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Vermont Health Insurance
Health insurance is an inevitable option that cannot be avoided. Purchasing appropriate health insurance coverage for your family is costly that requires a good evaluation of all future risks and its impact on your finances. More than 47 million Americans are uninsured, majority of whom are working families. These families, especially children, have to pay the price for the lack of proper health coverage and the costs associated with them. However, for those families who are not covered by their employers’ health group plan, there are low-priced state sponsored health insurance programs.
Vermont is healthiest state to live in and obtain health coverage as it took the 1st spot in the report released in the United Health Foundation’s 2008 Health Rankings. The healthcare system of the state has shown a remarkable improvement since the past ten years. Vermont has maintained its 1st position since 2007; it was on the 2nd spot in 2006. The major strengths of the state include low percentage of children in poverty, strong public funding and decreasing prevalence of smoking. The state of Vermont, having the population of more than six hundred thousand people, offers both private-market and public health insurance alternatives. The private-market health insurance consists of various types of health plans including family, Medicare supplemental, short-term, student, group and dental. In addition, the state and federal government sponsored programs provide subsidized health coverage to the uninsurable residents of Vermont who meet specific eligibility requirements.
The Vermont Department of Banking, Insurance, Securities & Health Care Administration protects the insurance consumers against unfair practices by regulating all kinds of insurance sold through private-market health insurers as well as public health coverage programs. However, despite better accessibility to Vermont health care system, nearly 10.7% of the state residents are uninsured. Approximately, 47.4% uninsured Vermont citizens come under the above 200% FPL bracket, according to the Censor Bureau’s 2007 and 2008 Current Population Survey.
When shopping for health coverage in Vermont, get in touch with a local licensed health insurance agent/broker to avail the benefits of health insurance alternatives.
Individual/Family Health Insurance
Below is the guidelines for applying for and obtaining individual health insurance in the state of Vermont. These regulations apply to all insurance companies offering individual or family health insurance in Vermont:
| Medical Underwriting | Yes |
Pre-Existing Condition Exclusion Period | 12 months |
Look Back Period | 12 months |
Look Back Standard | Prudent person |
Mandatory Benefits | Cancer screening for women including breast cancer screening, eating disorder parity, maternity care |
Market Rate Restrictions | Yes |
Guaranteed Issue Options | None |
Small Group Health Insurance
Below is the guidelines for small group health insurance in the state of Vermont. These regulations apply to all insurance companies offering small group health insurance in Vermont.
| Small Group Size | 1-50 |
Employee Qualifications | Two employees must be present for half of the preceding calendar quarter and |
Guaranteed Issue | Yes |
Premium Rating Factors | Adjusted Community Rating |
Rate Adjustment Factors | Modified Community Rate |
Look-Back Period | 6 months |
Pre-existing condition exclusionary period | 12 months |
Mandatory Benefits | Same as Individual |
State Cobra Variations for Small Groups
Below are the COBRA guidelines for small groups in the state of Vermont. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:
| Mini-Cobra Option | Yes |
Eligible Group Sizes | 2-19 |
Extension of Benefits Period - Standard | 6 months |
Extension of Benefits Period - Disabled | 6 months |
Maximum Premium Increase | 100% |
State Legislation Reference | |
Additional Notes | Individuals must have a minimum of 3 months of prior coverage under the group plan in order to be eligible and have 30 days to make this election. |
State Sponsored Health Insurance Programs
There are several state sponsored health insurance programs in the State of Vermont to assist those without insurance in obtaining adequate coverage.
High-Risk Pools
Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. However, Vermont does not have a high risk pool for its residents who cannot obtain private health insurance due to pre-existing health conditions.
Children’s Health Insurance Program
Through shared funding from the federal government, the State of Vermont provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:
| Program Name | Dr. Dynasaur |
Website | |
Phone Number | 800-250-8427 |
Apply Online | Yes |
Age Limits | Under 18 |
Insurance Carrier | Green Mountain Care |
Length of Coverage | Periodic eligibility review |
Residency Requirements | Vermont residents, U.S. citizens, legal immigrants |
Other Eligibility Requirements |
|
Pre-Existing Condition Exclusions | None |
Cost | Monthly premiums range from $0-$60 depending on your family’s income and there are no co-payments. |
Medicaid
Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of Vermont:
| Governing Agency | Office of Human Health Access |
Website | |
Phone Number | 800-250-8427 |
Residency Requirements | Vermont resident, U.S. citizen |
Federal Poverty Line Income Limits | Children ages 0-18 300% FPL |
Additional Resources
Vermont Health Care Options Matrix™ Guide
Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines Vermont’s public and private health care choices for individuals and groups with various demographic profiles.
Family Health Insurance Guide by HealthInsuranceFinders.com
The guide created by HealthInsuranceFinders.com provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.
Vermont: At-A-Glance
Provides exclusive health data of the Vermont state. Statehealthfacts.org, a project of the Henry J. Kaiser Family Foundation, is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.
