Vermont residents have access to some of the most comprehensive health insurance options in the country through the Affordable Care Act (ACA). The state operates its own marketplace, Vermont Health Connect, which serves as a one-stop shop for both subsidized private health plans and Medicaid enrollment. Whether you are uninsured, facing a job change, or simply looking for more affordable coverage, understanding your Vermont ACA benefits and coverage options can help you find the right plan and potentially save thousands of dollars each year.
What Is Vermont Health Connect?
Vermont Health Connect is the state-run health insurance marketplace established under the ACA. Unlike many states that use the federal HealthCare.gov platform, Vermont built its own exchange to give residents a streamlined experience. Through a single application, you can find out if you qualify for:
- Green Mountain Care (Medicaid) for free or low-cost coverage
- Dr. Dynasaur for children's health coverage
- Qualified Health Plans (QHPs) with premium tax credits
- Cost-sharing reductions that lower your deductibles and copays
The marketplace offers plans from Vermont-based insurers, and all plans must cover the 10 essential health benefits required by federal law.
Essential Health Benefits Covered Under Vermont ACA Plans
Every ACA-compliant plan sold through Vermont Health Connect must cover these 10 categories of essential health benefits:
- Ambulatory (outpatient) care including doctor visits and specialist appointments
- Emergency services at hospitals and emergency rooms
- Hospitalization for surgeries and overnight stays
- Maternity and newborn care before and after birth
- Mental health and substance use disorder services including counseling and behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services including physical therapy and devices
- Laboratory services such as blood tests and screenings
- Preventive and wellness services including vaccinations and chronic disease management
- Pediatric services including dental and vision care for children
Vermont plans often go beyond federal minimums. The state requires additional benefits such as comprehensive adult dental coverage in some plans and strong mental health parity protections.
Income Limits and Financial Assistance for 2026
Your household income determines the type of help you can receive through Vermont Health Connect. Vermont uses the Federal Poverty Level (FPL) to set eligibility thresholds.
Medicaid (Green Mountain Care) Income Limits
If your income falls at or below 138% of the FPL, you likely qualify for Green Mountain Care, Vermont's Medicaid program, which provides free or very low-cost coverage.
| Household Size | Monthly Income Limit (138% FPL) | Annual Income Limit |
|---|---|---|
| 1 | $1,732 | $20,783 |
| 2 | $2,351 | $28,208 |
| 3 | $2,969 | $35,634 |
| 4 | $3,588 | $43,056 |
Dr. Dynasaur (Children's Coverage)
Children under 19 may qualify for Dr. Dynasaur with household incomes up to 317% FPL. Families with income between 138% and 317% FPL pay small premiums.
Premium Tax Credits for Marketplace Plans
For 2026, premium tax credits are available to Vermonters with incomes between 138% and 400% of the FPL who are not eligible for Medicaid or affordable employer-sponsored coverage.
| Household Size | Max Annual Income for Credits (400% FPL) |
|---|---|
| 1 | $62,600 |
| 2 | $84,640 |
| 3 | $106,680 |
| 4 | $128,600 |
Important 2026 change: The enhanced premium tax credits that were available from 2021 through 2025 under the American Rescue Plan and Inflation Reduction Act are set to expire at the end of 2025 unless Congress takes action. This means that starting in 2026, individuals earning more than 400% FPL will no longer qualify for premium assistance, and those under 400% FPL may see reduced subsidies compared to prior years.
Cost-Sharing Reductions (CSRs)
If you enroll in a Silver-level plan and your income is between 138% and 250% FPL, you may qualify for cost-sharing reductions that lower your deductibles, copayments, and out-of-pocket maximums. About 20% of Vermont Health Connect enrollees receive CSR benefits.
Types of Plans Available
Vermont Health Connect offers plans in four metal tiers, each balancing monthly premiums against out-of-pocket costs:
| Plan Tier | Typical Coverage Level | Best For |
|---|---|---|
| Bronze | 60% of costs covered | Healthy individuals wanting low premiums |
| Silver | 70% of costs covered | Those qualifying for CSRs; moderate usage |
| Gold | 80% of costs covered | Families or individuals with regular care needs |
| Platinum | 90% of costs covered | Those who want the most comprehensive coverage |
Silver plans are often the best value for individuals and families who qualify for cost-sharing reductions, as the actual coverage can approach Gold or Platinum levels at Silver-tier prices.
How to Apply for Vermont ACA Coverage: Step by Step
Step 1: Gather Your Information
Before starting your application, collect the following:
- Social Security numbers for all household members
- Immigration documents (if applicable)
- Employer and income information (pay stubs, tax returns, or W-2 forms)
- Information about any current health coverage
- Tax filing status
Step 2: Visit Vermont Health Connect
Go to portal.healthconnect.vermont.gov and create an account. You can also call 1-855-899-9600 for phone assistance.
Step 3: Complete the Application
Fill out the single application, which determines your eligibility for both Medicaid and marketplace plans with financial assistance. The application asks about your household size, income, and other factors.
Step 4: Review Your Eligibility Results
Vermont Health Connect will display your eligibility determination, showing whether you qualify for:
- Green Mountain Care (Medicaid)
- Dr. Dynasaur (for children)
- Premium tax credits for marketplace plans
- Cost-sharing reductions
Step 5: Compare and Select a Plan
If you are eligible for marketplace coverage, browse available plans. Compare monthly premiums, deductibles, copays, provider networks, and prescription drug coverage.
Step 6: Enroll and Pay Your First Premium
Select your plan and complete enrollment. Your coverage starts once you pay your first monthly premium. Keep your confirmation information for your records.
Step 7: Use Our Free Screener
Not sure what you qualify for? Use our free benefits screener to check your eligibility for ACA subsidies and other programs in just a few minutes.
Open Enrollment and Special Enrollment Periods
Open Enrollment for 2026 coverage ran from November 1, 2025, through January 31, 2026. If you missed open enrollment, you may still be able to enroll through a Special Enrollment Period (SEP) if you experience a qualifying life event such as:
- Losing existing health coverage
- Getting married or divorced
- Having or adopting a child
- Moving to Vermont
- Turning 26 and aging off a parent's plan
- Changes in household income that affect eligibility
Medicaid and Dr. Dynasaur enrollment is available year-round with no enrollment period restrictions.
Vermont's Unique Healthcare Features
Vermont stands out nationally for several healthcare innovations:
All-Payer ACO Model: Vermont is the only state with an All-Payer Accountable Care Organization (ACO) model that coordinates care across Medicaid, Medicare, and commercial insurance. OneCare Vermont, the statewide ACO, works to improve health outcomes while controlling costs.
Early Medicaid Expansion: Vermont has provided Medicaid-like coverage to low-income adults since 1995, well before the ACA's expansion in 2014. This long history means the state has deep experience serving this population.
12-Month Postpartum Coverage: New mothers on Medicaid receive a full 12 months of postpartum coverage, ensuring continued access to care during the critical period after childbirth.
IHIP (Immigrant Health Program): Vermont offers coverage to children and pregnant women who would otherwise qualify for Medicaid except for their immigration status.
Additional Benefits You May Qualify For
When you apply through Vermont Health Connect, your information can also help determine eligibility for other assistance programs. Vermont residents frequently qualify for multiple programs. Check your eligibility for:
- 3SquaresVT (SNAP): Food assistance for households with gross income up to 185% FPL
- Seasonal Fuel Assistance (LIHEAP): Help with heating costs for households up to 185% FPL
- WIC: Nutrition support for pregnant women, infants, and children under 5
- Reach Up (TANF): Cash assistance for families with children
Visit our Vermont Benefits Overview page for a complete guide to all available programs, or use our free screener to check your eligibility for multiple programs at once.
Frequently Asked Questions
What is the difference between Green Mountain Care and Vermont Health Connect?
Green Mountain Care is Vermont's Medicaid program, providing free or very low-cost health coverage for individuals and families with incomes at or below 138% FPL. Vermont Health Connect is the state marketplace where you can apply for both Medicaid and subsidized private health plans through a single application.
Can I get ACA coverage if my employer offers insurance?
You may still enroll through Vermont Health Connect, but you will only qualify for premium tax credits if your employer's coverage is considered unaffordable (costs more than 9.02% of your household income for 2026) or does not meet minimum value requirements.
What happens if my income changes during the year?
You must report income changes to Vermont Health Connect within 30 days. Changes can affect your premium tax credits, cost-sharing reductions, or Medicaid eligibility. Failing to report changes could result in owing money back at tax time or missing out on additional assistance.
Are there free or low-cost options for my children?
Yes. Dr. Dynasaur covers children under 19 in households with incomes up to 317% FPL. Children in families at or below 138% FPL receive free coverage, while those in higher-income families pay small premiums.
How do I get help with my application?
Vermont Health Connect offers several ways to get assistance:
- Phone: Call 1-855-899-9600
- In person: Visit a Vermont Health Connect office
- Navigators and brokers: Free certified application counselors are available statewide to help you understand your options and complete enrollment
Will my premium tax credits change in 2026?
Yes. With the expiration of enhanced subsidies from the American Rescue Plan, many Vermonters will see changes to their premium assistance for 2026. Those earning over 400% FPL will lose eligibility for credits entirely, while those under 400% FPL may receive smaller subsidies than in prior years.
Can I apply for Medicaid at any time?
Yes. Unlike marketplace plans, which have specific enrollment periods, Medicaid and Dr. Dynasaur applications are accepted year-round. If you qualify, coverage can begin immediately.
Take the Next Step
Understanding your Vermont ACA benefits and coverage options is the first step toward finding affordable health insurance. The combination of Green Mountain Care, Dr. Dynasaur, and subsidized marketplace plans means that most Vermont residents can find coverage that fits their budget.
Use our free benefits screener to find out what programs you may qualify for in just a few minutes. It checks eligibility for ACA subsidies, Medicaid, and 10 other assistance programs all at once, giving you a complete picture of the help available to you.
For more information about all Vermont benefits programs, visit our Vermont Benefits Overview page.
