Vermont will embark on a new era in health care on October
1, 2013, as the health insurance marketplace, called Vermont Health Connect, opens for enrollment. Vermont
is one of several states that set up its own marketplace under the Affordable
Care Act (ACA), a.k.a. “Obamacare”. Vermont
Health Connect is designed to make it easier for eligible Vermonters to have
access to and choose the level of coverage and cost for their health insurance
as well as provide Vermonters access to federal subsidies based on their income
level. Only insurance purchased through Vermont
Health Connect is eligible for federal subsidies that can lower premiums, and
for many, out-of-pocket expenses. The
Vermont Health Connect website, www.VermontHealthConnect.gov, already has detailed information
available. As implemented in Vermont, Vermont
Health Connect will be used by Vermonters purchasing individual or family plans
and employers and employees of small businesses. It is easiest to address these categories
separately for clarity.
Coverage for Individuals and
Families
So, who is
eligible to participate? Simply put, any
Vermonter who does not have insurance through their employer or through a
government program like Medicare, Medicaid, Veterans Administration benefits, or
Dr. Dynasaur for children, is eligible. Even
if an employer offers health insurance, but the premiums cost more than 9.5% of
the employee’s household income, the
employee is eligible to purchase insurance through Vermont Health Connect and receive
federal subsidies. The open enrollment
period starts on October 1, 2013, and ends on March 31, 2014. After the open enrollment period, only “life
changes”, such as marriage, loss of job, change in family size, etc., will be acceptable
reasons to initiate or change insurance options.
Vermont
Health Connect offers a list of approved health insurance options that provide
standardized health care coverage at various levels of cost. The standard plans have four benefit levels:
·
Bronze
– 50% payment of covered medical expenses
·
Silver
– 60% payment of covered medical expenses
·
Gold
– 80% payment of covered medical expenses
·
Platinum
– 90% payment of covered medical expenses.
Each level
has different deductible and maximum out-of-pocket amounts. Insurance premiums will vary by insurance
provider, amount of deductibles and co-pays, benefit level, and amount of
subsidy an individual or family is eligible for. There are two insurance providers for
Vermont, Blue Cross Blue Shield of Vermont and MVP, each of whom offers the
same coverage in the standard plans. In
addition to the four standard plans, there are non-standard plans offered by
BCBS and MVP as well. Catastrophic
health plans are also available to individuals under 30 years old who meet
certain income eligibility standards.
Federal
subsidies for the premiums are based on household income and are paid directly
to the provider to offset the premiums.
While the estimated subsidy for 2014 is based on the household income
shown in the 2012 tax return filed this year, the subsidy will be adjusted when
the 2013 tax return is filed; so, those who have had a major change in income
can potentially see a change in the amount of the subsidy they are eligible
for. Adjustments for changes in a
household’s financial circumstances can be made on a monthly basis.
Besides the
health insurance plans, Vermont Health Connect also provides access to dental
plans through Delta Dental for both adults, as a supplemental plan, and
children, as dental is embedded in all medical plans for those up to 21. Catastrophic dental care is integrated with
the health insurance plans through BCBS and MVP.
There is
help every step of the way
for individuals to learn more now and to enroll after October 1st:
- Online – www.VermontHealthConnect.gov
- Phone – 1-855-899-9600
(toll-free)
- In-person – Use our
website or call center to find a Navigator near you. (Navigators are trained partner
organizations or individuals who can guide you through the process. A list can be found under the tab
“Assisters & Partners” at the website.)
Starting in
2014, there is a federal penalty for not carrying health insurance. The penalty
will be assessed on tax returns starting in 2014 and increasing each year
through 2016. For 2014 the penalty is
the larger of 1% of household income or $95 per individual household member
without coverage up to a maximum of $285.
Small Business Participation
Small
businesses, with 50 or fewer full-time employees will offer health insurance
through Vermont Health Connect starting in 2014. There is no federal penalty
for small businesses that do not offer health insurance to their employees. Businesses will select a contribution level
and the plans available to their employees (either all plans under one carrier
or the full range of options). The
employee would then enroll in the plan of their choice through Vermont Health
Connect. If the employer offers health
insurance to its employees, however, the employee would not be eligible for a
federal insurance subsidy unless the cost to the employee exceeded 9.5% of the
employee’s household income.
Employers are
eligible for federal tax credits if
-
they have fewer than 25 full-time-equivalent employees (FTEs),
- the average annual wage per FTE is less than $50,000, and
- they contribute at least 50% of the health insurance premium per FTE.
