primary care provider to manage their health and to provide referral for visiting a specialist. POS plans just like PPO plans also provide coverage for out-of-network healthcare services but the policyholders are required to pay more for the out-of-network services. Besides, the policyholders will also be responsible for filling all the paper work if they availed medical services form out-of-network provider.
HDHP with HSA – High Deductible Health Plan, which is used in conjunction with a Health Savings Account make healthcare more affordable for policyholders and also allow them save for the retirement. Vermont Residents enrolled in this plan can pay for qualified medical expenses with pre-tax dollars and can also save for retirement on a tax-deferred basis. A High deductible HSA compatible health insurance plan generally has a lower premium compared to plan with a lower deductible. Individuals with HDHP with an HSA can pay deductibles along with other qualified medical expenses with the money saved in their tax-free HSA. The amount saved in this account can rolls over year to year, thereby allowing individuals to build up reserve to pay for medical expenses and healthcare items.
Short-term Health Insurance Plans in Vermont
Though, Vermont technically allows short-term plans to be sold in the state for a term of up to three months but due to extensive rules and new regulations imposed significantly on short terms plans, no insurance carrier are offering short-term plans in the state. With the state mandating the short-term plan to cover pre-existing medical conditions made short-term plans unappealing for the insurance carriers in Vermont. Due to which no insurance company is currently offering short-term plans in the state.
Dental Plans in Vermont
Dental insurance plans are generally availed by Individuals due to the fact that these plans are affordable and its benefit starts immediately that also include regular check-ups too. Vermont residents very well understand that the cost of maintaining a healthy mouth throughout their lives will mount to thousands of dollars, which can certainly be saved by availing dental insurance plans at a fraction of cost. Dental insurance plans help prevent serious dental problems and provide dental care when required. Dental insurance plans available in Vermont are categorized as:
Indemnity Dental Plans – With an indemnity dental plan policyholders first have to pay upfront for the covered dental care cost and later on obtain reimbursement from their insurance company. Insured of Indemnity dental plans have a broader selection of dental care providers compared to managed care plans. The insurance carriers in this plan pay for the covered dental care cost only after receiving a bill.
Managed Care Dental Plans – Managed care plans usually maintain a network of dental care providers and all the participating dentists in the network agree to provide dental care services to patients at pre-negotiated rates and then submit the claim to the insurance company on behalf of the policyholders. Members of managed care dental plans have less paperwork and lower out-of-pocket costs.
Insurance Carriers in Vermont
For 2020 health insurance two insurance carriers are offering health plans in the individual market:
- Blue Cross Blue Shield of Vermont