Vermont’s Proposed Essential Health Benefits

Timeline for Health Care Reform

When the Supreme Court upheld the Affordable Care Act in June Vermonters had a much clearer idea of what health care reform will look like in our state over the next couple years.  As required by federal law, Vermont has begun to set up our state “health benefit exchange” that will go online in January of 2014. As part of the Affordable Care Act these exchanges are being set up in every state in the country. The exchange will be where many Vermonters get their health insurance until we transition to a publicly financed health care system that covers all Vermonters in 2017.

What is the Health Benefits Exchange?

The “health benefits exchange” is the new state regulated marketplace which will offer consumers the ability to choose an insurance plan from a set of benefits packages at price levels that work best for them. Vermonters will have the choice of three different benefits packages at varying price levels. There will be one package selected by the state, and two other plans offered by the federal government. Individuals and small businesses will start enrolling in the exchange as early as October of 2013, and low income individuals will receive federal subsidies for insurance plans bought through the exchange.

Where are we now?

Vermont is getting ready to put its new health exchange online in a little over a year. This means that we have to make some big decisions between now and then. The people in charge of making these decisions are the Green Mountain Care Board. The board is made up of health care experts and members of the business community that have been appointed to make many of the important decisions impacting the state. One of the biggest decisions they are currently considering is what will be covered in the standard benefits package.

What is the essential health benefits package?

Federal law requires the state to choose a benefits package to be the baseline for all other plans they offer through the exchange, this package is referred to as “essential health benefits” package. Though all of the state regulated plans would cover the same services, consumers will be able to choose how much they want to pay depending on the level of coverage that is right for them. Earlier this month the state proposed a benefits package based off of what is currently offered in the Blue Cross Blue Shield Blue Care plan. You can find out the specifics of the plan by clicking here, or you can review the quick summary below.

What will my choices look like?

We have a good idea of what types of plans people will be able to choose from under the exchange.  Consumers will be able to choose their level of coverage based off of what level of coverage is right for them. The four types of plans that will be offered are

  • Platinum- One plan similar to the most popular Vermont state employee plan. This includes a moderate deductible and comparatively small out-of-pocket maximum.

  • Gold- One plan similar to the Catamount Health plan.

  • Silver- Two plans: one deductible plan consisting primarily of co-pays, and one high deductible plan consisting primarily of co-insurance. 

  • Bronze- Two plans: one deductible plan consisting primarily of co-pays, and one high deductible plan consisting primarily of co-insurance.


 Options for Low Income Individuals

Under the Affordable Care Act, low to moderate income individuals will receive affordability assistance from the federal government. These individuals will be provided with reductions for out-of-pocket costs as well as tax credits to lessen the burden of premium costs. The percentage of your income you can be asked to pay in premiums changes depending on how much a person makes and the size of your household. Check out this chart If you want more specifics about these subsidies check out what low income individuals can be expected to pay for plans bought through the exchange.

Let the Board know what you think

The Green Mountain Care board will be voting to accept, reject or modify the proposed benefits package on Sept 20th, and they want to hear from you. If you have comments or concerns about what has been proposed you can submit a comment directly to the board by clicking here.

What’s next?

This is only one of many important health care decisions that will be made over the coming weeks and months. We will make sure you keep up to date on how these decisions will impact your life, and ways that you can help make sure that we have a health care system that works for all of us.


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