How to Apply - Individuals & Families

If you need to pick a Vermont Health Connect Qualified Health Plan (QHP) for the first time, here's what to do:

• Go to the Vermont Health Connect website to:
  • Find out if you qualify for Medicaid, for Dr. Dynasaur or for help paying the insurance premium or other costs
  • Find out how much help you qualify for
  • Compare the costs of each plan's monthly premium, copays and coinsurance
  • Pick a health plan and enroll online
• To get help picking the best plan for yourself and/or your family:
  • Call or meet with trained helpers called navigators or assisters
  • Call the Vermont Health Connect Customer Support Hotline: 1-855-899-9600
    • Hotline hours: Monday-Friday, 8 a.m. - 8 p.m.

After the open enrollment period ends, you can’t buy a health insurance plan through Vermont Health Connect (VHC) unless you have a "qualifying event." You can apply for Medicaid or Dr. Dynasaur any time of the year - you don't have to wait for open enrollment.

If you already have a plan from Vermont Health Connect and want to keep it, or if you want to change to a different plan, keep reading to find out what you need to do.

If you already have a Vermont Health Connect plan and you want to keep the same plan next year, you won't have to do anything except keep paying your premium. Your plan will be automatically renewed. In 2019, the prices for VHC silver plans increased significantly. It is a good time for everyone to look at the Plan Comparison Tool and make sure that they are on the best plan for their household. 

If you want to change the plan you got through Vermont Health Connect, you can change it during open enrollment. The open enrollment period is November 1 - December 15. Here's how it works:

1. Before open enrollment starts, you should get information about the cost of next year's plan in the mail. It will tell you what to do if you want to change plans. It will also tell you how to report changes in your income or household size.
2. Follow the directions for changing your plan.
3. If you want your new plan to be active on January 1, you will need to choose a new plan by December 15 and pay the premium as early in December as possible. The fastest ways to pay are online or by phone.

“Navigators” and “assisters” can give you one-on-one, in-person help with Vermont Health Connect. Their help is free.

They help you apply for health insurance and financial help. They also help you pick a plan and sign up for a plan. They explain Medicaid and other health insurance plans.

• Follow this link to find navigators near you.
• Follow this link to see a list of in-person assisters.

Help from the HCA

Do you have a question or issue that you have not been able to get answered or solved?

Call the Office of the Health Care Advocate (HCA) at 1-800-917-7787. To speak with an advocate, call during business hours (8:30 am - 4:30 pm, Monday - Friday, except holidays) or call anytime and leave a message. You can also ask for help by filling out our Help Request Form.

After you enroll in a plan, you need to tell Vermont Health Connect if your income or household size changes. You can report changes by calling the VHC Call Center at 1-855-899-9600. Or you can log into your VHC account and report most changes online.

Do you qualify for Medicaid and Dr. Dynasaur? Eligibility is based on the Federal Poverty Level (FPL) guidelines for the current year.

• The monthly income limit for Medicaid is 138% of the Federal Poverty Level for your household size.
• Women who are pregnant and whose monthly income is up to 213% FPL qualify for Dr. Dynasaur. Dr. Dynasaur provides the same coverage as Medicaid, plus full dental coverage. There are no premiums or prescription copays with this type of Dr. Dynasaur.
• The monthly income limit for Dr. Dynasaur for children is 317% of the Federal Poverty Level for your household size. (For more information, visit the Green Mountain Care website.)
• Children and youth who qualify for Dr. Dynasaur will be covered until their 19th birthday. 

Vermonters who do not qualify for Medicaid or Dr. Dynasaur may qualify for help paying for premiums and cost-sharing for Vermont Health Connect plans.

Vermonters who do not qualify for Medicaid may be able to get help that will lower premiums and cost-sharing for Vermont Health Connect plans.

You may get help if:

• your annual income is between 138% and 400% of the previous year's Federal Poverty Level (FPL) — for 2019 plans, use the 2018 FPL,
  or
• your annual income is below 138% and you are an individual from another country who is legally present, but who cannot get on Medicaid because of your immigration status

Vermont Health Connect will tell you if you qualify for financial help when you apply. VHC will also tell you how much help you can get.

You can use the Vermont Health Connect Plan Comparison Tool right now to find out how much help (Premium Tax Credits) you may be able to get to pay your monthly insurance premiums.

If You Disagree

If you don't think the amount of premium assistance and cost-sharing help are right for your income and household size, you can:

• Appeal the decision
• Contact our Office of the Health Care Advocate for help
  • Call 1-800-917-7787 or
  • Fill out our online help request

If You or Your Spouse Has an Offer of Insurance

If you have an offer of insurance through your employer or your spouse’s employer, you can still buy insurance through Vermont Health Connect during an open enrollment period. However, you can only get help paying premiums and cost-sharing if you meet the premium and cost-sharing income requirements and if the employer’s insurance:

• doesn't offer the 10 Essential Health Benefits required by law OR
• isn't “affordable” (Affordable means that the cost of the employee-only insurance premium is less than 9.56% of total household income. Use this online tool to see if your insurance is affordable.)

Tax Status, Domestic Violence and Abandoned Spouse

You cannot qualify for Premium Tax Credits if your tax filing status is Married Filing Separately, unless you are a victim of domestic violence* or you are an “abandoned spouse.” Abandoned spouse means that you are married, but you don’t know where your spouse is.

Domestic violence victims and abandoned spouses should call Vermont Health Connect at 1-855-899-9600 or work with a navigator to apply for help paying your monthly insurance premium (Premium Tax Credits.)

To find out how much help (Premium Tax Credits) you may be able to get to pay your monthly insurance premiums, use this online tool. Only include you and your dependent children and only count your income when you fill it out.

If your income is above 400% of the FPL, you can buy a Vermont Health Connect plan during open enrollment, but you will not be eligible for premium or cost-sharing help.

See the Insurance Costs and Subsidies section of this website for more information about premium and cost sharing help.

If your income is over 400% and you will not qualify for premium or cost-sharing help. You have two ways to enroll in a Vermont Health Connect Plan:

• You can enroll directly with the insurance company that offers the plan you want to purchase
  • Follow this link to enroll directly in a Blue Cross Blue Shield of Vermont plan.
  • To enroll directly in a MVP plan, call 1-800-825-5687 or go to the MPV Vermont page.
• You can still enroll through Vermont Health Connect. Please note: In 2019, if you want to enroll in a silver plan and are not eligible for premium help, you should enroll in  “Reflective Silver” directly through the carriers. If you want to enroll on another metal level, you can enroll directly through Vermont Health Connect.

The open enrollment period for buying (or changing) a 2019 Vermont Health Connect plan was November 1 - December 15, 2018. You can’t apply now for a 2019 Qualified Health Plan through Vermont Health Connect unless you have a “qualifying event” like losing insurance from your job, getting pregnant or having a baby.

You can apply for Medicaid or Dr. Dynasaur any time, even if you don’t have a qualifying event.