Green Mountain Care Programs
Green Mountain Care is a family of low-cost and free health coverage programs for uninsured Vermonters. Offered by the state of Vermont and its partners, Green Mountain Care programs offer no or low co-payments and premiums to keep out-of-pocket costs reasonable. There may be a program for you, no matter how much you earn.
Catamount Health (Full-Pay)
Catamount Health with Premium Assistance (CHAP)
Employer-Sponsored Insurance with Premium Assistance (ESIA)
Vermont Health Access Plan (VHAP)
Dr. Dynasaur
Medicaid
Prescription Assistance
Disability and Long-Term Care
Catamount Health (Full-Pay)
Catamount Health is a health insurance plan, offered in cooperation with the state of Vermont, by Blue Cross Blue Shield of Vermont and MVP Health Care.
Catamount Health provides comprehensive, quality health coverage. There is no upper income limit for Catamount Health, however, depending on your income, you may even qualify for assistance in paying your Catamount premium. See below for information on Catamount Health with Premium Assistance.
Who can enroll?
Catamount Health is designed for Vermonters age 18 or older and families who:
- Are not eligible for other Green Mountain Care plans such as the Vermont Health Access Plan (VHAP), or the premium assistance programs;
- Have been uninsured for 12 months or more – with exceptions for Vermonters who recently lost their insurance because of a life change such as a divorce or loss of a job. (Read further information on Catamount Health Qualifications) or have been enrolled for at least six months in an individual plan with deductibles of $10,000 or more for an individual or $20,000 or more for a family (April 1, 2010 these amounts will decrease to $7,500 and $15,000. Please note that you will not be eligible for premium assistance until you have been on Catamount Health for 12 months);
- Unlike our other programs, some college students also may qualify for Catamount Health.
What services are covered?
Benefits include doctor visits, checkups and screenings, hospital visits, emergency care, chronic disease care, prescription medicines and more.
How much does it cost?
If you do not qualify for premium assistance, you pay the full monthly premium directly to the insurance carrier of your choice. See Income & Premium Chart for Catamount Health & Employer-Sponsored Insurance.
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Catamount Health with Premium Assistance (CHAP)
Catamount Health with Premium Assistance (CHAP) provides the same comprehensive, quality health coverage as Catamount Health at full-pay; however, premiums are based on household income and family size. (Read further information on Catamount Health Premium Assistance Qualifications).
Who can enroll?
Catamount Health with Premium Assistance (CHAP) is for Vermonters with income at lower levels than those on Catamount Health at full-pay. The program is for Vermonters age 18 or older who:
- Are not eligible for other Green Mountain Care programs such as Premium Assistance for Employer-Sponsored Insurance or the Vermont Health Access Plan (VHAP);
- Have been uninsured for 12 months or more – with exceptions for Vermonters who recently lost their insurance because of a life change such as a divorce or loss of a job. (Read further information on Catamount Health Qualifications) or have been enrolled for at least six months in an individual plan with deductibles of $10,000 or more for an individual or $20,000 or more for a family (April 1, 2010 these amounts will decrease to $7,500 and $15,000. Please note that you will not be eligible for premium assistance until you have been on Catamount Health for 12 months);
- Do not have access to comprehensive insurance through an employer; and
- Meet program and income guidelines. See chart below.
- Unlike our other programs, some college students may qualify for Catamount Health with Premium Assistance.
What services are covered?
Benefits include doctor visits, checkups and screenings, hospital visits, emergency care, chronic disease care, prescription medicines and more.
How much does it cost?
See the Income & Premium Chart for Catamount Health & Employer-Sponsored Insurance below to determine what your monthly premiums may be. Your eligibility for a particular plan and your share of the cost will be determined based on the application you submit.
Employer-Sponsored Insurance (ESI) Premium Assistance
If you’re an uninsured Vermonter and have access to employer-sponsored health insurance, you can get help paying the health insurance premiums if all of the following criteria are met:
- You are eligible to enroll in Catamount Health or the Vermont Health Access Plan (VHAP);
- You are not yet enrolled in your employer’s plan;
- Your employer’s plan has comprehensive benefits, which means it covers both hospital and physician visits;
- It is more cost-effective for the state to provide premium assistance to enroll in your employer’s plan than to provide premium assistance to enroll in Catamount Health or VHAP; and
- You meet the income guidelines. See the chart below to determine what your premium cost may be. Your eligibility for a particular plan and your share of the cost will be determined based on the application you submit.
Income & Premiums for
Catamount Health & Employer-Sponsored Insurance
|
# in Household |
1 |
2 |
3 |
4 |
Your likely Individual Monthly Premium is |
|---|---|---|---|---|---|
|
If your total monthly/yearly household income is less than: |
$1,812/ |
$2,439/ |
$3,065/ |
$3,692/ |
$60/mo |
|
$2,039/ |
$2,744/ |
$3,449/ |
$4,154/ |
$122/mo |
|
|
$2,265/ |
$3,048/ |
$3,832/ |
$4,615/ |
$149/mo |
|
|
$2,492/ |
$3,353/ |
$4,215/ |
$5,077/ |
$177/mo |
|
|
$2,718/ |
$3,658/ |
$4,598/ |
$5,538/ |
$205/mo |
|
| If your total monthly/yearly household income is over: |
Over |
Over |
Over |
Over |
$435.03/mo |
- Your premiums are locked in for 12 months. Your premiums are subject to change on your one-year anniversary.
- You may still qualify if your monthly income is higher than the amounts in the chart if you have earned income and/or child care expenses.
- A household is defined as the number of related people living in the same house.
- Catamount Health copayments for office visits are $10, prescription copayments range from $10-$50. Deductibles are $250 for individuals / $500 for families (in-network).
- Unlike other programs, some college students also may qualify for Catamount Health.
- For further information on the guidelines and exceptions, please contact Health Access Member Services for Green Mountain Care at 1-800-250-8427 on business days between 7:45 a.m. and 4:30 p.m.
- This chart is updated each January.
Vermont Health Access Plan (VHAP)
VHAP is a health insurance program for adults age 18 and older who meet the income guidelines on the chart below and have been uninsured for 12 months or more – with exceptions for Vermonters who recently lost their insurance because of a life change such as a divorce or loss of a job (Read further information on VHAP Qualifications).
Who can enroll?
Adults who meet the VHAP Qualifications and the income guidelines below can enroll in VHAP. Adults with children qualify at higher income levels. Call Health Access Member Services for Green Mountain Care at 1-800-250-8427 for more information.
There are additional requirements for college students. You can find out whether or not you meet those requirements by sending in your completed application.
What services are covered?
VHAP covers a wide range of services including hospital care, prescription medicines, mental health and doctor visits.
How much does it cost?
Monthly premiums for your VHAP coverage are based on your household income and family size, or if you have access to Employer-Sponsored Insurance, you may get assistance from the state to help pay a monthly portion of your employer’s health plan. (Read further information on Employer-Sponsored Insurance (ESI) Premium Assistance.)
See the Income and Premium chart below to determine what your premium cost may be. Your eligibility for a particular plan and your share of the cost will be determined based on the application you submit.
Income & Premiums for Vermont Health Access Plan (VHAP)
|
# in Household |
1 |
2 |
3 |
4 |
Your likely Individual Monthly Premium is |
|
If your total monthly/yearly household income is less than: |
< $453/ |
< $610/ |
< $767/ |
< $923/ |
$0/mo |
|
$680/ |
$915/ |
$1,150/ |
$1,385/ |
$7/mo |
|
|
$906/ |
$1,220/ |
$1,533/ |
$1,846/ |
$25/mo |
|
|
$1,359/ |
$1,829/ |
$2,299/ |
$2,769/ |
$33/mo |
|
|
$1,676/ |
$2,256/ |
$2,836/ |
$3,415/ |
$49/mo |
- You may still qualify if your monthly income is higher if you have earned income and/or child care expenses.
- A household is defined as the number of related people living in the same house.
- There may be a pharmacy co-payment for prescriptions and emergency room visits.
- For further information on the guidelines and exceptions, please contact Health Access Member Services for Green Mountain Care at 1-800-250-8427 on business days between 7:45 a.m. and 4:30 p.m.
- This chart is updated each January.
Dr. Dynasaur
Dr. Dynasaur provides low-cost or free health coverage for children, teenagers under age 18 and pregnant women.
Who can enroll?
Eligibility is based on household income and family size. The number in the household can be any configuration of adults and children. For example a 3-person household could include two parents and a child or one parent and two children. In some cases insured children may also qualify for Dr. Dynasaur for an enhanced benefit. For further information on the guidelines and exceptions, please contact Health Access Member Services for Green Mountain Care at 1-800-250-8427.
What services are covered?
Benefits include doctor visits, prescription medicines, dental care, skin care, hospital visits, vision care, mental health care, immunizations and special services for pregnant women such as lab work and tests, prenatal vitamins and more.
How much does it cost?
Monthly premiums vary depending upon your household income and family size.
See the Income and Premium chart below to determine what your premium cost may be. Your eligibility for a particular plan and your share of the cost will be determined based on the application you submit.
Income & Premium for Dr. Dynasaur
|
# in Household * |
1 |
2 |
3 |
4 |
Your Individual Monthly Premium is |
|
Pregnant Woman: If your total monthly/yearly household income is less than: |
NA |
$2,439/ |
$3,065/ |
$3,692/ |
$0 - $15/mo |
|
Children age 0 – 18: |
$0 – 2,718 |
$0 - $3,658 |
$0 - $4,598 |
$0 - $5,538 |
$0 - $60 |
- You may still qualify if your monthly income is higher if you have earned income and/or child care expenses.
- Eligibility is based on household income and family size. The number in the household can be any configuration of adults and children. For example a 3-person household could include two parents and a child or one parent and two children.
- Pregnant women can qualify at higher income if expecting multiple births.
- A household is defined as the number of related people living in the same house.
- There are no co-payments.
- For further information on the guidelines and exceptions, please contact Health Access Member Services for Green Mountain Care at 1-800-250-8427 on business days between 7:45 a.m. and 4:30 p.m.
- This chart is updated each January.
Medicaid
Medicaid provides low-cost or free coverage for low-income children, young adults under age 21, parents, pregnant women, caretaker relatives, people who are blind or disabled and those age 65 or older.
Who can enroll?
Eligibility is based on your income and resources (e.g., cash, bank accounts, etc.). In some cases, Vermonters enrolled in Medicare may also be eligible for Medicaid.
What services are covered?
Medicaid covers most health care services such as doctor visits, hospital care, prescription medicines, vision and dental care, long-term care, physical therapy and more.
How much does it cost?
Medicaid fees may include co-payments for outpatient visits, prescription medicines and dentist visits. , Those under age 21, pregnant women or women in the 60 day post-pregnancy period and people in nursing facilities never have to pay co-payments.
See the Income and Premium chart below to determine what your premium cost may be. Your eligibility for a particular plan and your share of the cost will be determined based on the application you submit.
Income & Premium for Medicaid
|
# in Household * |
1 |
2 |
3 |
4 |
Your cost is |
|
If you live outside of Chittenden County and your total monthly/yearly household income is less than: |
$916/ |
$916/ |
$1,100/ |
$1,250/ |
$0/mo |
|
If you live inside of Chittenden County and your total monthly/yearly household income is less than: |
$991/ |
$991/ |
$1,175/ |
$1,316/ |
$0/mo |
- You may still qualify if your monthly income is higher if you have earned income and/or child care expenses.
- Eligibility is based on household income, resources (e.g., cash, bank accounts, etc) and family size.
- A household is defined as the number of related people living in the same house.
- For further information on the guidelines and exceptions, please contact Health Access Member Services for Green Mountain Care at 1-800-250-8427 on business days between 7:45 a.m. and 4:30 p.m.
- This chart is updated each January.
Prescription Assistance
Vermont has several Prescription Assistance programs to help uninsured Vermonters and those enrolled in Medicare pay for prescription medicines based on income, disability status and age. These programs include:
- VPharm assists Vermonters who are enrolled in Medicare Part D with paying for prescription medicines. This includes people age 65 and older as well as people of all ages with disabilities and includes an affordable monthly premium.
- VHAP-Pharmacy helps Vermonters age 65 and older and people with disabilities who are not enrolled in Medicare pay for eye exams and prescription medicines for short-term and long-term medical problems and includes an affordable monthly premium.
- VScript helps Vermonters age 65 and older and people of all ages with disabilities who are not enrolled in Medicare pay for prescription medicines for long-term medical problems. There is also a monthly premium based on your income.
- Healthy Vermonters provides a discount on short-term and long-term prescription medicines. There are no monthly premiums and eligibility is based on your family income.
Disability and Long-Term Care
Vermonters who need long-term care services either in their home or a nursing facility may qualify for financial assistance through the Department of Disabilities, Aging and Independent Living (DAIL). Visit the DAIL Web site to find out if you meet both the clinical and financial requirements.
