Vermont health insurance tips


Vermont insurance law and regulation

The Vermont Division of Financial Regulation Web site contains a link to the insurance laws posted on the legislative site, the state’s insurance regulations and bulletins.  The Web site has not yet developed resources to help individuals find commercial low cost health plans like mini-med or core coverage, specific illness policies, Supplemental Accident Insurance and basic health insurance.

The state insurance department can be reached by telephone at (802) 828-3301 or by mail at 89 Main St., Montpelier VT 05620. The state children’s health insurance plan (CHIP) Web site is Vermont Green Mountain Care.

News that affects your health insurance and planning

June 3, 2019 – Status of alternative non-ACA health plans: Vermont does not require individuals to maintain adequate health coverage. The state provides no premium or cost-sharing subsidies for individual market coverage, permits insurers to sell non-compliant transitional policies in the individual market. Vermont limits the sale of short-term coverage more strictly than the federal government. A maximum policy of 3 months and short-term coverage cannot exceed 3 months in a 12-month period.

March 19, 2019 -The House Health Care Committee passed a bill includes a financial penalty to enforce Vermont’s individual mandate when it goes into effect next year, and it lists who will be exempt from that mandate. 

The history of health care planning in Vermont (Information is outdated and links may be expired)

6/8/2016 Vermont insurance company’s proposals to raise 2017 health insurance rates by an average of 40% has sparked concern by individuals and small businesses that purchased Obamacare coverage. New York Times reports that similar health insurance cost hikes are proposed in many other states.

12/19/2014 Despite the fact that the majority of small businesses in Vermont do not offer health insurance, Governor Peter Shumlin announced in a press conference this week that the state will not make significant changes that would bring it policies in line with the benefits that are available to residents of other states. Our OnlineNavigator service offers a free consultation to businesses seeking an alternate strategy.

2/11/2014 Professional support for any health care reform issue is available free of charge through an arrangement with OnlineNavigator. All online inquiries are handled personally by Tony Novak, CPA. Online support is available through a number of popular social media channels including Facebook and Google+ as well as e-mail. Telephone support for insurance enrollment is available through Members Insurance Exchange at (800) 609-0683.

7/26/2013 Affordable Smart Term Life Insurance is now available to most Vermont residents from age 20 through 60 directly online with no physical exam, agent appointment or telephone verification. Most policies are issued on the same day with coverage amounts of $25,000 up to $350,000. The level premium life insurance is available for terms of 10, 15, 20 and 30 years. Sample rates for $150,000 coverage for a preferred risk male age 30, non-tobacco $30.85 per month; tobacco user $49.55 per month. A preferred risk female age 30 non-tobacco user would be $26.49 per month and a tobacco user would be $40.96 per month. Rates are higher for older applicants and lower health risks as described online. Pricing is based on input you provide about your medical history but, unlike most other life insurers, does not consider family medical history. Coverage is issued by innovative National Life Group, rated “A” by A.M. Best Company for 2013.

3/11/2013 This page was updated to include a link to the insurance plan that will be used to determine specific “essential health benefits” for insurance that qualified for 2014 federal tax purposes. Also, a link to additional covered benefits required by state law. Non-qualified insurance is likely to continue to be available at a lower cost that does not include these benefits nor qualify for federal tax purposes.

2/1/2012 The Center for Consumer Information and Insurance Oversight, a division of the Center for Medicare and Medicaid Services (CMS)reported that as of June 30, 2011 The Vermont Health Plan and MVP Health Insurance are the state’s largest health insurance providers and as such, earn the right to set the benchmark for the development of the state’s essential benefit plans to debut in 2014 under health reform law.

January 19, 2012 With just under two year remaining until final individual health insurance reform laws take effect, Vermont is one of only five states that does not have a short term medical insurance plan available to bridge the gap until affordable basic health insurance becomes available to everyone. Short term medical insurance is popular basic coverage because it is exempt from the restrictions of health reform law and therefore priced less than half of the rate of a plan that includes all state and federally mandated coverage. The lack of short term coverage in the state has boosted medical insurance tourism among those who need immediate coverage for 2012. A policy purchased while residing outside the state provides valid coverage nationwide including within Vermont.

July 25, 2011 Vermont’s health care providers are being criticized for high spending on lobbying on the formation of Green Mountain Care that will provide more favorable payment system than will be available in other states. Doctors and hospitals have spent more than $750,000 but the total amount is unknown due to loopholes in the state’s lobbyist disclosure rules. Critics say that the intended result of the lobbying effort would drive up long term health care costs for Vermont citizens as compared to the system used by Medicare and health plans in other states. Consumer interest groups like Common Cause-Vermont are focused on reforming Vermont’s lobbyist laws but it is unclear whether this can be done in time to reveal the financial backing behind the state’s health care reform.

May 28, 2011 Supplemental Accident Insurance market poised to expand – Vermont took the next step toward creating a single-payer health insurance system in the state that is expected to create a demand for millions of new supplemental individual health insurance policies from private insurance companies. Gov. Peter Shumlin is expected to sign bill H 202 this week that will put all state residents under the same primary basic health benefits. In other countries that use a similar system a high percentage of upper income and upper middle income working-class individuals voluntarily opt for a supplemental policy in order to gain access to the majority of health providers who do not accept patients with only the basic plan. Freedom Benefits and it affiliates already market these Supplemental Accident Insurance policies in other states and will expand the number of products, resources and online Request adviser support to help for Vermont residents enroll in these plans.

February 15, 2011 The proposed Green Mountain Care and the Vermont Health Benefit Exchange will set the stage to make Vermont the nation’s testing ground for a split-benefit level health system where the majority of residents have state-specified health benefits while the more affluent will be able to afford higher level care only by obtaining coverage through supplemental health insurance plans for enhanced benefits not covered in the basic health insurance. Executive benefit plans are relatively rare under current commercial health insurance plans but could grow rapidly under the reform proposals. Freedom Benefits received inquiries indicating an interest in out-of-state health insurance plans for Vermont executives who may have multiple residences or travel outside of the state. Commercial insurers would be prohibited from competing against Green Mountain Care provisions so the only option available to Vermont residents who are not satisfied with the basic coverage is to purchase supplemental coverage. This basic plus Supplemental Accident Insurance system is currently used in Great Britain and the impact of is covered on the Universal Health Insurance log.

2/7/2011 The state’s pre-existing condition insurance plan (PCIP) monthly premium rates (per person):

Plan/Age Band
PCIP will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available for you, beginning on your coverage effective date, even if it’s to treat a pre-existing condition – there are no waiting periods. PCIP applicants who are approved to participate in PCIP can choose from three plan options, with different levels of premiums, calendar year deductibles, prescription deductibles and prescription copays. The HSA Option provides an opportunity to open a Health Savings Account, a tax-exempt account where you can deposit funds for eligible medical expenses. Each of the three PCIP plan options provides preventive care (paid at 100%, with no deductible) when you see an in-network doctor and the doctor indicates preventive diagnosis. Included are annual physicals, flu shots, routine mammograms and cancer screenings. For other care, you will pay a deductible before PCIP pays for your health care and prescriptions. After you pay the deductible, you will pay 20% of medical costs in-network. The maximum you will pay out-of-pocket for covered services in a calendar year is $5,950 in-network/$7,000 out-of-network. There is no lifetime maximum or cap on the amount the plan pays for your care. If you apply for PCIP coverage on the government Web site, you will be billed for the premium once your application is approved. You will need to send in your payment in order for your coverage to be effective. Please do not send in the premium before you are billed. Note that your premium may increase if you age into a higher rate tier, or if PCIP adjusts its premiums to any changes in the commercial market.

1/2/2011 Vermont may become the nation’s testing ground for a single payer health system under direction of newly elected Governor Shumlin. A team of health experts officially begin comprehensive health reform work this month, headed by Anya Rader-Wallack who was involved in the development of the embattled Massachusetts universal-coverage system. If the Massachusetts system stumbles within the next three years before 2014 federal reforms take effect, either because of court challenges or due to runaway costs recently indicated, Vermont’s enthusiasm to make it’s own dramatic changes may be weakened. Freedom Benefits supports the sates’ reform initiative and remain committed as s leading provider of supplemental coverage during and after reform period. In other wealthy nations that have adopted a single payer health system, the demand for supplemental health insurance increases sharply immediately for upper economic class and then for middle class several years later. We expect to see the same reaction from the residents of Vermont.

12/16/2010 Vermont Department of Insurance officials met representatives of 44 other states and numerous employees of the federal Health and Human Services Department in Washington DC this week for a two-day working meeting to discuss the next steps in establish a government-run health insurance exchange under the American Health Benefit Exchange Model Act. Their attendance at this meeting was paid for by a $1 million federal grant awarded by HHS in September to the state for research how to set up an insurance exchange. Two states (Alaska and Minnesota) declined to participate, saying that it was a waste of taxpayer money. Four other states (not identified in press reports) that received federal grants did not send representatives to the meeting. Attendees included representatives of 16 states that are suing the federal government in an attempt to overturn the federal health reform law; specifically the requirement that forces individuals to buy health insurance on the insurance exchange or pay a hefty tax fine.

In its initial federal grant request for the insurance exchange project, Vermont said that it would: 1) Analyze the current insurance market to determine the quality and type of health insurance coverage, the appropriate regulatory environment for implementing the Exchange, and the potential impacts on the market of various options, 2) Assess various Exchange organizational models and the policy and fiscal implications of each, as well as resources needed to operate the Exchange, 3) Model potential funding mechanisms to achieve Exchange sustainability, and 4) Develop proposed legislation for the 2011 and 2012 sessions.

The meeting reportedly did not address the role of the commercial health insurance exchanges on the implementation of new competing government systems. The model act does not address inter-state insurance exchange proposals nor insurance sales across state lines. Federal officials admitted that they may not be able to provide further guidance until 2012. Meanwhile, most states are motivated to continue to meet requirements to obtain additional funding promised by the federal government for the establishment of insurance exchange by 2014. Freedom Benefits has previously voiced the opinion that the huge amount of money being spent to set up alternate insurance sales system technologies could be better used providing health benefits to the public. We proposed on the Universal Health Insurance blog that adequate commercial insurance sales systems are already in place that could be modified in a public/private partnership to make health insurance more affordable.

5/14/2010 Diabetes Coverage: A new resource to help find health insurance for diabetics in Vermont is now available at Freedom Benefits.