Catamount Health Plan for Uninsured Vermonter's

The Goal of Catamount Health

At the time of its creation during the 2007 Vermont legislative session, the Catamount Health Plan was designed to be comprehensive and rich-in-benefits but yet be affordable for Vermonters who were uninsured or had recently lost their health insurance. The goal of Catamount Health is to insure some 20,000 residents without coverage out of a current estimate of 60,000 to 65,000 living in Vermont so as to reduce the number of uninsured  to around 5% of the state's population. For individuals and families with low to moderate incomes (depending on family size), the privately run plan includes premium subsidies paid by the state.  Two carriers are offering the health plan, MVP Health Care and Blue Cross and Blue Shield of Vermont, with identical benefits and premiums.

 With nearly a year and a half experience since the plan was implimented, enrollment is slightly below projections and the demographics as well as health conditions of these early subscribers suggest a higher than anticipated utilization.  Higher than projected claims costs will have an adverse effect on the funding mechanism for Catamount Health.  This will likely have a direct bearing on the extent to which the same set of rich benefits can be continued and/or a future premium increase expected this summer. Right now, with the current rates listed below, many Vermonters who earn just over the income limits and therefore don't qualify for the premium subsidy are finding the cost of the insurance to be expensive or beyond their means. 

Legislative Update in the Vermont Statehouse

The Vermont legislature is nearing the end of this 2009 session dealing with the effects of the economic recession and a looming state budget deficit for the next two years.  Thus many of the reforms and enhancements proposed by legislative leaders before the session are likely to be abandoned. Govenor Douglas has been moving in the opposite direction by wanting to increase office visit copays and deductibles in an effort to keep the plan solvent. 

One proposal that has been gaining traction in the Vermont legislature is a bill to create a second Catamount Health plan that conforms to the U. S. Treasury Department's guidelines for an HSA-qualified policy (a high deductible health plan or HDHP) and that would enable the subscriber to open a tax-favored HSA bank account.  This bill would provide for two different sets of single and family deductibles to choose from, but would not include any premium assistance.  It is thought that the HSA model might reduce the current premiums by up to 35% when compared to the existing low-deductible plan.

For More Information on Catamount Health

For more information you can call the consumer information line at (800) 250-8427. You can also visit the state web sites at www.hcr.vt.gov or www.greenmountaincare.org. In the near future, the state of Vermont will be grouping all of the publically sponsored medical plans under the title Green Mountain Care. Alternatively, please contact Benefit Design & Strategies, LLC.

Catamount Coverages and Monthly Costs

Catamount generally offers better coverage than most plans in the private sector with premiums that are between $100 to $150 per month less than a comparable single/individual coverage plan. Briefly, the in-network benefits (out-of-network benefits have higher deductibles and no allowance for office visit co-payments) include;

• $10 co-payments for office visits with the balance picked up by the insurance;
• $10 co-payments for naturopathic physician visits and acupuncturist services;
• Preventive care services (physicals, well-baby and child check-ups, immunizations, female well-care, screening mammograms, PSA tests and colonoscopy screenings.
• No co-payments for services related to a chronic illness such as diabetes or obesity so long as the patient is enrolled in the chronic care management program;
• No co-payment or deductible for preventive care services such as routine physicals, female well care, well baby and shild exams, mammograms and Pap tests;
• $250 calendar year deductible for single and $500 deductible for family coverage;
• 20% co-insurance (you pay 20% and the plans pays the other 80%) for covered services for the next $2,750 for single and $5,500 for two-person or family coverage;
• Total out-of-pocket (the amount one would have to pay including deductible and co-insurance for treatment of a major medical condition for covered services with in-network physicians and facilities) are $!,500 for single and $3,000 for two-person/family coverage;
• Prescription drug co-payments are $10.00 for generic, $30 for drugs on the preferred list and $50 for non-preferred medications. There is no separate Rx deductible.
• Lifetime benefit of $1,000,000.

The medical networks of participating providers and facilities of thew two carriers sponsoring Catamount Health are very comprehensive and comparable throughout the state, so that participants should not have to change doctors in order access the richer in-network benefits. The monthly premiums of both carriers are exactly the same as well:

In addition, individuals and families whose family incomes fall below three times the Federal Poverty Level (FPL) will qualify for premium subsidies. Thus a single individual earning up to $33,000 per year and a family of four earning up to $64,000/yr. for 2007 may be eligible for a subsidy. The lowest eligible income earners may have a premium of as little as $60.00 per month for their health insurance, while a single coverage for an individual with income near the 300% on FPL will have a premium payment of $135.00 in first part of 2009. There appears to be a big jump in the non-subsidized premium for subscribers earning more then 300% of the FPL.

If your employer currently offers a comparably rich-in-benefits health plan to that offered by Catamount, you may be eligible for a state assistance to help make your share of the monthly premium payments and at no additional cost to your employer.

Funding Sources to Cover the Program's Cost

The sources of funding as provided for in the Catamount legislation include federal Medicaid grants, the state's Medicaid matching funds, premium contributions from enrollees, the modest out-of-pocket charges paid by participants as they utilize the plan and a special assessment placed on employers who either do not sponsor health insurance for their employees or who have a large number of employees who refuse coverage and are not covered by another comprehensive insurance plan. Such an other health plan could be one obtained through a spouse, another job, the military or Medicare.

A recent announcement from the Bush administration has put a new wrinkle into the funding sources just as Catamount Health was being launched. Since federal grants are one source of the program's funding, the Feds have a stake in how the program is run. In late September, President Bush denied Vermont's waiver request (and that of other states) to raise the factor for determining eligibility to 300% of the FPL and instead of the current 200%. Vermont officials plan to continue to determine eligibility based on the higher factor and are searching for other funding sources.

The 2008 special assessment was $91.25 per quarter or $365 for the year for each qualified, uninsured full-time employee working for that employer. This amount is due to increase annually based on the inflation rate. A qualified employee is one who would be listed on the employer's quarterly unemployment insurance filing with the state.

Special Assessments Exemptions for Employers

Exemptions from paying the special assessment were built into the initial law and a subsequent amendment for certain uninsured workers:

• part-time employees;
• farm hands on small farms;
• full-time college students employed in work-study programs;
• elected officials;
• emergency volunteers such as fire fighters or ambulance crews;
• licensed insurance and real estate commissioned sales people (i.e. independent contractors);
• seasonal employees working less than 520 hours in a quarter unless covered by Medicaid or VHAP; and
• employees under the age of 18 (who would presumably be covered by a parent under a two-person or family plan).

In an effort to help small businesses in the early years of this new health plan, the law provides out-right exemptions of the special assessment for 8 full-time employees during 2007 and 2008, 6 qualified employees in 2009 and finally leveling off at 4 employees thereafter.

What is "Crowd-Out"?

The legislature anticipated the new Catamount Plan would be attractive enough that some unscrupulous employers might try to circumvent the law in order to shift employees onto the state plan. To prevent the phenomenon of "crowd-out", the rules allow carriers (with prior approval of the Commissioner of Banking, Insurance, Securities and Health Care Administration), to decline coverage for any individual who becomes uninsured "...primarily to obtain access to Catamount Health in a manner that is contrary to the intent of the Act." An employer dropping health coverage for other than truly financial reasons might be an example of an elicit action to cause employees to migrate to the less expensive medical plan.

Apply Today

If you think you and/or your family qualify for the Catamount Health Plan, you are urged to contact the consumer help line at (800) 250-8427 for more information, or contact Benefit Design & Strategies, LLC. The long-term goal of insuring all Vermonters with a secure health insurance plan is in the best interest of everybody to help contain medical costs and encourage everyone to be responsible for their own health care.