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If you live in Vermont and can’t afford health insurance, the state offers several options to get the necessary care. Vermont Health Connect coverage provides affordable insurance for low-income residents, and Green Mountain Care is the state’s Medicaid program that provides free healthcare to qualifying children, adults, the elderly, and disabled individuals. This guide explains the Medicaid program and what you need to know about accessing this vital resource.
As of June 2023, 193,649 Vermonters use Medicaid as their primary health insurance. The Green Mountain Care program makes it possible for individuals and families who wouldn’t otherwise be able to afford health insurance or medical services to get the care they need to remain healthy. The Medicaid program fills many healthcare needs, from newborns and children who need vaccinations and well-child checkups to older adults with multiple complex conditions.
With the cost of everything increasing, many Vermont families don’t have the resources to purchase a comprehensive health plan, even when their employer offers insurance options. Green Mountain Care is a bridge to comprehensive coverage, ensuring the most vulnerable people in the state receive quality health care services. Medicaid eliminates the risk of further financial hardship or significant health risks due to deferred care.
To prevent shouldering the debt of unexpected medical expenses, many Vermonters extend their Medicaid coverage to include a more comprehensive range of benefits and services by way of private health insurance.
Vermont Health Connect is Vermont’s online health insurance marketplace. Residents use it to find health insurance that meets their family’s needs and budget. In addition to private health insurance from a qualified health plan, Vermonters can apply to Green Mountain Care, the state’s Medicaid program.
Green Mountain Care provides free or low-cost health care to adults and children who meet the income eligibility requirements. Adults and children who earn less than the Federal Poverty Level guidelines for their family size, as well as people who are blind, disabled, over age 65, or disabled and able to work, can apply for help. Vermonters who meet the income and resource requirements can also apply for assistance paying for long-term care through the Choices for Care program.
Anyone under age 26 who was a foster child and aged out of the system in Vermont or elsewhere also qualifies for Medicaid, regardless of income.
Vermont is one of only a handful of states that does not use a managed care or coordinated care organization to oversee Medicaid services. Instead, the Department of Health Access handles Medicaid benefits for all enrollees. This approach means that program participants do not need to choose a health plan or work with a separate organization to access health benefits.
Those who aren’t eligible for Medicaid can find resources and programs to help with healthcare costs on Vermont Health Connect. In addition to Dr. Dynasaur, the state’s version of the Children’s Health Insurance Program (CHIP), you can apply for financial assistance with insurance premiums on qualified health plans purchased through Vermont Health Connect. Vermont Health Connect also provides information and access to special programs, including:
Anyone who receives Vermont Medicaid benefits does not have to pay for their insurance policy or healthcare services. There are copayments for prescriptions, ranging from $1 to $3, $3 for dental visits other than preventive care, and $3 per day for outpatient hospital services. You will never face a copay for children if you are pregnant or gave birth in the last 12 months, live in a long-term care facility, or are part of the Breast and Cervical Cancer Treatment Program.
Some services never require a copayment, regardless of whether you visit the hospital or have a prescription. They include:
Some services limit the number of visits or the maximum dollar amount. Chiropractic, dental, and podiatry are just some of the services with restrictions. Other services, like some diagnostic imaging tests, require pre-authorization from Green Mountain Care.
Once the Department of Health Access approves your application for Green Mountain Care, which typically takes a few weeks, you’ll receive a card with details about your new insurance coverage. The card itself will indicate your name and have your unique identification number on it.
Vermont Health Connect offers multiple tools and portals to help Vermonters find the right healthcare coverage. This portal is the best place to apply for Green Mountain Care (the state Medicaid program) and other financial assistance programs or purchase a qualified health plan.
Although you can apply for Vermont Medicaid over the phone or in person with the help of a nearby assistant, the best way to submit your information is via the online portal. When you create an account on Vermont Health Connect and provide your information, the system will determine whether you qualify for assistance and match you with the correct program. Residents can apply for Medicaid at any time; if you aren’t eligible and have to purchase health insurance coverage, you must apply during the annual enrollment period in the fall.
Here’s how to apply for Vermont Health Connect online:
Once you provide the required information, the Department of Health Access will review your application and notify you of your status.
Income is the top factor in determining your eligibility for Vermont Medicaid. The thresholds vary by your family size, age, and circumstances. You must meet the following criteria to receive Green Mountain Care benefits:
Individuals who join Green Mountain Care receive a membership card in the mail. The card includes your plan details. You must present it when seeking medical services.
When the state approves your application for Medicaid, you can remain in the program indefinitely until your circumstances change. The Department of Health Access reviews eligibility annually; you’ll receive a notice of your status one month before your renewal date. If the state has enough information about your income, family size, and employment status, it may automatically renew your health insurance coverage.
In most cases, the state will request more information (which you can provide over the phone) or require that you complete and return a renewal packet. Respond to the renewal information request by the deadline on the letter, or you risk losing your benefits. If you have questions about Medicaid renewals, contact Customer Support by phone for help.
If you have a major life change, you must notify the Department of Health Access within ten days, either online via Vermont Health Connect or by phone. Events to report include the following:
If you lose or damage your Green Mountain Care card, call the Customer Support Center for a replacement.
Every state Medicaid program offers the same basic coverage based on federal government rules. Some state plans offer additional services, but at the minimum, you can receive the following services at no charge:
Dental care is a critical component of overall health and well-being. Green Mountain Care provides full dental coverage for children and some adult benefits. Adults can visit the dentist twice a year for preventive services (exam and cleaning) and have a $1,500 limit on other services like fillings and some crowns. Most services beyond basic care require pre-authorization.
While Green Mountain Care provides comprehensive dental coverage, it may not offer full assistance to those who have more serious dental issues. If you anticipate requiring more trips to the dentist, investing in private dental plans in Utah is advisable.
Vermont Medicaid covers prescription medications (with minimal copayments for some members) according to a Preferred Drug List (PDL). Healthcare providers can request pre-authorization for medically necessary medications not listed on the PDL.
Eligible Vermonters who don’t qualify for Medicaid can apply for help with prescription drugs via the Healthy Vermonters and VPharm programs.
Eligible Vermonters who need family planning services can apply for help through the Access Plan, a Medicaid option that only covers family planning and related services. These include birth control and contraceptive services, testing and treatment for sexually transmitted infections (STIs), and routine preventive care and screenings, like Pap smears and HPV vaccinations. The Access Plan is available to Vermont residents who are not pregnant, meet citizenship and income requirements, and don’t have any other insurance coverage for these services.
In the event of an accident causing either permanent or temporary disability, Vermont Medicaid will cover the cost of medications and mobility equipment. However, the program does not provide income reimbursement. In order to protect your income, it’s wise to consider investing in quality disability insurance.
Regardless of where you live, you cannot use Medicaid benefits outside the U.S. Before you see any out-of-state provider, confirm they are in the Green Mountain Care network and will accept your health insurance. Most of these providers are within Vermont, but you may be able to seek care at facilities in New York, Massachusetts, or New Hampshire because of their proximity to Vermont.
The major exception to this rule is emergency care. Medicaid benefits will cover the cost if you need life-saving care and cannot return to Vermont. If you intend to travel for leisure outside of Vermont or the U.S.A, always secure proper travelers insurance.
Although students can remain on their parents’ insurance policies until they turn 26, that isn’t always possible. Students who are Vermont residents and don’t have insurance that meets the minimum essential coverage requirement can apply for Medicaid as long as their parents or guardians don’t list them as dependents on their tax returns. If you don’t qualify for Medicaid and have to purchase a health plan on the exchange, you may be able to get financial help from the state.
Students from out of state who are not Vermont residents cannot apply for Green Mountain Care or financial assistance with health insurance.
Senior citizens who need long-term care can access the Choices for Care program, which provides services and support options for individuals who need a nursing home level of care. Elderly Vermonters who meet the criteria for Long-Term Medicaid, have specific clinical needs, and fall within the resource limits can apply for help at home or in a facility.
Vermont Medicaid provides assistance for subgroups, such as children as well as eligible women, who require cervical and breast cancer screenings.
Dr. Dynasaur is Vermont’s health insurance program for children. It provides free or low-cost insurance for qualifying children up to age 19 and pregnant women. Premiums range from $0 to $60 per child, depending on household income.
Whether you qualify for Dr. Dynasaur depends on your household income and family size. For children, the limit is 312% of the federal poverty level for your household size; for a family of four, that is $7,925 per month. For pregnant women, the limit drops to 208% of the federal poverty level ($5,325 for a family of four). Once enrolled in the program, women can keep their coverage until 60 days after giving birth, even if their income increases.
Dr. Dynasaur covers all medically necessary physical and mental health services. It also provides full dental coverage for children and pregnant women and eyeglasses for children.
If you fall within the income guidelines, you can receive free breast and cervical cancer screenings, assistance navigating the health system, and additional perks to support a healthy lifestyle. The You First program provides health coaching, fitness memberships, state park passes, and more to support Vermonters’ well-being.
Vermont Medicaid benefits support your overall well-being and provide the majority of medical services the average person needs. However, it doesn’t cover anything. Some of the services the program doesn’t pay for include:
In regards to funerals, although up to $1000 may be available at the county level, it is not nearly enough to cover the cost of final expenses. To protect your families’ finances, consider securing funeral insurance.
Green Mountain Care covers the services and procedures mandated by federal Medicaid guidelines. Your member handbook outlines the specific coverages and limits, but the following overview gives you an idea of what you get with this plan.
| Office Visits | |
|---|---|
| Primary care visits for acute illness | Yes |
| Chronic disease care and management | Yes |
| Preventive care and screening services | Yes |
| Annual physicals and well-child visits | Yes |
| Routine lab work and X-rays | Yes |
| Vaccines | Yes |
| Medical Imaging (with prior authorization) | |
|---|---|
| MRI | Yes |
| MRA | Yes |
| PET | Yes |
| CT scans | Yes |
| PET/CT | Yes |
| X-ray | Yes, no prior authorizations needed |
| Behavioral Health | |
|---|---|
| Mental health care | Yes, including including counseling and psychotherapy |
| Dental | |
|---|---|
| Full dental for children | Yes |
| Emergency dental for adults | Yes |
| Preventive visits for adults | Yes, two per year |
| Services for adults | $1,500 maximum |
| Vision | One comprehensive and one intermediate exam every two years, or two intermediate exams in two years. |
|---|
| Surgery | |
|---|---|
| Emergency surgery | Yes |
| Rehabilitation services | Yes |
| Habilitative services | Yes |
| Hospital | |
|---|---|
| Inpatient hospital stays | Yes |
| Outpatient hospital services | Yes |
| Emergency care | Yes |
| Maternity Care | |
|---|---|
| Gynecology | Yes |
| Family planning | Yes |
| Prenatal and postpartum care | Yes |
| Specialists | |
|---|---|
| Chiropractic | Yes, up to 12 visits per year for spinal manipulation |
| Naturopaths | Yes, some restrictions may apply |
| Podiatry for non-routine foot care | Yes |
| Durable medical equipment and supplies with a prescription | Yes |
| Hospice service | Yes |
| Home care services | Yes |
| Transportation | |
|---|---|
| Ambulance services | Yes |
| Non-emergency medical appointment transportation | Yes |
When you qualify for Green Mountain Care or a qualified medical plan from Vermont Health Access, you have choices for excellent healthcare services throughout the state. However, restrictions or limits on coverage can mean the policy doesn’t meet all your needs, and you should consider alternatives. For example, if you expect that you or a loved one will need long-term care but don’t qualify for Choices in Care, you may need additional long-term care insurance to cover the bills. Other types of private insurance, such as life insurance, can help pay for medical costs Medicaid will not cover, especially in the event of your passing.
An extended insurance policy from a third-party provider can fill the gaps and get you the services you need, like:
If you need help making sense of all your health insurance options beyond Vermont Health Connect, try Insurdinary’s simple tool. Just enter your information and we will compare quotes from top local insurance companies. Even if you qualify for Vermont Medicaid, we can help you compare expanded coverage options that fit your situation and budget.
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