See your Vermont health insurance coverage options now.

Vermont operates a state-run health insurance marketplace, called Vermont Health Connect. The marketplace offers coverage for individuals and families who need to purchase their own health insurance policies.

This includes people who retired prior to Medicare eligibility, people who are self-employed, and people who are employed by a small company that doesn’t provide health benefits. Financial assistance (to offset premium costs and out-of-pocket medical costs) is available through Vermont Health Connect, depending on the applicant’s household income.

Vermont has long been a health reform pioneer. The state had planned to convert to a single-payer system in 2017, but abandoned that plan in late 2014. Lawmakers in the state’s legislature have recently renewed the push for a single-payer system, with H.129, introduced in 2019, and H.860, introduced in 2020, although neither bill made it out of committee.

Vermont implemented an individual mandate as of 2020, requiring residents to maintain minimum essential health insurance coverage. But the state has not yet established any sort of penalty for non-compliance (so the mandate is essentially the same as the federal individual mandate, which no longer has a penalty for non-compliance).

Read our overview of Vermont’s health insurance marketplace.

In Vermont, the open enrollment period for individual/family health coverage runs from November 1 through January 15, which is the same schedule that’s used in the states that rely on the federally-run exchange. You can learn more about open enrollment in our comprehensive guide.

Outside of open enrollment, a qualifying event is generally necessary to enroll or make changes to your coverage. But enrollment in private plans through the exchange is available year-round to Native Americans and to subsidy-eligible enrollees whose household income doesn’t exceed 200% of the poverty level.

(In most states, this income-based year-round enrollment opportunity is limited to those with household income up to 150% of the poverty level, but Vermont’s additional state-funded subsidies make the benchmark plan premium-free at higher income levels.)

In addition, people who are eligible for Vermont Medicaid and Dr. Dynasaur coverage can enroll at any time, and do not need a qualifying event.

In Vermont, consumers may be able to buy affordable individual and family health insurance by enrolling through the ACA marketplace (HealthCare.gov). Nearly 90% of consumers who enrolled in 2022 coverage through their state exchange received premium subsidies.

Vermonters may also find affordable coverage through Medicaid if they’re eligible. See Medicaid eligibility guidelines in Vermont.

For 2023 coverage, there are two insurers that offer exchange plans in Vermont:

• Blue Cross Blue Shield of Vermont
• MVP

Both insurers also offer plans that can be purchased directly, instead of via the health insurance marketplace,  for people who don’t qualify for premium subsidies. (Subsidies are only available if the plan is purchased via the marketplace.)

Overall, the weighted average rate increase for 2023 was about 15% in Vermont, which was considerably above the national average for 2023. But premium subsidies grow to keep pace with the cost of the benchmark plan (second-lowest-cost silver plan), and subsidies continue to be larger and more widely available thanks to the American Rescue Plan and the Inflation Reduction Act. Vermont also has its own state-funded subsidies, in addition to the federal subsidies, which help to keep coverage more accessible than it would otherwise be.

The entire state of Vermont is one rating area (premiums don’t vary from one part of the state to another), and premiums in Vermont do not vary by age. Vermont also prohibits insurers from imposing a tobacco surcharge, so tobacco users in Vermont do not pay higher premiums. 

Vermont used to merge its individual/family and small group health insurance markets, but did away with that as of 2022. So the small group market and the individual market are now separate in terms of setting premium rates. 

26,705 people enrolled in private plans through Vermont Health Connect during the open enrollment period for 2022 coverage.

Before the ACA, Vermont was one of only a handful of states where individual healthcare insurance was not medically underwritten; this had been the case since 1992. This means that medical history was not used to determine eligibility for coverage. In addition to guaranteed issue policies, the state also utilized community rating, so premiums were not higher for older insureds (this is still the case; Vermont and New York are the only states where insurers cannot charge older applicants more than they charge younger applicants).

Although these are good measures to protect consumers, they are not necessarily beneficial for health insurance carriers looking to make a profit, thus the market had destabilized significantly by 2006. The legislature passed a measure in that year that contained a variety of reforms, and the ACA later piggy-backed nicely on what Vermont was already doing.

Because Vermont had a law that required all policies to be guaranteed issue, there was no need for a state-run high-risk pool prior to the ACA, but the law did still provide PCIP coverage in Vermont starting in 2010.

In 2013, about 7.2% of Vermont residents did not have medical insurance – far lower than the national average and the fourth-lowest rate in the country.

By 2016, with just 3.7% of its population uninsured, Vermont had cut its already-low uninsured rate nearly in half. The uninsured rate crept a little higher in 2017, to 4.6% (nationally, there was also a slight uptick in the uninsured rate in 2017, after President Trump took office), but it dropped down to 4% by 2018 (nationwide, the uninsured rate increased again in 2018, but Vermont bucked that trend). It increased in 2019, however, to 4.5%. But that was still less than half the nationwide average uninsured rate.

As of early 2022, there were 25,799 Vermont residents who had coverage through the exchange. All of them had coverage for the ACA’s essential health benefits, and 88% were receiving ACA premium subsidies to offset the cost of their coverage. And by mid-2022, nearly 189,000 Vermonters were enrolled in Medicaid/Dr. Dynasaur coverage, some of whom were eligible due to the ACA’s expansion of Medicaid. 

Vermont’s Congressional delegation is fully supportive of the ACA. Senators Patrick Leahy and Representative Peter Welch are both Democrats, and although Senator Bernie Sanders is an Independent, he caucuses with the Democrats and has long been in favor of expanding on the ACA with a Medicare for All proposal (during both of his presidential campaigns, Sanders temporarily became a Democrat).

Former Gov. Peter Shumlin was not only supportive of the ACA, he was also the first governor in the country to actively pursue the clause in the law that allows states to take it one step further and eventually implement a state-based single-payer system. Green Mountain Care was set to begin as early as 2017, but the state abandoned its progress toward a single-payer system at the end of 2014 – though, it still has its proponents and legislation was introduced in 2019, 2020, and 2021 to revive the idea.

In 2016, with Shumlin term-limited, a new governor was elected. Phil Scott, a Republican, was among a group of nine bipartisan governors who signed a letter in 2017 asking Congress to drop the Graham-Cassidy ACA repeal measure that was then under consideration, and instead focus on bipartisan efforts to stabilize the individual Health Insurance Marketplace. Scott was re-elected in 2018.

Utilizing federal funds to expand Medicaid eligibility to 138% of the poverty line has played a role in Obamacare’s success in Vermont. But the state had worked to implement accurate eligibility redetermination processes between 2016 and the start of the COVID pandemic, to ensure that people were enrolled in the correct coverage.

As a result, total Medicaid/CHIP enrollment in Vermont was 7% lower in late 2019 than it had been in late 2013 (as opposed to an average increase of 26% nationwide). But there has been a nationwide increase in Medicaid enrollment as a result of the job losses caused by the coronavirus pandemic, and by mid-2022, Medicaid/CHIP enrollment in Vermont was 17% higher than it had been in 2013 (nationwide, the enrollment growth had reached 57% by that time).

Medicaid eligibility redeterminations have been paused nationwide since the start of the pandemic, but will resume once the COVID public health emergency ends. 

Read more about Medicaid expansion in Vermont.

Although Vermont does not prohibit short-term health insurance plans, the state’s benefit mandates and the requirement that plans cover pre-existing conditions make Vermont’s short-term market unappealing for insurers. As a result, no insurer is currently selling short-term health insurance plans in the state.

Read more about short-term health insurance regulations in Vermont.

As of August 2022, there were 158,373 Vermont residents with Medicare coverage. This is more than 24% of the state’s population – the national average is about 19%, but Vermont’s population is older than the national average.

In Vermont, nearly 13% of Medicare beneficiaries are under age 65 and eligible for Medicare because of a disability. The other 87% are at least 65 and eligible for Medicare due to their age (nationwide, 12% of Medicare beneficiaries are under age 65).

Read more about Medicare in Vermont, including the state’s rules for Medigap plans.

Vermont had initially planned to implement a single-payer system, but those plans were abandoned in late 2014 amid cost concerns. But the Green Mountain Care Board voted in 2016 to sign the All-Payer Model Agreement.

This agreement between the State of Vermont and the Centers for Medicare and Medicaid Services is designed to transition the state’s health plans away from fee-for-service reimbursement and incentivize doctors who keep people healthy – something former Governor Peter Shumlin said made Vermont the first in America to do so.

In 2017, the state began piloting the all-payer model, OneCare, with 2,000 providers and 30,000 Medicaid insured patients. In 2018, the all-payer model was expanded to include nine of the state’s 14 hospitals (some are only partially participating, with Medicaid patients only), and OneCare provided care to roughly 120,000 patients in 2018. By 2019, that number had grown to 175,000 Vermonters. Details and updates about the state’s all-payer program are available here.

The All-Payer Accountable Care Organization Model Agreement was initially approved from 2018-2022. It has been extended through the end of 2023, and likely through 2024, with plans for a new model to start in 2025.

• Vermont Health Connect — Health insurance marketplace/exchange. Individuals and families use the marketplace to obtain health coverage, with financial assistance based on income.
• Filing an insurance complaint in Vermont
• Vermont State Health Insurance Program — A local service that provides enrollment counseling and assistance for Medicare beneficiaries
• Medicare Rights Center — A service that can provide assistance with Medicare-related questions and issues. Includes a website and call center.

Vermont enacted an individual mandate in 2020, but lawmakers failed to agree on a penalty for non-compliance. As a result, the mandate has thus far been essentially toothless, with no penalty for non-compliance.