Vermont Health Care Exchange Frequently Asked Questions (FAQs)

Aug 2, 2013

Credit Flickr/Alex E. Proimos

What is the health care exchange?

Vermont Health Connect - Vermont's health insurance exchange - is a web-based marketplace where Vermonters can go to get health care coverage, whether that is public or private. This can be compared to sites like Travelocity, where people can enter information about what they are looking for and then compare an array of options available for purchase.

The exchange is not a health insurance company or a health care company. The plans in Vermont Health Connect will be provided by either private health insurance plans or public coverage like Medicaid.

When will the Vermont Health Connect be up and running? 

October 1, 2013. But the coverage for any plans on the exchange does not begin until January 1, 2014.

What are differences between the “metal levels” on Vermont Health Connect?

The exchange offers Platinum, Gold, Silver, and Bronze level plans. The benefit package provided at each “metal level” are the same, however, the co-pays, deductibles, and premiums vary by level. This allows people to shop between companies while still receiving the same basic health care services. The baseline of what must be covered under each these plans is set by the Affordable Care Act.

Will individuals be able to access plans with high deductibles via Vermont Health Connect?

High deductible plans are available on the exchange.

Should Vermonters be concerned that their rates will go up?

The premiums in the exchange are consistent with those on the market today. However, Vermont Health Connect plans provide higher levels of coverage than many external plans. Users will be able to pair higher deductible plans with a health savings account under the exchange.

If you qualify for Medicare or are on disability benefits, do you have to buy coverage through Vermont Health Connect?

No. If you are receiving Medicare or disability benefits you will continue to receive your government benefits and will not have to buy coverage through Vermont Health Connect. The exchange is for people under 65 who are not receiving Medicare benefits to access health insurance.

Will Medicare beneficiaries have to purchase their supplementary coverage through Vermont Health Connect?

No. At this stage the exchange does not provide these types of supplemental “Medigap” plans. Medigap plans will continue to be sold outside of Vermont Health Connect.

Will the exchange have implications for health insurance coverage for state employees?

There are no changes for state employees or for other employees who work for large businesses. You will continue to receive your coverage as you did before the exchange. Vermont Health Connect is for individuals and for small employers with 50 employees or fewer.

What will happen to businesses in the next couple of years?

Beginning in 2016, businesses with 100 employees or less will be required to buy into the exchange. By 2017, the state hopes to have a single-payer system where every Vermonter is contributing to, and participating in, Green Mountain Care.

How will the exchange affect Vermont Health Access Plan?

It depends on your income. About 80 percent of people who currently qualify for VHAP will move into Medicaid because the Affordable Care Act raised the income cap for Medicaid. The top 20 percent of people (in terms of income) who qualify for VHAP will go into the exchange, but will qualify for a federal premium tax credit and a state subsidy to assist with paying for their plan.

Will people who move from Catamount and VHAP to the exchange be subject to higher costs? Either in terms of premiums or out of pocket expenses?

It will be different for every individual case. With federal tax credits and the state based premium assistance program, some people currently on Catamount will see lower premiums, while some may see higher premiums.

Will the premium assistance program be available for individuals who currently have private plans?

Yes.  

What is the cut-off point for federal assistance in the exchange?

The cut-off is 400 percent of the federal poverty level. For a single person the income cap would be roughly $46,000, for a couple the cap would be around $62,000, and for a family of four the cap is $94,000. Under these caps, individuals then pay a certain percentage of their income for their premium. The lower your income, the lower the percentage of your income you pay for coverage. Vermont Health Connect provides a calculator on their website where Vermonters can find out what type of premium they may be eligible for based on family size and income.

How do you access the health care exchange if you don’t have a computer?

Vermont Health Connect will have representatives who can sit down with you in person and go over your options on the exchange. There will also be a phone number you can call for information.

Is Vermont Health Connect available for individuals working for companies with more than 50 employees if their workplace-based coverage is deemed “unaffordable”?

Anyone can buy plans from Vermont Health Connect at full price. If the portion of the annual premium the employee must pay for self-only coverage exceeds 9.5% of household income (the standard for "unaffordable"),  you can apply for financial assistance through Vermont Health Connect.

If your employer is offering you affordable coverage, can you still go into the exchange as an individual?

Yes. You can buy plans for full price on the exchange as an individual. You can only receive financial assistance for your plan through the exchange if your employer is not offering coverage of if this coverage is "unaffordable."

How will the exchange impact the Dr. Dinosaur Program?

Dr. Dinosaur and other children’s health care programs will remain unchanged.

How will Vermonters be able to access information about the differences between different levels of plans and different plans within each level?

Starting on October 1, 2013,  the Vermont Health Connect website will be interactive and you will be able to click on all the different plans and access information about them. You will also be able to do a side-by-side comparison of plans via the website like you are able to do with other products, such as airline tickets or cars. However, there will be no differences in services covered. The differences will be in co-pays, premiums, out of pocket expenses, and deductibles.

How is single-payer system factored into the design of the current exchange?

All the technology and resources developed for the exchange will be reusable for the state’s single-payer goals in the future. 

Click here for a glossary of terms provided by Vermont Health Connect.

Click here for an FAQ provided by Vermont Health Connect.

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