Health Insurance Challenges for Vermonters

Sharon Podick meticulously manages her budget. After losing her job over a year ago, along with her employer-backed health insurance, she and her husband turned to Vermont Health Connect, which is the state’s marketplace under the Affordable Care Act.

The Poddyks, as Sharon put it, felt they had to “tighten wherever they could” financially. They had already paid off their car and made adjustments, such as buying refurbished phones. So, when she discovered that the subsidies making health plans more affordable would end in 2025, it felt overwhelming. “Like a tsunami was rolling in,” she described.

“We were managing well up until this point,” Sharon reflects, a hint of frustration in her tone.

Sharon and her husband Kurt aren’t alone; many Vermonters are facing notable hikes in insurance premiums. The Enhanced Advanced Premium Tax Credit, which helped people earning over 400% of the federal poverty line, will expire, increasing deductibles. Luckily, those earning less than 400% will still benefit from the original subsidies.

Enrollment for health insurance through Vermont Health Connect closed on January 15, without the federal subsidies that had kept many plans accessible.

They delayed signing up for their 2026 coverage, hoping that the ongoing discussions in Washington would lead to an extension. It didn’t happen.

Sharon now has a new job she enjoys at a local restaurant group, but it’s too small to offer insurance benefits. Meanwhile, Kurt is self-employed in contracting. At their age—both 55—quitting insurance entirely wasn’t a feasible option.

“We didn’t feel like we had a choice. We had to get some coverage,” Sharon stated firmly.

In December, they opted for MVP’s Bronze plan, costing $1,700 per month, which is the most affordable choice available to them. With a deductible of $10,000 per person, it feels daunting. Just last year, they paid about half that amount—$900—for a BlueCross BlueShield gold plan.

Recently, the state began to see the impact of these changes. Data suggests that more Vermonters are facing the likelihood of being uninsured or underinsured.

Overview of Enrollment Changes

Over 2,500 Vermonters have canceled their 2026 plans, a significant increase compared to last year’s figures, according to the Vermont Department of Health Access.

With the loss of the federal aid, Vermont is set to lose around $72 million. The Deputy Director noted that this loss was initially estimated at $65 million.

Currently, about 30,334 people remain enrolled in Marketplace plans, and many, like the Poddyks, are shifting the types of plans they select. This year, approximately one-third of subscribers have chosen the Bronze plan, a rise of about 4% to 5% compared to last year, while Silver plan popularity has fallen.

The Deputy Director indicated that it may take some time to understand the full implications of these shifts. As people receive their first bills, more may find their coverage unsustainable.

The trend toward selecting cheaper Bronze plans seems to be tied to the absence of subsidies, making affordability a pressing concern.

Mike Fisher, a health care advocate, stressed the need for more context regarding who is dropping their plans. “It’s essential not just to count the numbers but understand the underlying reasons,” he said.

With premiums increasing, healthier individuals often leave the insurance pools, causing costs to rise for those still enrolled.

“Even a small exit from healthier individuals can affect the overall market significantly,” Fisher explained, anticipating further premium increases in 2026 based on dropping healthy enrollees.

Insurance Without Utilization

This trend deeply concerns advocates like Fisher, particularly for individuals like Sharon and Kurt, facing high premiums and deductibles.

“The unfortunate narrative is, ‘I have insurance but can’t afford to use it,’ and I think we’ll see more of that,” he remarked solemnly.

The Poddyks have even canceled routine doctor visits to save money, wary of unexpected bills.

“There’s no routine check-ups; we’ve just cut it out,” Sharon noted. When she does go to the doctor, uncertainty looms about whether she can cover the visit.

She expressed, “The only reason we’re keeping this insurance is in case of a serious health issue. If we don’t have that, we risk financial ruin. Yet paying the monthly premium feels just as damaging.”

Health care professionals are concerned about the broader implications of decreasing access to preventive care. Regular check-ups can avoid higher treatment costs later, such as those for advanced cancer.

The pressure on hospitals is mounting as they continue to treat patients, regardless of insurance status, leading to financial strain on Vermont’s health system.

For Sharon, juggling work to cover expenses is becoming more necessary. She’s taking on evening shifts while Kurt seeks additional contracting work. Paying the premium monthly feels like a small victory. “We celebrated our coverage in January,” she said, though uncertainty about the future remains palpable. “We’re just doing our best with what we’ve got,” she added with a resolute spirit.