One of the northernmost New England states, Vermont it the second least populous state in the country. Settled in the Green Mountains, the state is also very green in lifestyle and environment. Consistently considered one of the healthiest states, Vermont residents are few but are aware of wellness for the most part. Vermont is also known equally for its progressive law making as its ski resorts. Health insurance is guaranteed issue in the state, which makes it available to all residents through all insurers.
Residents of Vermont can purchase individual health insurance through Green Mountain Care and Catamount Health. East Coast Health Insurance is not yet licensed in Vermont, therefore use this page as a guide to the health system in your state.
For the past 3 years consecutively, Vermont has been the most healthy state in the nation. According to the UnitedHealth Foundation rankings, many positive statistics contribute to Vermont’s success. Undoubtedly, there can be much credit given to the institution of guaranteed issue policies. Vermont seeks more prenatal care that any other state, and there are plenty of primary care doctors available for use. They have one of the lowest percentages of uninsured residents as well, at 9 percent of all Vermonters. The mountain location adds to the good health of Vermont, as there is one of the lowest counts of air pollution.
As with everywhere else in the nation, obesity has increased in Vermont over the past ten years. Currently, nearly 24 percent of adults are considered obese. Diabetes also increased, though both factors are still some of the least drastic in the country. There is also an incredibly low account of infectious disease in Vermont, and public health funding is considerably higher than most other areas. The whole nation could use a healthier approach to food and physical activity, it seems, but overall Vermont is doing a great job to stay healthy and nurture its health care system.
Health Insurance Plans
Catamount Health is a health insurance plan available to residents of Vermont who are 18 or older and families. The state of Vermont, Blue Cross Blue Shield of Vermont, and MVP Health Care collaboratively offer this plan with high quality, comprehensive coverage. There is no income limit for Catamount Health plans, and if you have low income you may be eligible to receive premium payment assistance.
- Individuals who are not eligible for other Green Mountain Care Plans including the Vermont Health Access Plan (VHAP) or premium assistance programs.
- Individuals who have been uninsured for at least 12 months, except of those who have recently lost coverage due to a life event such as employment loss or divorce.
- Those who have been enrolled in an individual plan for a minimum of six months with a deductible of at least $7500 individuals, or $15,000 for families.
- Premium assistance is not available until you have been on the plan for at least 12 months.
- Some college students may qualify for Catamount Health.
Plan Details & Covered Services
- Physician office visits for $10 copay
- Checkups and screenings
- Hospital care
- Emergency services
- Chronic disease care
- Prescription medications ranging from $10 to $55
- $500 deductible for individuals
- $1000 deductible for families
Income and Premiums
The monthly premium cost is evaluated based on your monthly income level with Catamount Health plans. By offering fair rates with each company administering coverage, Catamount Health gives Vermonters the opportunity to pay what they can afford. The household size is determined by the number of individuals living under the same roof.
For more information about Catamount Health, contact Green Mountain Care at 800 250 8427.
Public Health Options
Green Mountain Care provides the majority of Vermont low cost or free health insurance programs administered by the state or jointly through a private insurer. Various programs exist to help those who cannot otherwise afford health insurance, including Medicaid, Dr. Dynasaur, and Vermont Health Access Plan. As a guaranteed issue state, neither income nor health status can prohibit a Vermonter from obtaining coverage. The Vermont Department of Health also offers a variety of services to assist individuals in need.
- Medicaid: medical coverage for Vermont children, families, pregnant women, and those who are blind, disabled or elderly. Refer to this article for more information about Medicaid eligibility in Vermont.
- Dr. Dynasaur: health insurance for children under age 18 and pregnant women in Vermont.
- Vermont Health Access Plan (VHAP): coverage for low-income adults who meet certain income criteria and have been without insurance for at least 12 months.
- Prescription Assistance: several programs to help Vermont residents without insurance and Medicare beneficiaries pay for prescriptions is they meet the program requirements.
Health Insurance Laws
As a guaranteed issue state, Vermont health insurance laws are clearly very consumer-friendly. Guaranteed issue makes it possible for all Vermonters to receive individual coverage if they are not eligible to obtain health benefits through their employer. Regardless of any resident’s health status or medical history, they must be approved by all insurance companies for all products offered in the state. Additionally, civil unions must be recognized on all family health plans sold in the state.
However, despite all individuals being accepted for coverage, the state’s insurers can still make certain exceptions for pre-existing conditions. Pre-existing conditions are considered any condition that an individual may have been able to use care for in the 12 months before they applied for health insurance. If they feel inspired, a Vermont insurer can add an exclusion period of up to 12 months, refusing to pay for any treatment of the pre-existing condition. Elimination riders are not permitted for use among Vermont insurance companies, thus the limit on exclusions is 12 months.
An exclusion period will be waived if you have proof of prior creditable coverage. The look back period is only applicable to individuals who will receive an exclusion period. Premiums are also judged fairly in Vermont, as they are regulated at the state level. All individuals must be offered the same premium rates, with no basis on age, gender, lifestyle, locale, or medical history. Standardized policies are also not required from any insurer in Vermont, therefore they issue their own company-specific plans.
Guaranteed renewal also applies to Vermont health insurance policies. Despite your health condition, your insurer is required to renew your benefits for individual health insurance as long as you have paid your premiums in a timely manner and not committed fraud. Certain HMOs require members to stay in the service area to be eligible for guaranteed renewal.
Mandatory benefits in Vermont include alcoholism and drug abuse treatment, breast reconstruction, clinical trials, contraceptives, diabetic supplies, emergency care, home health care, mammograms, maternity care and hospital stays, mental health care, PKU/Formula, and TMJ disorders.
Coverage is mandatory for newborns and adopted children under their parent’s policy, dependents with disabilities, non-custodial children, and continuation/dependents under their guardian’s policy, domestic partners, conversion to non-group coverage, and continuation/employees.