Vermont Goes For Gold (Silver, Bronze And Platinum, Too)



Vermont is the only state in the nation on a path to a single payer health system. That could take a while, though. And in the meantime, the state has to set up an insurance exchange to comply with the Affordable Care Act.

While some states are still struggling with the basic question of whether to do their own exchanges, Vermont is moving ahead at a rapid clip, digging into the details of how much various health plans will cost on its exchange.

The Green Mountain Care Board this week released the basic outline of benefit packages that will be available to all individuals and small businesses in January 2014.

Consumers will have a range of options with different deductible levels, co-payment requirements and caps on out of pocket expenses.

Under the Affordable Care Act, there are four levels of coverage; platinum, gold, silver and bronze.  The benefit package is the same in each category, but the costs consumers will have to pay when they need health care services are different at each level. And this factor will influence the premium cost of the policy.

For example, the annual deductible in the platinum plan is $250 – in the bronze plan it’s almost $2,000. The cap for out-of-pocket medical expenses in the platinum plan is roughly $1,000 – in the bronze plan it’s just over $6,000.

The cost of a trip to the emergency room is capped at $100 under the platinum plan – it’s $350 under the bronze plan.  The cost of these services under the gold and silver plans fall between these two extremes.

The platinum plans, having the most generous benefits, would have the highest monthly premiums, and bronze plans would have the lowest premiums.

“What we’re trying to do is balance diverse needs of consumers and diverse desires of consumers by having a range of choices,” said Robin Lunge, the director of health care reform for Democratic Gov. Peter Shumlin’s administration.

Federal subsidies will be available for individuals and families with incomes up to 400 percent of the federal poverty level.  That’s roughly $45,000 a year of income for an individual and $92,000 for a family of four.

For example, an individual with a $30,000 salary and an employer who doesn’t offer health insurance would pay roughly $2,400 a year for the middle range policy known as the “silver” option – federal subsidies would pay the rest.

Lunge says the federal subsidies are a critical way to make coverage more affordable: “There are some affordability options in the federal law as well through the premium tax credits that should make insurance much more affordable for folks.”

The Green Mountain Care Board will now study the cost sharing plan developed by the Shumlin Administration, and it will seek public comments through Sept. 11 as part of that review.

This story is part of a reporting partnership that includes Vermont Public Radio, NPR and Kaiser Health News.