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Vermont Medicaid Complete Guide

The Vermont Medicaid program, sometimes referred to as Green Mountain Care, is for low-income individuals who legally reside in the state of Vermont. Green Mountain Care was originally used to refer to the universal health insurance model that the state of Vermont used from 2011 through 2014. Green Mountain Care effectively ended in 3014 due to a lack of funding and concerns about high tax rates. Today, the Medicaid program (which is both federally and state-funded) is the only remaining part of Green Mountain Care.

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What does VT Medicaid Cover and Cost?

Vermont Medicaid includes coverage for all of the basic healthcare services (hospital stays, doctor’s appointments, emergency care, etc.). With any Medicaid program, covered health services must be medically necessary to receive full coverage. This is especially prudent for services such as physical therapy and chiropractic care, which typically require multiple visits. There must be sufficient medical evidence that you need those services before Medicaid will cover your full treatment. In some cases, a doctor will have to reassess to prove that you still require care.

The primary services that VT Medicaid does NOT cover are dentures, orthodontics (braces), and eyeglasses. Those who are under the age of 21, pregnant, or in a long-term care facility will never owe any copays with VT Medicaid. Some adults will be asked to pay small copayments for some services ranging from $1 to $3.

Dental, Vision, and Hearing

Dental, vision, and hearing benefits are limited with VT Medicaid. Each beneficiary has coverage for up to $510 in dental services. Any cosmetic or elective procedures (cast crowns and bridges, orthodontics, periodontal care, sealants, bonding) are not covered. Every member will be covered for one comprehensive eye exam and one intermediate eye exam (or two intermediate eye exams) within a two year period. Members can get hearing aids once every three years and when a doctor proves that it is medically necessary.

Prescription Drugs

Vermont Medicaid covers most generic prescriptions. Your doctor should know to always select generic drugs from the Vermont preferred drug list instead of brand-name prescriptions. If for some reason there is not a generic or preferred drug available, your doctor will need to request approval from the Medicaid program before you can get coverage for that drug.

Some adults will owe copayments for prescription drugs. Drugs with a price tag of $30 or less will cost a $1 copay, drugs costing between $30.01 and $50 will cost a $2 copay, and drugs costing over $50 will cost a $3 copay.

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Non-Emergency Medical Transportation

Vermont Medicaid does cover emergency ambulance transportation, but it also covers transportation for non-emergency medical situations like doctor’s appointments! Eligible members who do not have a reliable means of transportation or cannot afford the gas to get to their doctor’s appointments should use this chart to find non-emergency medical transportation in their area.

Dr Dynasaur Children's Health Insurance Program

Dr. Dynasaur is the name for the Children’s Health Insurance Program (Medicaid for kids) in Vermont. Kids under 19 with a household income below 312% of the Federal Poverty Level (FPL) and pregnant women with income below 208% of the FPL should apply. Pregnant women with qualifying incomes can get Dr. Dynsaur coverage for free. Some children might owe a monthly premium of $15 or $20 per month, depending on household income. It is possible for kids to qualify even if the parents do not.

Dr. Dynasaur covers mostly the same services as the Medicaid program for adults. You may be required to get doctor referrals for some specialist services.

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Vermont Medicaid Eligibility Requirements

To be eligible for Vermont Medicaid, you must be a legal resident of the state and meet the income and resource guidelines.

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How to Apply for Medicaid in Vermont

The application for Vermont Medicaid is called “202MED.” You can complete the form online through Vermont Health Connect, or you can mail in a printed copy. You can either print a copy at home or call 1-800-250-8427 to have an application mailed to you. When you’re ready, mail your application to Green Mountain Care | Application and Document Processing Center at 280 State Drive, Waterbury, VT 05671. You will also need to send in supporting documentation regarding your income and health (outlined on the application).

How to get Both Medicare and Medicaid in Vermont

Did you know that if you are eligible for both programs, you can benefit from both Medicare and Medicaid at the same time? Enrollment in both programs can mean more benefits, a more extensive network, and more cost savings. Plus, most people who meet the eligibility requirements for both programs can enroll in a DSNP, a Dual-Eligible Special Needs Plan. DSNPs come at very low and sometimes no cost to the consumer and will cover all or most of your healthcare needs.

For help selecting a DSNP plan, call us at 833-438-3676 or send us a message with your questions.

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