Click here for the application to Catamount Health
Click here for a comparison of Catamount Health to other non-group plans in Vermont

Individuals who need answers to specific questions about their eligibility for Catamount Health should speak to Green Mountain Care Member Services at 1 (800) 250-8427. The State of Vermont is the final authority on all matters related to Catamount.

Any Vermonter who experiences difficulty enrolling in Catamount Health should call the Vermont Health Care Ombudsman's Office at 1 (800) 917-7787.

Who is eligible for Catamount Health?

You are eligible for Catamount Health without any waiting period if you are 18 or older, a Vermont resident, and one of the following applies:

• you have been uninsured for at least 12 months
• you are between the ages of 18 and 26 and currently on your parents' health insurance plan
• you have insurance that only provides hospital care or doctors’ visits (but not both)
• you have an individual health insurance plan for 6 months or longer with a deductible of at least $7,500 for a single person/$15,000 for a family

Click here for more information about enrolling in Catamount Health if you are in a high deductible plan

OR if you lost your health insurance for one of the following reasons:

1. retirement, lost or quit your job, or had your hours at work reduced
2. the death of a household’s principle insurance policy holder
3. divorce or dissolution of a civil union
4. no longer receiving coverage as a dependent under the insurance plan of a parent or relative
5. no longer qualifying for, or voluntarily choosing to end COBRA coverage
6. college or university-sponsored health insurance is no longer available because of graduation, a leave of absence or the termination of studies.
7. are a victim of domestic violence

You can still apply for Catamount Health even if you are not a U.S. citizen. Click here for more information.

However, if your income is above 300% of poverty ($2,873/mo for an individual, $5,888/mo for a family of 4), AND you have access to insurance through your employer, you are not eligible for Catamount Health.

How much does Catamount Health cost?

What eligible Vermonters pay for Catamount is determined by their income. Many uninsured Vermonters will qualify for premium assistance from the state so they can afford Catamount.

The Cost of Catamount Health without Premium Assistance

Vermonters whose gross household income is more than $2,873 a month or more can buy into Catamount Health for its full price: $456 for Catamount Blue (Blue Cross Blue Shield) or $513 for MVP Catamount Choice.

The Cost of Catamount Health with Premium Assistance

Vermonters whose gross household income is between $1,915 and $2,873 a month may be eligible for a premium subsidy from the state.  These figures are different for 2 person households, 3 person households, etc.

Click here for a table that can help you calculate your premium subsidy.

Who sells Catamount Health in Vermont?

Catamount Health can be purchased from:

• Blue Cross Blue Shield: Catamount Blue

What does Catamount Health cover in the way of health benefits?

The core benefits of the plan are comprehensive and mandated by the State of Vermont. They include hospitalization and drug benefits, doctor visits for primary and specialty care, and mental health and substance abuse treatment.

• Outline of coverage for Catamount Blue
  

Does Catamount Health have office visit fees, deductibles and co-insurance charges?

There are out-of-pocket costs, in addition to premium payments. In some cases, these costs will be waived.

Deductibles and Co-Insurance:

• Annual in-network deductible is $500 for single coverage after which there is a co-insurance charge of 20% until the out-of-pocket maximum is met.  
• Annual in-network, maximum out-of-pocket costs for deductibles and co-insurance combined are $1,050 for single coverage and $2,100 for a family plan.

Office Visit Fees

• There is a $10 office visit fee. 

Prescription Out of Pocket Costs:

There is a three-tier program helps keep prescription drug costs down. You pay:

• $10 for each generic drug prescription
• $35 for a brand-name drug on our Preferred brand-name Drug List
• $55 for a brand-name drug that is NOT on our Preferred brand-name Drug List

Waiver of Out-of-Pocket Costs

Out-of-pocket costs are waived (no deductible, no co-insurance, no co-payments) for patients who need clinically recommended treatment for a chronic condition or disease. 

Chronic Care Management Programs offered

Catamount Blue (Blue Cross Blue Shield of Vermont):

• Asthma
• Chronic Obstructive Pulmonary Disease (COPD)
• Diabetes
• Heart Disease
• Anxiety Disorder
• Bipolar Disorder
• Major Depression
• Post-traumatic Stress Disorder
• Schizophrenia
• Substance Abuse

Conditions that do not have a Care management program yet, but will in the future are:

• Chronic Renal Failure
• Hyperlipidemia
• Hypertension

**Please check with the providers as management programs may have been added

You can contact Blue Cross Blue Shield directly if you don't qualify for a premium subsidy.

• Blue Cross Blue Shield 1 (888) 445-5805

If you do qualify for a premium subsidy, contact Member Services for the state health care programs: 1 (800) 250-8427

How does a person enroll in Employer Sponsored Insurance (ESI)?

An uninsured Vermonter who is employed may be required to participate in their employer sponsored health insurance (ESI) plan. While there are many details, in general, a person who is employed and who applies for Catamount Health may be required by the State to enroll in their employers plan, IF the State determines that the ESI plan is comparable in cost and benefits to Catamount Health. If employees make under $34,000 per year, they may also qualify for premium assistance to help pay for their employer’s plan.

Premium Assistance will help pay for coverage in their employer's plan only for uninsured employees.  It will not help employees who are already insured by their employer's plan.