Now Displaying 2020 Plan Details!

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Your Answers

  1. 1. Purchasing Type:
  2. 2. Income Subsidy:
  3. 3. Employer Contribution:
  4. 4. Plan Preference:
  5. 5. Plan Interest:
  1. Purchasing Type

    How are you purchasing your coverage?

    We use this to help determine what options are available to you. For example, if you are purchasing as an individual/family you may be eligible for tax credit. Whereas those purchasing as an employee of small group are ineligible for a tax credit but may want to account for an employer contribution towards their premium.

    • As an employee of small group
    • On my own, not through an employer
  2. Income Subsidy

    What is your modified adjusted gross income for 2020?

    This estimate is based on your Modified Adjusted Gross Income (MAGI), which for most tax payers is the same as Adjusted Gross Income (AGI) which is found on your most recent income tax return. You can find your AGI on Line 4 of Form 1040EZ, Line 21 of Form 1040A or Line 37 of Form 1040. This information is used to calculate your percent (%) of Federal Poverty Level (FPL). To learn more about how the premium tax credit works, please visit Vermont Health Connect, http://healthconnect.vermont.gov.

    There's a possibility you may qualify for a tax credit.

    Household Members:

    The number of people that live in your household.

    Enter Income:

    This estimate is based on your Modified Adjusted Gross Income (MAGI), which for most tax payers is the same as Adjusted Gross Income (AGI) which is found on your most recent income tax return. You can find your AGI on Line 4 of Form 1040EZ, Line 21 of Form 1040A and Line 37 of Form 1040
  3. Employer Contribution

    How much is your employer contributing towards your monthly premium?

    For the best estimate of monthly premium, we encourage you to get this information from your employer.

    Enter Employer's Monthly Contribution($):

    We will use this to calculate your adjusted monthly premium.

    I don't know...

    Once you find out from your employer, come back and see how it changes your monthly premium. In the meanwhile, we can show you what plans best meet your needs !
  4. Plan Preference

    What is your preference?

    We will use these numbers to help estimate your expected costs.

    • Low Deductible High Premium
    • High Deductible Low Premium
  5. Plan Interests

    Interested in seeing plans that are...

  6. Yes, you may qualify for a tax credit.

    Based on the values you provided for our calculation, it appears you may meet the IRS qualifications for premium assistance as well as a cost-shared reduction plan.

    Calculator Use Vermont Health Connect’s plan comparison tool to determine your eligibility Tax Info What does this mean?
  7. It appears you may not qualify for a tax credit.

    Based on the values you provided for our calculation, it appears you may not meet the IRS qualifications for this tax credit.

    Why not Why Not?
  8. Yes, it appears you may qualify for a tax credit.

    Based on the values you provided for our calculation, it appears you may meet the IRS qualifications for premium assistance.

    Calculator Use Vermont Health Connect’s plan comparison tool to determine your eligibility Tax Info What does this mean?
  9. Questionnaire Complete

    Questionnaire Complete

    The plans that best match your needs are shown below

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  10. Questionnaire Complete

    Questionnaire Complete

    The plans that best match your needs are shown below

    "Your Share," under Monthly Premium, has been updated to reflect your employer's contribution.  

    Start Over
  11. Questionnaire Complete

    Questionnaire Complete

    If you're eligible for premium assistance and/or a cost-share reduction plan, you should enroll through Vermont Health Connect

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14 plans that match
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Blue Rewards Catastrophic

EPO

Aggregate deductible & out-of-pocket limit.

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Benefit Chart and/or Summary of Benefits Coverage

Blue Rewards Bronze

EPO

Aggregate deductible & out-of-pocket limit.

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Benefit Chart and/or Summary of Benefits Coverage

Blue Rewards Bronze CDHP

EPO

Aggregate deductible & out-of-pocket limit.

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Benefit Chart and/or Summary of Benefits Coverage

Standard Bronze

EPO

Stacked deductible & out-of-pocket limit.

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Benefit Chart and/or Summary of Benefits Coverage

Standard Bronze CDHP

EPO

Aggregate deductible & out-of-pocket limit.

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Benefit Chart and/or Summary of Benefits Coverage

Standard Bronze without RX MOOP

EPO

Stacked deductible & out-of-pocket limit.

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Benefit Chart and/or Summary of Benefits Coverage

Blue Rewards Silver

EPO

Aggregate deductible & out-of-pocket limit.

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Benefit Chart and/or Summary of Benefits Coverage

Blue Rewards Silver CDHP

EPO

Aggregate deductible & out-of-pocket limit.

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Benefit Chart and/or Summary of Benefits Coverage

Standard Silver

EPO

Stacked deductible & out-of-pocket limit.

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Benefit Chart and/or Summary of Benefits Coverage

Standard Silver CDHP

EPO

Aggregate deductible & out-of-pocket limit.

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Benefit Chart and/or Summary of Benefits Coverage

Blue Rewards Gold CDHP

EPO

Aggregate deductible & out-of-pocket limit.

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Benefit Chart and/or Summary of Benefits Coverage

Blue Rewards Gold

EPO

Aggregate deductible & out-of-pocket limit.

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Benefit Chart and/or Summary of Benefits Coverage

Standard Gold

EPO

Stacked deductible & out-of-pocket limit.

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Benefit Chart and/or Summary of Benefits Coverage

Standard Platinum

EPO

Stacked deductible & out-of-pocket limit.

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Benefit Chart and/or Summary of Benefits Coverage

Anticipated Costs

Deductible Limit

$8,150 (Single)

$16,300 (2+/family)

Out-of-Pocket Limit

$8,150 (Single)

$16,300 (2+/family)

Monthly Premium

Single

$266.82

Couple

$533.64

Adult & child or children

$514.96

Family

$749.76

Deductible Limit

$7,900 (Single)

$15,800 (2+/family)

Out-of-Pocket Limit

$7,900 (Single)

$15,800 (2+/family)

Monthly Premium

Single

$545.43

Couple

$1,090.86

Adult & child or children

$1,052.68

Family

$1,532.66

Deductible Limit

$6,750 (Single)

$13,500 (2+/family)

Out-of-Pocket Limit

$6,750 (Single)

$13,500 (2+/family)

Monthly Premium

Single

$545.59

Couple

$1,091.18

Adult & child or children

$1,052.68

Family

$1,533.11

Deductible Limit

$6,000 (Single)

$12,000 (2+/family)

Out-of-Pocket Limit

$8,150 (Single)

$16,300 (2+/family)

Monthly Premium

Single

$549.48

Couple

$1,098.96

Adult & child or children

$1,060.50

Family

$1,544.04

Deductible Limit

$5,500 (Single)

$6,750 (2+/family)

Out-of-Pocket Limit

$8,150 (Single)

$16,300 (2+/family)

Monthly Premium

Single

$559.27

Couple

$1,118.54

Adult & child or children

$1,079.39

Family

$1,571.55

Deductible Limit

$7,900 (Single)

$15,800 (2+/family)

Out-of-Pocket Limit

$7,900 (Single)

$15,800 (2+/family)

Monthly Premium

Single

$560.45

Couple

$1,120.90

Adult & child or children

$1,081.67

Family

$1,574.86

Deductible Limit

$3,000 (Single)

$6,000 (2+/family)

Out-of-Pocket Limit

$8,150 (Single)

$16,300 (2+/family)

Monthly Premium

Single

$607.28

Couple

$1,214.56

Adult & child or children

$1,172.05

Family

$1,706.46

Deductible Limit

$4,450 (Single)

$8,900 (2+/family)

Out-of-Pocket Limit

$4,450 (Single)

$8,900 (2+/family)

Monthly Premium

Single

$630.08

Couple

$1,260.16

Adult & child or children

$1,216.05

Family

$1,770.52

Deductible Limit

$3,200 (Single)

$6,400 (2+/family)

Out-of-Pocket Limit

$7,900 (Single)

$15,800 (2+/family)

Monthly Premium

Single

$644.75

Couple

$1,289.50

Adult & child or children

$1,244.37

Family

$1,811.75

Deductible Limit

$1,700 (Single)

$3,400 (2+/family)

Out-of-Pocket Limit

$6,750 (Single)

$13,500 (2+/family)

Monthly Premium

Single

$663.91

Couple

$1,327.82

Adult & child or children

$1,281.35

Family

$1,865.59

Deductible Limit

$3,250 (Single)

$6,500 (2+/family)

Out-of-Pocket Limit

$3,250 (Single)

$6,500 (2+/family)

Monthly Premium

Single

$694.59

Couple

$1,389.18

Adult & child or children

$1,340.56

Family

$1,951.80

Deductible Limit

$1,550 (Single)

$3,100 (2+/family)

Out-of-Pocket Limit

$5,150 (Single)

$10,300 (2+/family)

Monthly Premium

Single

$698.95

Couple

$1,397.90

Adult & child or children

$1,348.97

Family

$1,964.05

Deductible Limit

$900 (Single)

$1,800 (2+/family)

Out-of-Pocket Limit

$5,000 (Single)

$10,000 (2+/family)

Monthly Premium

Single

$777.60

Couple

$1,555.20

Adult & child or children

$1,500.77

Family

$2,185.06

Deductible Limit

$350 (Single)

$700 (2+/family)

Out-of-Pocket Limit

$1,350 (Single)

$2,700 (2+/family)

Monthly Premium

Single

$900.13

Couple

$1,800.26

Adult & child or children

$1,737.25

Family

$2,529.37

Prescriptions - based on 30 day supply

Rx Deductible

Combined with Medical

Rx Out-of-Pocket Limit

Combined with Medical

Generic

Deductible, then $0

Preferred Brand

Deductible, then $0

Non-preferred Brand

Deductible, then $0
Deductible applies.

Rx Deductible

Combined with Medical

Rx Out-of-Pocket Limit

Combined with Medical

Generic

Deductible, then $0

Preferred Brand

Deductible, then $0

Non-preferred Brand

Deductible, then $0
Deductible applies.

Rx Deductible

Combined with Medical

Rx Out-of-Pocket Limit

Combined with Medical

Generic

Wellness: $25
Non-Wellness: Deductible, then $0

Preferred Brand

Wellness: 40%
Non-Wellness: Deductible, then $0

Non-preferred Brand

Wellness: 60%
Non-Wellness: Deductible, then $0

Rx Deductible

$1,000 per member

Rx Out-of-Pocket Limit

$1,350 (Single)

$2,700 (2+/family)

Generic

Deductible, then $20

Preferred Brand

Deductible, then $85

Non-preferred Brand

Deductible, then 60%
Deductible applies.

Rx Deductible

Combined with Medical

Rx Out-of-Pocket Limit

$1,400 (Single)

$2,800 (2+/family)

Generic

Wellness: $12
Non-Wellness: Deductible, then $12

Preferred Brand

Wellness: 40%
Non-Wellness: Deductible, then 40%

Non-preferred Brand

Wellness: 60%
Non-Wellness: Deductible, then 60%

Rx Deductible

Combined with Medical

Rx Out-of-Pocket Limit

Combined with Medical

Generic

$25 (Deductible is waived for Generic Rx)

Preferred Brand

Rx deductible, then $0

Non-preferred Brand

Rx deductible, then $0
Deductible applies.

Rx Deductible

Combined with Medical

Rx Out-of-Pocket Limit

$1,400 (Single)

$2,800 (2+/family)

Generic

Deductible, then $5

Preferred Brand

Deductible, then 40%

Non-preferred Brand

Deductible, then 60%
Deductible applies.

Rx Deductible

Combined with Medical

Rx Out-of-Pocket Limit

$1,400 (Single)

$2,800 (2+/family)

Generic

Wellness: $15
Non-Wellness: Deductible, then $0

Preferred Brand

Wellness: 40%
Non-Wellness: Deductible, then $0

Non-preferred Brand

Wellness: 60%
Non-Wellness: Deductible, then $0

Rx Deductible

$350 per member

Rx Out-of-Pocket Limit

$1,350 (Single)

$2,700 (2+/family)

Generic

$15 (Rx deductible is waived for Generic Rx)

Preferred Brand

Rx deductible, then $60

Non-preferred Brand

Deductible, then 50%
Deductible applies.

Rx Deductible

Combined with Medical

Rx Out-of-Pocket Limit

$1,400 (Single)

$2,800 (2+/family)

Generic

Wellness: $10
Non-Wellness: Deductible, then $10

Preferred Brand

Wellness: $40
Non-Wellness: Deductible, then $40

Non-preferred Brand

Wellness: 50%
Non-Wellness: Deductible, then 50%

Rx Deductible

Combined with Medical

Rx Out-of-Pocket Limit

Combined with Medical

Generic

Wellness: $5
Non-Wellness: Deductible, then $0

Preferred Brand

Wellness: 40%
Non-Wellness: Deductible, then $0

Non-preferred Brand

Wellness: 60%
Non-Wellness: Deductible, then $0

Rx Deductible

Combined with Medical

Rx Out-of-Pocket Limit

$1,400 (Single)

$2,800 (2+/family)

Generic

Deductible, then $5

Preferred Brand

Deductible, then 40%

Non-preferred Brand

Deductible, then 60%
Deductible applies.

Rx Deductible

$100 per member

Rx Out-of-Pocket Limit

$1,350 (Single)

$2,700 (2+/family)

Generic

$10 (Rx deductible is waived for Generic Rx)

Preferred Brand

Rx deductible, then $50

Non-preferred Brand

Deductible, then 50%
Deductible applies.

Rx Deductible

$0

Rx Out-of-Pocket Limit

$1,350 (Single)

$2,700 (2+/family)

Generic

$10

Preferred Brand

$50

Non-preferred Brand

50%

Office Visits

Primary Care & Mental Health

Combined 3/6/9 visits with no cost-sharing, then deductible applies, then $0

Chiropractor & Outpatient Physical Therapy

Deductible, then $0

Specialist

Deductible, then $0
Deductible applies.

Primary Care & Mental Health

Combined 3/6/9 visits with no cost-sharing, then deductible applies, then $0

Chiropractor & Outpatient Physical Therapy

Deductible, then $0

Specialist

Deductible, then $0
Deductible applies.

Primary Care & Mental Health

Deductible then, $0

Chiropractor & Outpatient Physical Therapy

Deductible, then $0

Specialist

Deductible, then $0
Deductible applies.

Primary Care & Mental Health

Deductible, then $35

Chiropractor & Outpatient Physical Therapy

Deductible, then $45

Specialist

Deductible, then $90
Deductible applies.

Primary Care & Mental Health

Deductible, then 50%

Chiropractor & Outpatient Physical Therapy

Deductible, then 50%

Specialist

Deductible, then 50%
Deductible applies.

Primary Care & Mental Health

$40

Chiropractor & Outpatient Physical Therapy

$50

Specialist

$100
$40

Primary Care & Mental Health

Combined 3/6/9 visits with no cost-sharing, then deductible applies, then co-pay $30

Chiropractor & Outpatient Physical Therapy

Deductible, then $45

Specialist

Deductible, then $50
Deductible applies.

Primary Care & Mental Health

Deductible then, $0

Chiropractor & Outpatient Physical Therapy

Deductible, then $0

Specialist

Deductible, then $0
Deductible applies.

Primary Care & Mental Health

$35

Chiropractor & Outpatient Physical Therapy

$45

Specialist

$80
$30

Primary Care & Mental Health

Deductible, then 10%

Chiropractor & Outpatient Physical Therapy

Deductible, then 30%

Specialist

Deductible, then 30%
Deductible applies.

Primary Care & Mental Health

Deductible then, $0

Chiropractor & Outpatient Physical Therapy

Deductible, then $0

Specialist

Deductible, then $0
Deductible applies.

Primary Care & Mental Health

Combined 3/6/9 visits with no cost-sharing, then deductible applies, then co-pay $20

Chiropractor & Outpatient Physical Therapy

Deductible, then $30

Specialist

Deductible, then $40
Deductible applies.

Primary Care & Mental Health

$20

Chiropractor & Outpatient Physical Therapy

$30

Specialist

$50
$15

Primary Care & Mental Health

$15

Chiropractor & Outpatient Physical Therapy

$20

Specialist

$40
$10

Hospital Services

Urgent Care

Deductible, then $0

Emergency Room

Deductible, then $0

Outpatient Surgery

Deductible, then $0

Inpatient Surgery

Deductible, then $0
Deductible applies.

Urgent Care

Deductible, then $0

Emergency Room

Deductible, then $0

Outpatient Surgery

Deductible, then $0

Inpatient Surgery

Deductible, then $0
Deductible applies.

Urgent Care

Deductible, then $0

Emergency Room

Deductible, then $0

Outpatient Surgery

Deductible, then $0

Inpatient Surgery

Deductible, then $0
Deductible applies.

Urgent Care

Deductible, then $100

Emergency Room

Deductible, then 50%

Outpatient Surgery

Deductible, then 50%

Inpatient Surgery

Deductible, then 50%
Deductible applies.

Urgent Care

Deductible, then 50%

Emergency Room

Deductible, then 50%

Outpatient Surgery

Deductible, then 50%

Inpatient Surgery

Deductible, then 50%
Deductible applies.

Urgent Care

Deductible, then $0

Emergency Room

Deductible, then $0

Outpatient Surgery

Deductible, then $0

Inpatient Surgery

Deductible, then $0
Deductible applies.

Urgent Care

Deductible, then $50

Emergency Room

Deductible, then $450

Outpatient Surgery

Deductible, then $1,750

Inpatient Surgery

Deductible, then $1,750
Deductible applies.

Urgent Care

Deductible, then $0

Emergency Room

Deductible, then $0

Outpatient Surgery

Deductible, then $0

Inpatient Surgery

Deductible, then $0
Deductible applies.

Urgent Care

$90

Emergency Room

Deductible, then $250

Outpatient Surgery

Deductible, then 50%

Inpatient Surgery

Deductible, then 50%
Deductible applies to some services.

Urgent Care

Deductible, then 30%

Emergency Room

Deductible, then 30%

Outpatient Surgery

Deductible, then 30%

Inpatient Surgery

Deductible, then 30%
Deductible applies.

Urgent Care

Deductible, then $0

Emergency Room

Deductible, then $0

Outpatient Surgery

Deductible, then $0

Inpatient Surgery

Deductible, then $0
Deductible applies.

Urgent Care

Deductible, then $40

Emergency Room

Deductible, then $250

Outpatient Surgery

Deductible, then $750

Inpatient Surgery

Deductible, then $750
Deductible applies.

Urgent Care

Deductible, then $60

Emergency Room

Deductible, then $150

Outpatient Surgery

Deductible, then 30%

Inpatient Surgery

Deductible, then 30%
Deductible applies to some services.

Urgent Care

$50

Emergency Room

Deductible, then $100

Outpatient Surgery

Deductible, then 10%

Inpatient Surgery

Deductible, then 10%
Deductible applies to some services.

Wellness

Individualized online wellness portal, one-to-one medication therapy management and discounts on health and wellness services and equipment at selected businesses.
Individualized online wellness portal, one-to-one medication therapy management and discounts on health and wellness services and equipment at selected businesses.
Individualized online wellness portal, one-to-one medication therapy management and discounts on health and wellness services and equipment at selected businesses.
No
No
No
Individualized online wellness portal, one-to-one medication therapy management and discounts on health and wellness services and equipment at selected businesses.
Individualized online wellness portal, one-to-one medication therapy management and discounts on health and wellness services and equipment at selected businesses.
No
No
Individualized online wellness portal, one-to-one medication therapy management and discounts on health and wellness services and equipment at selected businesses.
Individualized online wellness portal, one-to-one medication therapy management and discounts on health and wellness services and equipment at selected businesses.
No
No

HSA (Health Savings Account) Compatible Plan

No

No

No

No

No

No

No

No

No

Notes

Pediatric Dental & Vision is available for dependents under the age 21

*Must be under age 30 or income qualified

Pediatric Dental & Vision is available for dependents under the age 21

Pediatric Dental & Vision is available for dependents under the age 21

**Deductible is waived for Wellness Drugs

Pediatric Dental & Vision is available for dependents under the age 21

Pediatric Dental & Vision is available for dependents under the age 21

**Deductible is waived for Wellness Drugs

Pediatric Dental & Vision is available for dependents under the age 21

**Deductible is waived for Wellness Drugs

Pediatric Dental & Vision is available for dependents under the age 21

*This is a Reflective plan offering, available to those who enroll with BCBSVT directly as an individual or a group

Pediatric Dental & Vision is available for dependents under the age 21

*This is a Reflective plan offering, available to those who enroll with BCBSVT directly as an individual or a group

**Deductible is waived for Wellness Drugs

Pediatric Dental & Vision is available for dependents under the age 21

*This is a Reflective plan offering, available to those who enroll with BCBSVT directly as an individual or a group

Pediatric Dental & Vision is available for dependents under the age 21

*This is a Reflective plan offering, available to those who enroll with BCBSVT directly as an individual or a group

**Deductible is waived for Wellness Drugs

Pediatric Dental & Vision is available for dependents under the age 21

**Deductible is waived for Wellness Drugs

Pediatric Dental & Vision is available for dependents under the age 21

Pediatric Dental & Vision is available for dependents under the age 21

Pediatric Dental & Vision is available for dependents under the age 21

Find a Plan Disclaimer: The estimated and maximum costs displayed should be used for plan comparison purposes only.  These amounts are provided simply to allow you to see how the different plans work in sample situations. The actual amounts you pay will vary based upon numerous factors, including the specific services received and the providers used.

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