Thousands more Vermonters are eligible for health insurance savings this year December 2, 2022 by admin Thousands more Vermonters are poised to qualify for health insurance savings this year after two recent changes in federal guidelines. Enrollment season for Vermont Health Connect, the state’s health insurance marketplace and gateway to federal health insurance subsidies, is open for six more weeks. Just over 25,000 Vermonters get their insurance through the marketplace, which is operated by the Vermont Department of Health, according to the most recent data available. But the government officials who run it and the insurance companies that sell their products on it believe more people should buy their health insurance there. They are pushing right now to publicize the recent changes. About 5,360 Vermonters still buy insurance directly through providers like Blue Cross Blue Shield of Vermont and MVP, according to recent figures. Eligibility for subsidies was extended to higher income groups during the pandemic. This extension will be in place until at least the end of 2025, but not everyone knows that. This year, Blue Cross is asking all re-enrolling customers to confirm verbally by phone or by checking a box on a form that they are ineligible for the federal subsidies available through Vermont Health Connect. “It was a way to get people to pay attention,” said Sarah Teachout, director of government and media relations at Blue Cross Blue Shield of Vermont. “We want to do everything we can to help people get the benefits they’re eligible for and deserve.” The company is also working to notify employers of an even more recent change in federal regulations that could save employees’ families thousands of dollars a year in health insurance. The regulatory change means many more of Vermont’s working families will be eligible in 2023 for reduced-cost insurance, but only if it’s purchased on the marketplace rather than directly through a family member’s employer. One estimate suggests that about 14,000 Vermonters qualify. The deadline to enroll in the marketplace is Jan. 15, but people must sign up before Dec. 15 for coverage to begin in early 2023. Since 2014, when the subsidies began, families in which one person has access to employer-based health insurance have been blocked from accessing it, even if the employer does not contribute enough to make insurance for the entire family affordable. This nationwide problem, which politicians advocating for change call a “family problem,” has finally been solved. Beginning this enrollment period, family members of covered employees living in Vermont are now eligible to purchase insurance through Vermont Health Connect and receive income-based subsidies if they are not already covered by other federal health insurance programs such as Medicaid or Medicare. Adaline Strumulo, deputy commissioner at the Vermont Department of Health Access, said this change, along with the expanded income criteria, should make health insurance more affordable for thousands more working families in Vermont. “We think this brings the full promise of the Affordable Care Act to life in a way that we just couldn’t do before,” she said. Strumulo hopes that anyone in the state who wants to pay less for private health insurance will revisit the state website in the next few weeks to see if they qualify for enrollment and subsidies, even if they’ve already looked in previous years. Navigating the site is easier than ever, with online tools and in-person consultations available from department staff or trained “assistants” at health clinics across the state. “We’d really love for everyone to take another look,” Strumulo said. What’s new? Not Vermont Health Connect, which has been in business for nearly a decade. Vermont is one of 18 states that operates its own health insurance marketplace for consumers and small businesses under rules set by the Affordable Care Act of 2010. Residents of states that don’t operate their own marketplace buy through a federally run website. Extended subsidies are also already in place. The American Rescue Plan Act of 2021 increased the amount of subsidy available through the program to households already receiving it — those making less than 400 percent of the federal poverty level, which in 2023 is $54,000 for a single person or $111,000 for a family of four, for example. The Pandemic Recovery Act also created a framework that limits the cost of a basic (silver-level) health plan to 8.5% of annual household income. As a result, there is a subsidy — a small amount at the top of the range — available at much higher income levels, with the highest level being households of three or more people making up to $330,000. But what is What’s new is that in August, as part of the Inflation Reduction Act, Congress extended those increased subsidies for three more years, through the end of 2025. State officials hope that this assurance of continuity will make those who opt out, to start buying through the market. The grant expansion has made a difference for many Vermonters, Strumulo said. Now 90% of market users receive a subsidy. A quarter of participants pay less than $25 a month for insurance, and overall premiums have fallen to three-quarters of the previous price. The extra help also allowed more Vermonters to buy lower-deductible gold plans, which increased in popularity by 25 percent, four times the rate of enrollment growth between February 2021 and February 2022. Vermont officials were very concerned that this improvement would end this year. “We spent a lot of time lobbying for the expansion,” Strumulo said. “That would have created this huge affordability scale for 2023.” The correction is not permanent. The extension of benefits expires after three years. Strumulo said state officials will look to Congress or the Vermont Legislature during that time for a more permanent solution. Who is eligible? Eligibility for extended grants has changed even more recently. The “family problem” was a result of how the Internal Revenue Service interpreted part of the Affordable Care Act as it was being implemented. (The IRS is involved because subsidies are tax credits, although they are most often applied up front through the marketplace in the form of a reduction in the monthly premium fee.) A rule change that was approved in October and goes into effect before the end of the year will allow roughly 14,000 more Vermonters access to the market, according to a 2021 study by the Kaiser Family Foundation. Since the program’s inception, individuals and families can shop through the federal and state marketplaces and access income-based subsidies if their employer-based coverage is deemed inadequate or if the monthly premium is unaffordable. In 2023, the definition of unaffordable for this purpose is over 9.12% of monthly household income. That’s about $482 a month for households with incomes of $63,500, the national average in 2022. Until now, however, the price offered by the employer used to calculate affordability was the price of a single plan, not the family plan the employee would actually purchase. In general, family plans can cost three to four times more than individual plans. And now, nine years from now, family spending will be what counts. How big are the potential savings? There is no simple answer to this. That’s why state officials are urging families struggling to pay for employer-based health care to take a second look at the marketplace. Each situation will be somewhat different depending on household income, household size, ages of dependent children, and whether any household members are eligible for Medicaid or Medicare. The subsidies are likely to be most impactful for middle-income families making less than $106,000 a year who now buy a family plan through an employer, according to a national study that suggests savings through the state marketplace for a family of four with an income of $53 000 would be about $3450 each year. However, the details make it much more complicated than that. In Vermont, children under 19 in households of four with income approaching $90,000 a year are eligible for Medicaid coverage. (Coverage is only available to adults for households making about $38,000 or less.) So, for example, in a middle-income household in Vermont, an employed adult might be covered by employer insurance, and a younger child from Medicaid, while the employee’s partner and older child (under 26) are now eligible for a subsidy through Vermont Health Connect.That level of complexity is what makes changing health care plans so intimidating for many, Strumolo said. The department has tried to help by providing several online support tools. She hopes the prospect of additional savings will prompt people to take the first step: get on the phone or set up an account online. Don’t miss anything. Sign up here to receive a weekly email from VTDigger about Vermont hospitals, health care trends, insurance and state health care policy. Related Leave a Comment Cancel replyCommentName Email Website Save my name, email, and website in this browser for the next time I comment.
 100vw, 610px”/></noscript><img data-attachment-id=)
