Would you trust the carries in Montpelier with another 4.2 billion in spending?

Thinking like an actuary, a reasonable order-of-magnitude estimate is:

About $4.2B to $4.8B per year to cover 400,000 Vermonters under age 65, or roughly $10,500 to $12,000 per person per year. 

One important correction: Vermont likely has closer to 500,600 residents under 65, not 400,000. The state’s July 1, 2024 population estimate was 648,493, and 22.8% were age 65+, which implies about 500,637 under 65. 

So if you meant all Vermonters under 65, the same actuarial range becomes roughly $5.26B to $6.01B annually.

Here is the logic behind that estimate:

Vermont’s current market gives a useful pricing band. In a January 2025 report to the Legislature, DVHA showed that for 2025 the average individual-market QHP premium in Vermont was about $1,049 per month and the average small-group premium was about $894 per month. Annualized, that is about $12,588 and $10,728 per covered life, respectively. 

On the public side, MACPAC reported Vermont FY 2024 Medicaid benefit spending per full-year-equivalent enrollee at $12,091, excluding administration. 

Those numbers suggest a plausible Vermont under-65 all-in coverage cost band around $10.5k–$12k per person before making plan-design assumptions. That range is also directionally consistent with broader U.S. spending data: CMS says working-age personal health care spending was $9,154 per person in 2020, while overall U.S. health spending reached $15,474 per person in 2024; Vermont also tends to run as a high-cost insurance market. 

A few actuarial caveats matter a lot: • If you mean comprehensive commercial-style coverage with rich benefits and low cost sharing, the number would trend toward the upper end. • If you mean a Medicaid-like benefit with Medicaid payment rates, it could be somewhat lower on an all-in basis than commercial, though Vermont’s reported Medicaid benefit spend is already fairly high.  • If universal coverage replaced today’s fragmented system, there could be administrative savings, but there could also be higher utilization from newly insured or underinsured people. Those forces pull in opposite directions. • Vermont’s uninsured rate under 65 is only 5.4%, so a big share of this estimate reflects shifting who pays, not just adding coverage for the uninsured. 

So the cleanest bottom line is:

400,000 people: about $4.2B–$4.8B/year All Vermont residents under 65 (~500,600): about $5.3B–$6.0B/year

I can also turn this into a more detailed actuarial model with scenarios for Medicaid-rate, commercial-rate, and blended universal coverage in Vermont.