|Vermont Health Access Program (VHAP)
The information below is intended to provide some basic information to Vermonters about eligibility criteria for the Vermont Health Access Program (VHAP), its benefit package, the enrollment process and its cost. The information presented below has not been approved by the State of Vermont, which is the final authority on all Medicaid issues.
Any Vermonter that wishes to ask specific questions about their eligibility should speak to a state certified enrollment specialist at Member Services at 1 (800) 250-8427.
Any Vermonter that experiences difficulty with VHAP-related issues should call the Vermont Health Care Ombudsman’s Office at 1 (800) 917-7787
ABOUT THE VERMONT HEALTH ACCESS PROGRAM (VHAP)
You are eligible for VHAP if you are 18 or older, a Vermont resident, meet the income guidelines, and one of the following applies:
Having Medicaid or VHAP in the past 12 months does not count against you when determining if you meet the 12 month uninsured requirement. You can have had either or both Medicaid and VHAP in the past 12 months and still be eligible for VHAP.
In addition, individuals whose income is at or below 75% of the federal poverty level (FPL) do not have to meet the 12-month uninsured rule. For an individual, 75% FPL is $719 and for a household of 2 it is $970.
Students under age 23 who are in college are not eligible for VHAP if they didn’t elect the insurance the school offered as long as it covers both doctor and hospital care, or if their parents have the option of covering them under their insurance but didn’t elect to do so. Other students can be eligible for VHAP if they meet the eligibility requirements for students, which are somewhat complicated.
Eligibility for VHAP is determined by household income only. See the chart below.
Monthly premiums for your VHAP coverage are based on your household income and family size, or if you have access to Employer-Sponsored Insurance, you may get assistance from the state to help pay a monthly portion of your employer’s health plan.
Income & Premiums for Vermont Health Access Plan (VHAP)
You can apply online for VHAP at mybenefits.vt.gov. If you apply online, make sure you keep your confirmation number.
If you prefer to mail your application, you can Click here for the application. This application cannot be filled out on your computer, but it must be printed, filled out, signed and mailed to the state at the address on the application. Make a copy of your application to keep for your records before mailing it in.
Generally, the state has 30 days to process an application. If the individual is applying because he or she is disabled, the state has longer to process the application.
Individuals who qualify for VHAP are required to “recertify” their eligibility every 12 months. The state will mail you a notice when it is time to recertify with the necessary forms to fill out and send back. In addition, beneficiaries are required to report changes in their income to the state within 10 days of the change.
Generally, for adults VHAP covers physical and mental health services, naturopathic care, doctor office visits, prescriptions, and periodic eye exams. Some important services that are not covered include: eyeglasses and dental care.
VHAP has a $25 emergency room fee ($60 if it is determined the visit was not medically necessary). Depending on your income and the prescription cost, there may be a $1/$2/$3 co-pay per prescription and for durable medical equipment. There are no other out-of-pocket costs.