Cost and Coverage for Medicaid in Vermont

Several types of Medicaid insurance plans are available in the state of Vermont. Vermont’s Green Mountain Care (Medicaid) offers Medicaid plans to qualifying children and adults or aged, blind and disabled applicants. Long-term Medicaid services are also available to qualifying beneficiaries. VT Medicaid coverage also includes prescription drug coverage and Dr. Dynasaur services. Dr. Dynasaur provides free or low-cost health coverage to teenagers under 19, low-income pregnant women and children. All Medicaid types of insurance are available to qualifying applicants who meet age requirements or household size and income restrictions.

Below, Medicaid coverage applicants can find information pertaining to Medicaid services and costs in Vermont:

  • What services are covered by Medicaid in Vermont?

  • What does Medicaid not cover in Vermont?

  • Types of Medicaid insurance in Vermont

  • How much does Medicaid cost in Vermont?

What services are covered by Medicaid in Vermont?

All types of Medicaid insurance plans cover similar services. However, what is covered by Medicaid may vary. Certain Medicaid services, like prescription medication, and the cost of monthly premiums are not always covered. VT Medicaid coverage for Children and Adults, low-income pregnant women, Aged, Blind and Disabled applicants and Dr. Dynasaur applicants all include a wide range of Medicaid services covered, from ambulance transport to diabetic supplies.

Most Vermont Medicaid coverage plans include doctor visits, prescriptions and hospital care. Generally, types of Medicaid insurance plans also cover the following services: family planning services, gynecological services, hospice care, medical equipment, nutritional therapy, inpatient hospital care, home health care, mental health assistance, midwife services and occupational therapy. Other Medicaid services covered include respiratory therapy, speech therapy, substance abuse counseling and prosthetics. However, referrals may be required for certain Medicaid and Dr. Dynasaur services.

If Vermont Medicaid does not include a specific service, beneficiaries may contact the Green Mountain Care Customer Service Center to request that a service be covered under their plan. Recipients should receive an answer regarding their non-covered service within 30 days.

What does Medicaid not cover in Vermont?

Most types of VT Medicaid insurance plans cover medically-necessary services. However, what is not covered by Medicaid includes dentures, eyeglasses and orthodontics. Additionally, Medicaid coverage is limited for the following services: chiropractic care, dental care, eye exams, hearing aids, nursing facility care and outpatient hospital care. Medicaid coverage in VT is also limited for podiatry, physical therapy, speech therapy, occupational therapy, substance abuse, team care and transportation services.

Types of Medicaid Insurance in Vermont

Several types of Medicaid insurance plans are available to residents of Vermont. Provided by Green Mountain Care, Vermont Medicaid is available to Children and Adults or Aged, Blind and Disabled candidates. To qualify for Children and Adults Medicaid services, applicants must be under 65 and meet household income size and restrictions. To qualify for Aged, Blind and Disabled Medicaid coverage, applicants must be blind, disabled or 65 and older.

Dr. Dynasaur coverage is an additional Medicaid program available to teenagers under 19, pregnant women and children. Beneficiaries must be low-income to receive free or low-cost coverage through the Dr. Dynasaur program.

Vermont Medicaid coverage also offers a Prescription Assistance program for candidates who need prescription financial assistance. Currently, two prescription programs are available, including the Healthy Vermonters program and the VPharm program. Healthy Vermonters provides beneficiaries with a discount on medical prescriptions. Beneficiaries are not required to pay a monthly premium. The VPharm program helps beneficiaries to pay for prescription medications but patients are required to pay low-cost monthly premiums.

To qualify for prescription Medicaid services in Vermont, income restrictions apply. Additionally, The Healthy Vermonters plan requires patients to be low-income and to have no other prescription coverage services. However, Healthy Vermonters may also be available to beneficiaries who already have prescription coverage but have exceeded their maximum benefit amount.

The VPharm Medicaid coverage program is available to low-income beneficiaries who are enrolled in Medicare Part D.

Long-term Medicaid coverage is available through Vermont’s Choices for Care program. This medical coverage program helps beneficiaries to pay for long-term care services in a variety of settings. The health plan includes long-term care out of the patient’s home, assisted-living facility or residential care facility, or a Medicaid-approved nursing home facility. To be eligible for the Choices for Care program, beneficiaries must reside in Vermont, be 65 and older or be 18 and older and have a physical disability. Candidates may also be eligible for Medicaid services under the Medicaid for Children and Adults guidelines. However, applicants must also meet income restrictions and clinical criteria for receiving nursing home care.

How much does Medicaid cost in Vermont?

Vermont Medicaid coverage provides free or low-cost health insurance coverage to applicable beneficiaries in Vermont. Medicaid cost estimates and co-payments vary depending on the age, the household size and the income limit of the patient. However, co-payments are never required for beneficiaries in long-term care facilities, petitioners under age 21 and pregnant women. Pregnant women will have no copayments for up to 60 days after giving birth.

How much is Medicaid for other patients’ co-pays? Typically, costs are $3 per dental visit or $3 per day for outpatient hospital services. And, how much is Medicaid for prescription medication? Prescription Medicaid cost estimates are as follows: $1 for prescriptions under $30, $2 for prescriptions between $30 and $50 and $3 for prescriptions of more than $50. However, Prescription Assistance coverage is available to eligible candidates who need help paying for medical prescriptions.



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