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    v1.0.28
    OpenPayerPolicy UpdatesAdministrative/Operational PolicyVermont Premium Assistance Policy Update | OpenPay…
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    RetiredVermont Agency of Human Services – Department of Vermont Health AccessPolicy GCR 22-100 FINAL

    Temporary Adjustments to Premium Assistance under the American Rescue Plan Act

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    This policy governs time-limited changes to premium assistance eligibility and expected premium contribution percentages for Vermonters enrolling in qualified health plans through Vermont Health Connect.

    Policy Summary
    PayerVermont Agency of Human Services – Department of Vermont Health Access
    PolicyTemporary Adjustments to Premium Assistance under the American Rescue Plan Act
    Policy CodePolicy N/A
    Change TypeTemporary federal premium assistance adjustment
    Effective DateJanuary 1, 2021
    Next Review DateN/A
    Key ActionEnroll in a qualified health plan through Vermont Health Connect to be evaluated under the temporary premium assistance rules.
    SourceLink
    POLICY UPDATE CHANGES

    Federal law temporarily expanded premium tax credit eligibility to individuals with household income above 400% of the Federal Poverty Level and reduced expected premium contribution percentages for individuals between 100% and 400% of the Federal Poverty Level.

    The temporary premium assistance adjustments were extended through taxable year 2025.

    HBEE Part 2, Section 12.03(a) and HBEE Part 7, Section 60.07(b) are superseded by the time-limited federal premium assistance adjustments.

    2021-2025

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Taxable years covered
    >400% FPLIncome threshold for premium tax credits
    100%-400% FPLIncome range with reduced contributions
    100%Federal funding share

    Temporary Premium Assistance Eligibility and Contribution Rules

    Temporary premium assistance eligibility and contribution rules

    Premium assistance is available when ALL of the following are met during the temporary period:

    ALL of the following

    • The individual is a Vermonter who is enrolling in, or may be eligible for, a qualified health plan through Vermont Health Connect.
    • The coverage and assistance determination falls within January 1, 2021 through December 31, 2025.

      These temporary adjustments apply for taxable years 2021 through 2025.

    • ONE of the following household-income rules applies

      • Household income is above 400% of the Federal Poverty Level (FPL); premium tax credits are available under the temporary federal rules.>400% FPL

      • ALL of the following

        • Household income is between 100% and 400% of FPL; reduced expected premium contribution percentages apply.100%-400% FPL

        • The applicable percentage is determined by the household-income band

          • Federal applicable percentage: -1.50%; Vermont applicable percentage: -1.50%.100% to <133% FPL
          • Federal applicable percentage: -1.50%; Vermont applicable percentage: -1.50%.133%-150% FPL
          • Federal applicable percentage: -1.50%; Vermont applicable percentage: 0.50%.150%-200% FPL

    Income Eligibility and Applicable Percentages

    Premium tax credit income eligibility
    Income thresholdHousehold income above 400% of the Federal Poverty Level (FPL)
    EligibilityEligible for premium tax credits under the temporary federal adjustment
    Applicable periodTaxable years 2021 through 2025, from January 1, 2021 through December 31, 2025
    Reduced applicable percentages
    Income rangeHousehold income between 100% and 400% of the Federal Poverty Level (FPL)
    AdjustmentReduced applicable percentages apply
    Effect

    Key Terms

    Qualified health plan (QHP)
    TermQualified health plan (QHP)
    AvailabilityA health plan available through Vermont Health Connect
    Premium assistanceAn eligible individual may receive premium assistance for the plan
    Premium tax credit
    TypeFederal tax credit
    PurposeHelps eligible individuals pay premiums
    Eligible plansQualified health plans available through Vermont Health Connect
    Policy Summary
    PayerVermont Agency of Human Services – Department of Vermont Health Access
    PolicyTemporary Adjustments to Premium Assistance under the American Rescue Plan Act
    Policy CodePolicy N/A
    Change TypeTemporary federal premium assistance adjustment
    Effective DateJanuary 1, 2021
    Next Review DateN/A
    Key ActionEnroll in a qualified health plan through Vermont Health Connect to be evaluated under the temporary premium assistance rules.
    SourceLink
    On This Page
    Temporary Premium Assistance Eligibility and Contribution RulesIncome Eligibility and Applicable PercentagesKey Terms
  1. Federal applicable percentage: 0.50%; Vermont applicable percentage: 2.50%.200%-250% FPL
  2. Federal applicable percentage: 2.50%; Vermont applicable percentage: 4.50%.250%-300% FPL
  3. Federal applicable percentage: 6.00%; Vermont applicable percentage: 8.50%.>300%-400% FPL
    4. The expected premium contribution percentage is decreased for eligible individuals
    Applicable percentages for 2021–2025
    Below 133% FPLFederal applicable percentage: -1.50%; Vermont applicable percentage: -1.50%
    133–150% FPLFederal applicable percentage: -1.50%; Vermont applicable percentage: -1.50%
    150–200% FPLFederal applicable percentage: -1.50%; Vermont applicable percentage: 0.50%
    200–250% FPLFederal applicable percentage: 0.50%; Vermont applicable percentage: 2.50%
    250–300% FPLFederal applicable percentage: 2.50%; Vermont applicable percentage: 4.50%
    >300–400% FPLFederal applicable percentage: 6.00%; Vermont applicable percentage: 8.50%
    >400% FPLFederal applicable percentage: 8.50%; Vermont applicable percentage: 8.50%
    Federal Poverty Level (FPL)
    MeasureHousehold income expressed as a percentage of the Federal Poverty Level
    Eligibility useUsed to establish premium assistance eligibility
    Contribution useUsed to establish applicable premium contribution percentages
    Applicable percentage
    DefinitionThe percentage of household income expected to be contributed toward the premium
    ApplicationUsed for purposes of calculating premium assistance
    Income basisVaries according to household income expressed as a percentage of the Federal Poverty Level