With the cost of gasoline, heating fuel and food (and just about everything else it seems) going through the roof, the State of Vermont's subsidized health care plans--Catamount Health, VHAP, and Medicaid are a better deal than ever. Each of these plans offers comprehensive coverage including hospitalization,

Who is Eligible for Catamount Health?

Any Vermonter who is 18 years old or older is eligible for Catamount Health if they have been uninsured for more than 12 months OR if they lost their insurance because: they retired, a spouse died, they divorced, lost or quit a job, left college, no longer choose to receive COBRA, are no longer able to be a dependent on someone else's policy or they had their hours reduced at work. There is no waiting period to enroll in Catamount Health for individuals that lose their insurance for one of these reasons. You are also immediately eligible for Catamount Health if you are enrolled in a plan with a deductible over $10,000.

How much does Catamount Health Cost?

Catamount Health's monthly premium is based on your household's monthly income only, not your assets. Household income is determined by family size (the number of people living with you under age 21 who are related). For those meeting the income criteria for premium assistance (roughly $21,000-$33,000/year for a single person or $43,000-$64,000/year for a family of four), premiums range from $65/month-$185/month. Uninsured Vermonters making less than these amounts are eligible for either VHAP or Medicaid. If you are over these income limits, you can still enroll in Catamount Health but must pay the unsubsidized price of $393/month. Out of pocket expenses for Catamount Health are limited to $800/year for an individual, not including premiums.

What are Catamount Health's Co-Pays and Co-Insurance Costs?

There is no prescription drug deductible. For other services, there is a deductible of $250. After your deductible is met, you pay a co-insurance charge of 20% until you reach the $800 out of pocket maximum. These out of pocket expenses are waived if you are in an approved chronic care management program. Catamount Health also has a $10 office fee visit, and prescription drug co-pays of $15 for generic brands, $25 for preferred brands and $50 for non-preferred brands.

What about Catamount Health's Pre-Existing Conditions Clause?

Catamount Health has a pre-existing conditions clause (VHAP and Medicaid do not) that applies to anyone who has a medically diagnosed condition and has had a gap in insurance coverage in the previous nine months. They must pay out of pocket for all treatment related to this preexisting condition for the first year they are in Catamount Health.

However, the legislature created an "amnesty period" whereby anyone who applies for, or is enrolled in, Catamount Health before November 1st will have their pre-existing condition covered. So, now is an excellent time to enroll in Catamount Health.

Who is Eligible for VHAP?

Any Vermonter who is 18 years old or older and whose income is less than roughly $21,000/yr for a single person or $43,000 for a family of four AND has been uninsured for more than a year or lost their insurance because: they retired, lost or quit their job, left college, a spouse died, they divorced, no longer choose to receive COBRA, are no longer able to be a dependent on someone else's policy or they had their hours reduced at work. There is no waiting period to enroll in VHAP for individuals that lose their insurance for one of these reasons.

Household income is determined by family size (the number of people living with you under age 21 who are related).

How Much Does VHAP Cost?

VHAP's monthly premium amounts range from 0-$49/ month and are based on the household income; and whether there are dependent children in the family. VHAP's only out of pocket expenses, other than the premium, is a $25 co-pay for emergency room care.

What about Medicaid?

Medicaid has very specialized eligibility requirements and premium considerations. Call to find out the details.

Who Can I Call for an Application or For More Information?

Call the Vermont Campaign for Health Care Security Education Fund at 1 866 482 4723 to talk to a specialist about enrolling or go to www.catamounthealth.org.

What's Next?

Even with Catamount Health, VHAP, and Medicaid, there are still tens of thousands of uninsured Vermonters and many, many more who are paying too much for inadequate health care. As an important next step the coalition's goal is ensuring that every Vermonter has affordable, high quality health care, the legislature must act to allow businesses to buy Catamount Health for their employees. In addition, the next legislature must permanently eliminate the pre-existing conditions clause, lower Catamount Health's and VHAP's premiums to make them more affordable in these tough economic times and lower the eligibility for those in high deductible plans from $10,000 to at least $3,000 so these people can buy into Catamount Health without a waiting period.

Peter Sterling is the Executive Director of the Vermont Campaign for Health Care Security Education Fund, a non-profit organization working to educate Vermonters about and help them enroll in public health care programs. VCHCSEF is a project of AARP-Vermont, the Vermont NEA, Bi State Primary Care Association and the Vermont Citizens Campaign for Health.