Insurance Costs & Subsidies

Before you buy, use these tools to help you make the decision that’s right for you:

• Read these guides to buying health insurance before making a decision about which plan is right for you.
   
• Visit the Vermont Health Connect website for plan comparison brochures.
   
• Use the Plan Comparison Tool to find out if you qualify for help paying for insurance and how much the plans will cost.

“Subsidy” is another word for financial help. When you apply for Vermont Health Connect plans, the two subsidies that might help you are Premium Tax Credits and Cost-Sharing Reductions.

Vermont Health Connect uses MAGI (Modified Adjusted Gross Income) to decide if you qualify for Medicaid or Premium Tax Credits and Cost-Sharing Reductions.

MAGI is your Adjusted Gross Income (AGI) from your federal tax return, plus foreign income, plus tax exempt interest, plus non-taxable Social Security benefits.

For most people, MAGI is the same as AGI. Find your AGI on your federal tax return on:

• Line 4 of Form 1040EZ, or
• Line 21 of Form 1040A, or
• Line 37 of Form 1040

To decide if you qualify for Premium Tax Credits and Cost-Sharing Reductions, Vermont Health Connect uses your tax household as your household size. This means that your household consists of you, your spouse (if you have one), and any dependents in your household.

If your income is up to 138% of the Federal Poverty Level for your household size, you are income-eligible for Medicaid. You do not have to have a child to be eligible. Find out more about Medicaid on this website.

Premium Tax Credits will be calculated automatically when you apply through Vermont Health Connect. You can get an estimate for your Premium Tax Credits right now by using the Vermont Health Connect Plan Comparison Tool.

If you are under the age of 65 and plan to try to get Medicaid, Dr. Dynasaur or other help with health care costs through Vermont Health Connect in future years, filing a tax return can make the process easier and faster. You may benefit from filing a return even if you do not need to pay taxes.

You cannot qualify for Premium Tax Credits if your tax filing status is Married Filing Separately, unless you are a victim of domestic violence* or you are an abandoned spouse. Abandoned spouse means that you are married, but you don’t know where your spouse is.

*Under the IRS rule, domestic abuse includes physical, psychological, sexual, or emotional abuse, including efforts to control, isolate, humiliate, and intimidate, or to undermine the victim’s ability to reason independently. The IRS considers all facts and circumstances in determining whether an individual is abused.

Domestic violence victims and abandoned spouses will need to call Vermont Health Connect at 1-855-899-9600 to apply for the Premium Tax Credits. 

• See the helpful information on our page about Health Insurance, Taxes and You
• Visit our Tax Help page to learn how to get free help filing a tax return

If you disagree with Vermont Health Connect’s decision about your subsidy amount (the amount of your financial help) or eligibility, you can appeal. When you get the decision, it will tell you how to appeal.

You can contact the Office of Health Care Advocate (HCA) at 1-800-917-7787 for help understanding how to appeal the decision. You can also ask for help by filling out our Help Request Form.

You may want to enroll in a plan while you’re waiting for the outcome of the appeal.