Haris Ashley
If you're looking to get medical insurance in Vermont, there are a few options available to you. The state runs its own health insurance exchange called Vermont Health Connect, where eligible residents can shop for individual and family health plans offered by two private health insurance carriers. You can also apply for Medicaid or Dr. Dynasaur, which offers free or low-cost health coverage for those who qualify. Additionally, Vermont offers state-funded subsidies on top of federal subsidies provided under the ACA. If you're looking for short-term coverage, you can explore options like Medicare Supplement plans or accident insurance. It's important to carefully review the terms of your policy to understand any exclusions or limitations on coverage.
| Characteristics | Values |
|---|---|
| Name of the health insurance marketplace | Vermont Health Connect |
| Website | VermontHealthConnect.gov |
| Phone number | 1-855-899-9600 |
| Address | Vermont Health Connect Application and Document Processing Center, 280 State Drive Waterbury, VT, 05671-8100 |
| Types of health insurance available | Qualified health plans (QHP) and Medicaid for Children and Adults, including Dr. Dynasaur |
| Availability of financial help | Yes, for eligible Vermonters |
| Enrollment period | Open Enrollment: November 1 to January 15; Special Enrollment Period (SEP) available for certain life changes |
| Dental plans | Yes, with no maximum age limits |
| Vision plans | Yes, with no maximum age restrictions |
| Accident Insurance | Yes |
| Critical Illness insurance | Yes |
| Hospital indemnity insurance | Yes |
| Short-term health insurance | Yes |
| Medicare | Yes, insured by UnitedHealthcare Insurance Company |
| Supplemental plans | Yes, for dental, vision, accident insurance, etc. |
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What You'll Learn
- Vermont Health Connect: the state's health insurance marketplace
- Medicaid: free or low-cost health coverage
- Dr. Dynasaur: health coverage for children
- Short-term health insurance: flexible coverage until you find a long-term plan
- Special Enrollment Period: a 60-day window to enrol or change plans outside of Open Enrollment
Vermont Health Connect: the state's health insurance marketplace
Vermont Health Connect (VHC) is the state of Vermont's health insurance marketplace, where eligible Vermonters can purchase health insurance with financial assistance. The platform offers two types of health insurance: a qualified health plan (QHP) or Medicaid for Children and Adults, including Dr. Dynasaur.
VHC allows residents to shop for individual and family health plans offered by two private health insurance carriers. These plans are for people who aren't eligible for Medicare, Medicaid, or an affordable employer-sponsored health plan. Vermont is among the states that offer state-funded subsidies in addition to federal subsidies provided under the Affordable Care Act (ACA).
To enrol in an ACA Marketplace/exchange plan in Vermont, you can visit the VHC website, call their centre, or visit them in person. There, you can compare the health plans available in your area, determine your eligibility for financial assistance, and enrol in coverage during open or special enrolment periods.
Open Enrolment runs yearly from 1 November to 15 January. It is the only time, outside of a Special Enrolment Period, that you can sign up for new coverage or change plans. You may be eligible for a Special Enrolment Period following certain life changes, such as the loss of health coverage or a change in household members.
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Medicaid: free or low-cost health coverage
Vermont residents can apply for free or low-cost health coverage through Medicaid or Dr. Dynasaur. Dr. Dynasaur is aimed at uninsured children in families with moderate incomes that are too high to qualify for Medicaid.
Vermont Health Connect (VHC) is the State of Vermont's health insurance marketplace, where eligible Vermonters can get health insurance with financial help. There are two types of health insurance available through VHC: Medicaid or Dr. Dynasaur, and Qualified Health Plans (QHP).
Medicaid and Dr. Dynasaur are available year-round for eligible applicants. To apply for Medicaid, you can contact your state Medicaid agency. You can also apply for Medicaid or Dr. Dynasaur through the Vermont Health Connect website. The website allows residents to compare health plans, determine eligibility for financial assistance, and enroll in coverage. You can also call the Vermont Health Connect call center at 855-899-9600 or visit one of their locations for assistance.
For a QHP, there are specific times when you can get coverage. People who meet income rules and other requirements can sign up or change their plan at any time. To qualify for financial help paying for a QHP, your income must be at or below 200% of the Federal Poverty Level.
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Dr. Dynasaur: health coverage for children
Dr. Dynasaur is a program that provides free or low-cost health coverage for children and teens through age 17, with no maximum age limit. It is a secondary payer if there is other coverage. The name "Dr. Dynasaur" was chosen to appeal to both children and parents, with the idea that a genial name would make people feel more comfortable enrolling their children in the public health care system. Dr. Dynasaur is offered as part of the state of Vermont's Medicaid for Children & Adults (MCA) program, which is run by Vermont Health Connect (VHC).
Eligibility for Dr. Dynasaur is based on family size and household income. As of January 1, 2002, this translated to an income of $45,216 for a family of three for coverage for children. There is no asset limit for Dr. Dynasaur eligibility. The monthly income limit for children is 317% of the Federal Poverty Level (FPL) for household size, and 213% of the FPL for pregnant women. For families with income exceeding 185% of the FPL but less than or equal to 225%, a monthly program fee of $30 per family is required for coverage for people under age 18 and pregnant women. A $50 per month per family program fee is required for children with income in excess of 225% of the FPL and no other insurance coverage.
Dr. Dynasaur provides comprehensive coverage for prenatal care, routine check-ups, immunizations, hospital care (both inpatient and outpatient), prescriptions, x-ray and lab tests, limited dental and vision services, and other medical services. Most beneficiaries receive services through an HMO or PPO, and no co-payments are required for any of these services.
You can apply for Dr. Dynasaur at any time during the year through the Vermont Health Connect website. Children can stay on Dr. Dynasaur until the last day of their birthday month when they turn 19.
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Short-term health insurance: flexible coverage until you find a long-term plan
Vermont Health Connect (VHC) is the state's health insurance marketplace, where eligible Vermonters can get health insurance with financial help. There are two types of health insurance available through VHC: a qualified health plan or Medicaid for Children and Adults, including Dr. Dynasaur.
Short-term health insurance is a fast, flexible insurance solution until you find long-term coverage. For example, you might be between jobs, a new college graduate, or have retired early. Short-term health plans in Vermont must conform to numerous state regulations. They must provide coverage for essential health benefits, and they cannot impose exclusions or require waiting periods for pre-existing conditions. They also cannot be renewed, and a person can only have a maximum of three months of short-term coverage within any 12-month period.
Short-term health insurance coverage is not required to comply with certain federal market requirements for health insurance, principally those contained in the Affordable Care Act. As a result, be sure to check your policy carefully to make sure you are aware of any exclusions or limitations regarding coverage of pre-existing conditions or health benefits, such as hospitalization, emergency services, maternity care, preventive care, prescription drugs, and mental health and substance use disorder services. Your policy might also have lifetime and/or annual dollar limits on health benefits. If this coverage expires or you lose eligibility for this coverage, you might have to wait until an open enrollment period to get other health insurance coverage.
As of 2024, no insurers offer short-term health insurance in Vermont due to the state's restrictive regulations regarding these plans.
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Special Enrollment Period: a 60-day window to enrol or change plans outside of Open Enrollment
In Vermont, eligible residents can enrol in health insurance outside of the Open Enrollment Period (which runs from November 1 to January 15) by applying for a Special Enrollment Period. This is a 60-day window to enrol or change plans triggered by specific life events or changes in household income.
You may qualify for a Special Enrollment Period if you or anyone in your household has experienced certain life events, including:
- Losing health coverage
- Moving
- Getting married
- Having a baby
- Adopting a child
- Death
For example, if you get married on November 27, you can select a new plan that day or up until the 30th and have coverage effective December 1 if you use your special enrolment period. Similarly, if you lose your health coverage, you can choose a new plan within 60 days after your old plan ends, and the new plan will start the first day of the month after your old plan ended.
In addition to life events, changes in household income may also qualify you for a Special Enrollment Period. For example, if you start receiving increased financial help through Vermont Health Connect due to a change in your income, you may be able to change your plan during a Special Enrollment Period.
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Frequently asked questions
Vermont Health Connect (VHC) is the State of Vermont's health insurance marketplace, where eligible Vermonters can get health insurance with financial help.
There are two types of health insurance you can get through VHC: Qualified Health Plans (QHP) or Medicaid for Children and Adults, including Dr. Dynasaur.
You can apply online at VermontHealthConnect.gov or by calling 1-855-899-9600. You can also get help from a certified assister or by visiting one of the five walk-in locations of the Vermont Consumer Assistance Program.
Open Enrollment runs yearly from November 1 to January 15. During this time, you can sign up for a new plan or change your existing plan. You can also apply during a Special Enrollment Period if you experience certain life changes, such as losing your health coverage or a change in your household members.
It's important to carefully review the terms of the plan, including any exclusions or limitations on coverage of pre-existing conditions, health benefits, and lifetime or annual dollar limits on health benefits. You may also want to consider supplemental plans for dental, vision, or accident insurance to meet your specific needs.
