How to get Medicaid or low-cost care in Vermont

Dr. Dynasaur and who runs Medicaid here

Medicaid is a health program that the state and federal government pay for together. Here it is run by the Department of Vermont Health Access, which people shorten to DVHA. DVHA is part of the Agency of Human Services. The Vermont Health Connect website uses the names Medicaid and Dr. Dynasaur for its free or low-cost coverage.

The Kaiser Family Foundation says Vermont adopted Medicaid expansion on January 1, 2014. Expansion means that adults can qualify based on income alone. The state says the Medicaid limit is 138 percent of the federal poverty level. That level is a yearly income line the government uses to measure poverty. For one person that is about $22,025 a year, and for a family of four it is about $45,540. These figures come from the state's own page, so check the Vermont Health Connect eligibility tables for the current year.

Children, pregnant people and people with disabilities can qualify under other rules. Our guide on who qualifies for Medicaid explains the groups.

Applying through Vermont Health Connect

Vermont Health Connect is the state's marketplace for health coverage, and it is also the front door to Medicaid. You can apply online through its secure portal, or you can call customer service at 1-855-899-9600. Phone hours are Monday through Friday from 7:45 a.m. to 4:30 p.m., except on holidays. Callers who use a relay service can dial 711.

Local helpers called assisters are also there to guide you. They can meet with you in person, talk by phone or work with you online. The Vermont Health Connect website has a directory to find one near you.

To apply by mail, use the address the state lists for its Application and Document Processing Center at 280 State Drive in Waterbury. You can enroll in Medicaid or Dr. Dynasaur at any time of year, the state says. Our guide on how to apply for Medicaid lists the papers to gather first.

After you are covered, keep your contact details current. DVHA tells members to update their information online or by calling, to watch their mail and to answer letters right away.

What changes in 2027

A new federal law changes Medicaid for some adults ages 19 to 64, and Vermont says most of the changes start in 2027. The first change is a work rule, which the government calls community engagement. Adults must show some mix of work, volunteering or school that adds up to 80 hours a month. Another way to meet it is to earn at least $580 a month.

The state has set exact dates for each group. New applicants must show they met the rule during the month before they apply, starting January 1, 2027. Current members who renew starting March 1, 2027 must show they met it in one of the months since their last renewal.

The state says some people are not affected. They include people who are pregnant, up to 12 months after a birth or on Medicare. People under 19 or age 65 and older are not affected either. Other exemptions apply to caregivers of a child 13 or younger and to people with certain health conditions. Our guide on the Medicaid work rule covers the full list.

Vermont also says renewals will happen every six months instead of once a year for the affected adults. Retroactive coverage, which is coverage for bills from before you applied, will shrink to one month for most affected adults. The state has a short screening tool on its DVHA site that tells you if the rule may apply to you.

What the Vermont tax return asks about coverage

Vermont law asks residents to keep health coverage, which is unusual. State law also asks each resident who files a Vermont income tax return to say whether they had coverage in each month of the year. That is why you may see a coverage question when you file.

The law does not list a cash penalty for going without coverage. It does tell the state to use tax information to reach out to people who had no coverage and help them find a plan. Our guide on whether it is illegal to go without insurance compares Vermont with the few states that do charge a penalty.

Plans for people who earn too much for Medicaid

Vermont Health Connect also sells private plans, which it calls qualified health plans. The website says Open Enrollment runs from November 1 to December 28 each year. It also says you can get financial help for one of these plans only if you sign up through Vermont Health Connect. Some life events, such as losing other coverage, open a Special Enrollment Period, which is a window to join outside those dates.

Our guide on losing a job and losing insurance walks through the first steps.

Clinics, license lookups and the ER

Community health centers get federal money and serve everyone. Their prices follow your income and family size. Search by zip code with the Find a Health Center tool from the Health Resources and Services Administration. Our guide to community health centers lists good questions to ask when you call.

The Vermont Board of Medical Practice runs a lookup system called VtBMPOnline. It lists public information about physicians licensed in Vermont. The state says its rosters count as a primary source check of a license.

Some Vermont doctors charge a flat monthly fee for primary care without billing insurance, which is called direct primary care. Our directory of cash-pay doctors is a good place to start, and you can ask any office for its fee in writing.

In an emergency, call 911 or go to the nearest emergency room. Under federal law, a hospital ER has to check you and treat an emergency even if you have no insurance.