Health Care Advocate Project

The Office of the Health Care Advocate (HCA) helps Vermonters with problems and questions related to health care services and health insurance. We often help people:

  • get onto insurance plans
  • sort out problems, and
  • get involved when an insurance company improperly denies medical treatment.

In many cases, we empower people by giving advice and education that helps them understand and resolve their health care issues and questions.

We act as a voice for Vermonters in health care policy matters before the Vermont legislature. We serve as their advocate before government agencies that oversee state insurance and other health care programs.

We have worked to expand health care coverage in the state by making it more affordable and accessible. We advocated for a change in the state’s pharmacy assistance program to expand the prescription coverage for low-income Vermonters with Medicare. We also played a central role in creating the state’s new Immigrant Health Insurance Plan. It will provide health coverage to children and pregnant individuals who are not eligible for Medicaid due to their immigration status.

We represent the public in matters before the Green Mountain Care Board. In rate review hearings for commercial insurance companies, we argue for affordable insurance rates. In other matters before the board, including hospital budget requests and Certificates of Need, we advocate that providers maintain or improve quality of care and cut unnecessary costs.

The Office of the Health Care Advocate (HCA) has developed online information on many Vermont health care topics. Access them on our website.

Helping Vermonters afford health care

Anel called the HCA after he tried to pick up a 90-day supply of a prescription at the pharmacy. He could not afford the cost. When we spoke with him, we discovered Anel was on Medicare, but he was not enrolled on a Part D prescription plan.

For the immediate prescription, we directed Anel to the Health Assistance Program at UVMMC to get help paying for that prescription. We investigated and found that Anel was eligible for a Medicare Savings Program. Being on a Medicare Savings Program also meant that he would be eligible for a program called Extra Help. Extra Help pays for the Part D premium and keeps copayments low. By being eligible, he would be enrolled in a Part D plan, even though it was not during the open enrollment period. This also waived his Part D late-enrollment penalty.

We helped Anel complete the application. He is now able to afford his prescriptions and he has help paying his Medicare premium.

Name(s) and some details have been changed to protect anonymity and confidentiality.

More information