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VermontH.352025-2026 SessionHouseWALLET

An act relating to unmerging the individual and small group health insurance markets

Sponsored By: Lori Houghton (Democratic)

Signed by Governor

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Bill Overview

Analyzed Economic Effects

6 provisions identified: 3 benefits, 0 costs, 3 mixed.

Guaranteed acceptance for individuals and small groups

Beginning January 1, 2026, registered carriers must accept all applicants in the individual and small-group markets. This includes individuals, small employers, their employees, and dependents. Carriers must accept you even if you owe premiums from the prior plan year.

Small-group cutoff raised to 100 workers

Beginning January 1, 2026, employers with an average of 100 or fewer employees qualify as small employers for Exchange coverage. Use the IRS counting method in 26 U.S.C. § 4980H(c)(2). Employers that grow past 100 can keep participating if they continue to offer qualified plans.

Separate pricing for individual and small-group plans

Beginning January 1, 2026, carriers must use a community-rating method approved by the Commissioner. They must set individual-market premiums separately from small-group premiums. This can raise or lower costs for different groups.

Only registered carriers can sell plans

Beginning January 1, 2026, no one may sell a health plan to individuals or small employers unless they are a registered carrier. The Commissioner sets financial, marketing, service, and other standards for registration. A filing is effective unless disapproved within 30 days. A carrier may withdraw its registration with six months’ written notice.

More ways to enroll and get help

Beginning January 1, 2026, you can enroll through the Exchange, by phone, with a navigator, or directly from a registered carrier that offers direct enrollment, if federal rules allow it. Carriers that enroll directly must follow open and special enrollment periods. The Exchange sets procedures so licensed agents and brokers get paid to help with sign-ups and with premium tax credit and cost-sharing applications.

Stronger reporting on subsidies and coverage changes

Beginning January 1, 2026, the Exchange sends Treasury the names and taxpayer IDs of employees found eligible for the premium tax credit, including when employer coverage is missing or unaffordable. The Exchange also sends Treasury names and IDs when someone reports changing employers or stops coverage during a plan year, with the stop date. Employers receive the names of their employees who ended coverage and the effective date. These steps do not change credit amounts.

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Sponsors & Cosponsors

Sponsor

  • Lori Houghton

    Democratic • House

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

No roll call votes available for this bill.

Actions Timeline

  1. House message: Governor approved bill on February 19, 2025

    2/21/2025Senate

  2. Signed by Governor on 2/19/2025

    2/20/2025House

  3. Delivered to the Governor on February 14, 2025

    2/14/2025House

  4. Senate Message: Passed in concurrence

    2/14/2025House

  5. Read 3rd time & passed in concurrence

    2/12/2025Senate

  6. New Business/Third Reading

    2/12/2025Senate

  7. Reported favorably by Senator Cummings for Committee on Finance, read 2nd time and 3rd reading ordered

    2/11/2025Senate

  8. Favorable report by Committee on Finance

    2/11/2025Senate

  9. New Business/Second Reading

    2/11/2025Senate

  10. Favorable report by Committee on Finance

    2/7/2025Senate

  11. Second Reading

    2/7/2025Senate

  12. Entered on Notice Calendar

    2/7/2025Senate

  13. Read 1st time & referred to Committee on Finance

    2/4/2025Senate

  14. Read third time and passed

    1/30/2025House

  15. Action Calendar: Third Reading

    1/30/2025House

  16. Third Reading ordered

    1/29/2025House

  17. Rep. Demar of Enosburgh reported for the Committee on Health Care

    1/29/2025House

  18. Read second time

    1/29/2025House

  19. Action Calendar: Favorable

    1/29/2025House

  20. On Notice Calendar

    1/28/2025House

  21. Read first time and referred to the Committee on Health Care

    1/15/2025House

Bill Text

  • As Enacted (ACT 2)

    2/21/2025

    PDF

  • As Passed by Both Chambers

    2/14/2025

    PDF

  • As Passed by Both Chambers (Unofficial)

    2/14/2025

    PDF

  • As Passed by the House

    1/31/2025

    PDF

  • As Passed by the House (Unofficial)

    1/31/2025

    PDF

  • As Introduced

    1/15/2025

    PDF

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