The Affordable Care Act was signed into law to improve the quality, affordability, and accessibility of healthcare across the country.  As a result of this, the federal government requires that in 2014 all states offer a marketplace (also known as an exchange) where individuals and small businesses may purchase health care plans.

The Health Assistance Program at the University of Vermont Medical Center is designed to assist income eligible patients to afford the health care they need. Here, in order to better serve our patients, we have been certified as “Navigators” to help individuals and small businesses tread the uncharted waters of selecting and enrolling in a health insurance plan.

Each state was given the option of putting in place their own exchange, or having the federal government do it for them. Since Vermont already had robust health care programs in place, we opted to implement our own exchange, naming it Vermont Health Connect. Open enrollment for Vermont Health Connect begins October 1, 2013 for selecting coverage that starts January 1, 2014.

You may have heard that there are quite a few options to choose from, including different carriers, levels of coverage, and financial assistance for those who qualify.  The private carriers offering plans on Vermont Health Connect are Blue Cross Blue Shield of Vermont (BCBSVT) and MVP Health Care.  All plans are required to cover the same 10 essential benefits as follows:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care

The level of coverage, Platinum, Gold, Silver, and Bronze refers how much is paid for by the insurance plan, and how much is paid out of pocket by the consumer.

Metal LevelsTo put this in context, a Platinum plan would cost the consumer more in monthly premiums, but less out of pocket for services received. This would be a good choice for someone who has a chronic condition with frequent health care visits and medical needs. On the flip side, a healthy adult that just uses preventive services could select a lower level such as Silver plan to pay less in premium each month.

Financial assistance through reduced premiums and out-of-pocket costs will be available to Vermonters with annual incomes at approximately $46,000 for an individual and $94,200 for a family of four.  Additionally, Medicaid is expanding to cover more low income Vermonters and the Dr. Dynosaur program will remain the same.

We can imagine that this is all very confusing and want Vermonters to know that we are here to help! Please contact the Health Assistance Program Navigators at (802)847-6984 with any questions and to set up in-person assistance with enrollment.

For more information you can visit the Vermont Health Connect website at http://healthconnect.vermont.gov

Maya Thompson and Amanda Biggs are Case Managers and Ann Slattery is the lead for the Health Assistance Program in Community Health Improvement at the University of Vermont Medical Center.

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