Residents of the Green Mountain State are spoiled when it comes to health care. According to a study by US News, Vermont has the sixth best health care in the nation! The study accounts for health care access, quality, and overall public health.
Health insurance options in Vermont
According to Vermont’s Insurance Division, residents have several options for health care:
Employer-provided
- From your employer
- Through your spouse's employer
Individual or family plans
- Through HealthCare.gov
- Directly from a health insurance company
Government-assisted
- Medicare
- Medicaid
Where do most Vermont residents get their health insurance coverage?
| Sources | Percent | ||
|---|---|---|---|
| Employer-Provided | 49% | ||
| Individual or family | 6% | ||
| Medicaid | 23% | ||
| Medicare | 16% | ||
| Military | 1% | ||
| Uninsured | 4% | ||
| Source: Kaiser Family Foundation, Health Insurance Coverage of the Total Population | |||
Only four percent of VT residents are uninsured, a great deal less than the national average. That’s good news for policyholders, as the more uninsured people there are, the higher prices are for insured people.
Vermont health insurance companies
VT residents have a few options for health insurance companies in their state. These providers offer both individual and family plans in your state:
- BlueCross BlueShield of Vermont
- MVP
Vermont health insurance costs and rate factors
VT residents spend an average of $10,190 on health care every year, more than the national average. What influences your prices in the Green Mountain State? Costs vary person to person, but are based primarily on these factors:
Plan type
Marketplace plans come in metal tiers: bronze, silver, and gold. The more coverage you want, the more you’ll pay.
So, how much should you expect to spend on health care every month? These are the average monthly prices for each plan type for a middle-aged VT resident in 2020:
| Bronze | Silver | Gold | |
|---|---|---|---|
| $476 | $645 | $652 | |
| Source: Kaiser Family Foundation, Change in Average Marketplace Premiums by Metal Tier | |||
Premiums for a gold plan cost about 37 percent more than for a bronze plan. That’s because gold plans cover 80 percent of medical costs, whereas bronze plans cover 60 percent of costs.
VT residents may also qualify for a catastrophic plan, the lowest level of coverage available in the marketplace. Catastrophic plans have low monthly premiums but a yearly deductible of $8,150. Because of that deductible, it may save you money to invest in a bronze or silver plan if you need preventative care.
Body mass index
According to the CDC, a high body mass can lead to serious health conditions. Because of this, insurance companies analyze your BMI to determine your risk-level. A high BMI means higher premiums.
In 2019, VT had a 27 percent obesity rate, the 6th lowest in the country. Of the many state residents who used QuoteWizard to compare health insurance plans, 23 percent had a BMI in the obese range.
Tobacco use
Tobacco users spend more on health insurance because of the high risks from smoking. About 17 percent of VT residents are smokers, the 23rd lowest rate in the country.
Age
Health insurance plans cost up to three times more for older people compared to younger people. State residents who used QuoteWizard to shop for health insurance are, on average, 40 years old.
Location
Where you live plays an important role in your rates. Every state has different health insurance laws, regulations, and providers. Options can even vary between counties.
Insurance companies use a community-rating to determine your premiums. That means your rates are partly based on the combined claims that everyone files. So, if your state files an abnormally high number of claims, your prices could skyrocket.
So, your state’s overall health is a part of how much you pay for insurance. According to America’s Health Rankings, VT is the third healthiest state in the country! That’s a great sign for policyholders and insurance shoppers.
Vermont health insurance laws
The Affordable Care Act restricts health insurance companies from using certain factors when pricing your policy.
- Pre-existing conditions: Insurance companies used to charge you more if you had a pre-existing condition. The ACA limits companies from using that as a reason to raise your prices.
- Gender: Providers also can’t charge women and men different prices for the same plan. That’s good news, especially because women historically pay more for health care.
- Insurance and medical history: Insurance companies also used to analyze your medical history and past insurance coverage to determine your prices. Now, they can’t charge you more for previous medical problems or lapses in insurance coverage.
There’s a limit to how much you’ll pay out-of-pocket for a marketplace plan. In 2020, the out-of-pocket maximum is $8,150 for an individual plan and $16,300 for a family plan.
Vermont state law requires health insurance companies to offer at least some coverage for the following services:
- Prosthetic device
- Chiropractic services
- Maternity coverage
- Chemotherapy treatment
- Clinical trials for cancer patients
- Diabetes treatment
- Child vaccine benefits
- Home health care
There are additional services that providers need to offer coverage for. Find the entire list on cms.gov.
Medicare and Medicaid in Vermont
Medicare and Medicaid are both government-funded health care programs. Medicare helps seniors, whereas Medicaid aids low-income families and children.
Medicare
VT residents 65 and over qualify for Medicare. There are several coverage options within the program, including parts A, B, C, D, and supplemental coverage plans. You may also qualify for a Medicare Savings Program:
- Individual monthly income limit: $1,456
- Married couple monthly income limit: $1,960
Medicaid
Medicaid aids low-income families and children. These are the state’s Medicaid financial requirements:
| Household Size | Maximum Yearly Income |
|---|---|
| 1 | $16,971 |
| 2 | $22,930 |
| 3 | $28,888 |
| 4 | $34,846 |
| 5 | $40,805 |
| 6 | $46,763 |
| 7 | $52,722 |
| 8 | $58,680 |
Vermont Department of Financial Regulation - Insurance Division
- Website:
- Homepage
- Insurance Commissioner:
- Michael S. Pieciak
- Insurance Hotline:
- (802) 964 – 1784
- Office Hours:
- Monday - Friday
7:45am to 4:30 pm
- File a Consumer Insurance Complaint
- Complaint Page
Sources:
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