This information is available on the Vermont Health Care Reform‘s website.
A key provision of the Patient Protection and Affordable Care Act (ACA) requires the creation of a Health Benefit Exchange in each state. The Exchange is an online marketplace for health insurance products that requires all vendors (insurance carriers and state health programs) to play by the same rules. In 2011, the Vermont legislature passed Act 48 — a law that created the Vermont Health Benefit Exchange. Vermonters will be able to start shopping for health plans on October 1, 2013 and the Exchange plans will kick in on January 1, 2014. The Exchange will be the only place where individuals and businesses with 50 or fewer employees can get health insurance.
About the Vermont Health Benefit Exchange:
Insurance companies offering products through the Exchange will be the same companies selling health insurance in Vermont today. In addition, Act 48 provides for health insurance to be offered through the Exchange by two federally designated multi-state carriers and by a federally approved and state licensed member-run non-profit insurance company.
Only health insurance products certified by the state as “Qualified Health Plans” will be available on the Exchange. The ACA sets uniform standards for qualified plans, including what constitutes essential health benefits. This means that — as a minimum — all plans will offer essential health benefits as defined by law. This gaurantees that plans on the Exchange will cover key medical services so there’s no guesswork.
The health plans on the Exchange will be offered at different levels: bronze, silver, gold and platinum. Within each category, all of the plans will offer the same benefits. Because the benefits are the same, insurance carriers will compete for your business based on consumer service and efficiency. Knowing the benefits ahead of time and being certain which services will be covered allows consumers to make “apples-to-apples” comparisons when selecting a health plan.
The Exchange is the mechanism through which small businesses and individuals will receive tax credits to make health insurance coverage affordable. Businesses with 50 or fewer employees can decide not to offer health insurance to their employees with no penalty. But if a business with 25 or fewer employees and an average annual wage of less than $50,000 decides to offer coverage to its employees, the business will be eligible for a small business tax credit beginning with the 2010 tax year. For details, click here.
Some individuals and families who purchase their own health insurance through the Exchange will be eligible for refundable tax credits that will cap their premium costs at a percentage of their income on a sliding scale up to $92,200 of household income for a family of four. To see a chart of projected premium costs in the exchange in 2014, click here.
In addition, the ACA sets maximum caps on annual out-of-pocket costs to the consumer. Even for higher wage earners, a Vermonter insured by one of the qualified health plans would not be liable to pay more than $5950 including deductible, co-pays, and co-insurance; a lot of money, but not enough to threaten the loss of a home, which could happen for many underinsured Vermonters today. The law created rules that scale these out-of-pocket maximums based on income; for example, a single Vermonter making between $15,000 and $22,000 annually would be liable for a maximum of $1983.
The Exchange will most commonly be accessed by an easy-to-navigate website. This website can be compared to travel websites—like Travelocity or Expedia—that are commonly used by shoppers to compare prices and make purchases. The Exchange is also required to be accessible by telephone and in-person, so consumers can get the information they need and enroll the way that works best for them. After providing some of your information to the Exchange, the system will automatically check your eligibility for publicly funded programs, subsidies and tax credits.
Health Benefit Exchange Implementation Timeline
Like all states, Vermont must implement the requirements of the ACA according to a federally-mandated schedule. Act 48, the bill signed by Governor Shumlin in 2011, spelled out the specifics of how and when these requirements will be met. It also established a group of health care experts called the Green Mountain Care Board, who will be responsible for making many of the technical decisions involved in implementing health care reform. Because the law did not focus on cost-containment, Vermont created the Green Mountain Care Board to ensure that costs in our state’s health care system are contained. The Green Mountain Care Board appointees include a business person, a practicing Vermont physician, an internationally-known health policy leader, a state leader with extensive health care experience, and an expert in state-based health care reform. In putting together this team, Governor Shumlin looked for people who could think creatively about how to encourage and reward Vermonters and Vermont health care practitioners for improving health and getting the most value out of our health care dollars.
The federal Affordable Care Act is a step in the right direction, but for Vermont, it’s only the beginning. After implementing federal ACA requirements, Vermont will use the new Health Benefit Exchange infrastructure as a springboard to implement universal Green Mountain Care coverage beginning in roughly 2017.
Key steps for the implementation of the Health Benefit Exchange and ACA:
May 2011: Act 48 signed into law
May 2012: The Vermont General Assembly passes legislation (H.559) finalizing plans for the health care Exchange
Spring 2012: Small business tax credit available for tax year 2011
Summer 2012: The Green Mountain Care Board approves the essential health benefits benchmark plan for the Exchange
January 2013: The Agency of Administration submits a health care reform financing plan to the General Assembly
October 2013: Exchange enrollment begins for Vermonters. Small businesses (50 employees or fewer) and individuals/families who are not covered by their employer will now search for and select qualified health plans through the Exchange. Subsidies and tax credits will be available to help individuals and families afford insurance.
January 2014: Exchange health coverage begins
