Vermont Health Insurance You Can Buy For Yourself

Health Insurance You Can Buy Yourself

If you cannot get health insurance through your employer, or if you are not employed, you may buy health insurance coverage for yourself and your family. This is called individual or non-group coverage. Please note that if you are employed and your employer offers you health insurance coverage, even if your employer requires that you pay 100% of the premium, you cannot buy individual coverage.

Special Protections for Small Group and Individual Policyholders

Small group policies and individual policies in Vermont contain special protections for Vermont consumers that include:

• "Guaranteed issue." All small group and individual policies are "guaranteed issue." This means health insurers must issue them to all groups or persons eligible under Vermont law to buy such policies, and the insurers must accept every eligible group member or individual.
• "Guaranteed renewable." Health insurers can not cancel your small group or individual coverage even at the end of your policy term (usually one year), because of the number of services you use or a change in your health status, as long as the premium is paid on time.
• "Community rating." Vermont law requires all small group and individual comprehensive major medical insurance policies to offer at least three "tiers" of coverage, which are "community rated." This means that insurance companies cannot make you pay more than anyone else buying the same type of policy because of your age, health condition or where you live. The three most common tiers of coverage are:
  • Single coverage. This covers one adult.
  • Two-person coverage. This covers two adults or one adult and one dependent.
  • Family coverage. This covers two adults and any dependent children, or one adult and two or more dependent children.

State and Federally-Sponsored Health Insurance

You may be eligible for one or more of the following government health insurance programs:

• Medicaid is a state-sponsored health insurance plan paid for by state and federal taxes. You must meet certain income and eligibility requirements in order to get Medicaid coverage. Vermont's Medicaid programs provide coverage for children (Dr. Dynasaur), coverage for uninsured low-income Vermonters (Vermont Health Access Plan [VHAP]), and coverage for low-income families with children or people who are disabled.
  
  For more information contact the Office of Vermont Health Access (OVHA) at 800-250-8427 or call your local Department of Children & Families (DCF) district office, listed in your telephone book.
• Medicare is a federally funded health insurance program for people age 65 and older and certain disabled people under age 65. Most people who qualify are covered under one or more of the three parts of Medicare shown below:
  • Part A covers hospital charges. You do not have to pay anything for Part A coverage if you have paid into the federal Social Security program for at least 40 quarters.
  • Part B covers physician and other professional health care services. You pay a monthly premium for Part B coverage, which is deducted from your Social Security check.

Supplemental Insurance for People who have Medicare

• medicare supplemental (or Medigap) insurance is also available to pay for benefits not covered by Medicare. It is offered through insurance companies and covers some of the cost of services not covered by Medicare, such as coinsurance, deductibles and co-payments and may include additional benefits for certain services. It is therefore a "supplement" to the basic Medicare policy. Your current options in Vermont include seven standardized plans (known as plans A, B, C, D, E, H, and J,) each of which has specific benefits. Two new plans, K and L, will be offered effective January 1, 2006.
  
  If you apply for a Medicare supplement policy within six months of when you enroll in Medicare Part B, the insurance company must accept you. All insurance companies that offer Medicare Supplement policies to people who are 65 years or older, must now offer the same policies to people who are under 65 years old, disabled and are in the first six months of Medicare eligibility.
  
  If you have Medicare and you are not sure which Medigap choice is best for you, call 1-800-MEDICARE or visit the Medicare website at www.medicare.gov. You may also contact the State Health Insurance Assistance Program (SHIP) at 800-642-5119.