Blue Cross and Blue Shield of Vermont continues to dominate commercial enrollment in the state, followed by Cigna and MVP Health, battling for market share in a state with a low uninsured rate. Blue Cross and Blue Shield of Vermont and Blue Cross Blue Shield of Michigan announced a formal affiliation agreement on May 1, 2023, subject to regulatory approval. This partnership would provide BCBSV with access to BCBSM’s data processing and technological capabilities, ensuring viability in a competitive market while retaining nonprofit status and community focus. The Consolidated Appropriations Act of 2023 requires states to start Medicaid determinations beginning in April 2023. DVHA has begun the process of redeterminations. The resumption of eligibility redeterminations and reduced federal funding could result in enrollment declines and budget constraints. In the Medicare segment, Aathough the overwhelming majority of Vermont’s Medicare beneficiaries receive coverage through traditional Medicare, competition among Medicare Advantage carriers is increasing.