The information below is intended to provide a basic introduction to Vermonters about eligibility criteria for the Catamount Health Plan, its benefit package, enrollment process and cost.
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.
ABOUT 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:
OR if you lost your health insurance for one of the following reasons:
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.
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.
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.
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.
*reflects $45/month “participation fee” for those over 300% FPL
Catamount Health can be purchased from:
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.
There are out-of-pocket costs, in addition to premium payments. In some cases, these costs will be waived.
Deductibles and Co-Insurance:
Office Visit Fees
Prescription Out of Pocket Costs:
There is a three-tier program helps keep prescription drug costs down. You pay:
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.
Catamount Blue (Blue Cross Blue Shield of Vermont):
Conditions that do not have a Care management program yet, but will in the future are:
**Please check with the providers as management programs may have been added
How does a person enroll in Catamount Health?
You can contact Blue Cross Blue Shield directly if you don't qualify for a premium subsidy.
If you do qualify for a premium subsidy, contact Member Services for the state health care programs: 1 (800) 250-8427
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.