New Hampshire health insurance
Medicaid expansion and a partnership exchange in a state with a GOP trifecta
- Louise Norris
- Individual health insurance and health reform authority; broker
- May 8, 2018
New Hampshire’s partnership exchange relies on the federal platform (HealthCare.gov) for application and enrollment, but the state operates Covering New Hampshire, which serves as a resource for those who purchase health insurance in the individual market. Enrollment for 2019 coverage will begin on November 1, 2018, and will continue until December 15, 2018. All plans selected during open enrollment will take effect January 1, 2019.
Insurers wishing to offer plans in New Hampshire’s exchange for 2019 must submit rate filings to the state by May 9, 2018, with revisions due by June 20, 2018. The filings will be made public on HealthCare.gov’s rate review page as of August 1, 2018, and will be reviewed by regulators throughout the summer.
NH exchange carriers
Three carriers are selling individual health insurance plans through New Hampshire’s exchange in 2018.
Anthem Blue Cross Blue Shield was the only insurer that offered plans in New Hampshire’s exchange in 2014 but that had grown to five carriers by 2015. But both of the CO-OPs that offered plans in New Hampshire have stopped doing so: Community Health Options left at the end of 2016, to focus entirely on the Maine market. The state’s other CO-OP, Minuteman Health, continued to offer plans through New Hampshire’s exchange in 2017, but was placed in receivership that year and did not offer plans for 2018.
New Hampshire’s remaining exchange carriers are as follows:
- Ambetter by Celtic
- Anthem Blue Cross Blue Shield of New Hampshire
- Harvard Pilgrim Health Care of New England
New Hampshire’s exchange also includes dental plans from Anthem and Delta Dental in 2018.
New Hampshire health ratings
In 2018, New Hampshire was ranked 11th out of the 50 states and the District of Columbia by The Commonwealth Fund’s Scorecard on State Health System Performance. The state performed in the top ten for two out of five measures: Access & Affordability, and Prevention & Treatment. But it ranked 35th for the Disparity metric.
New Hampshire’s scorecard provides more specific details about public health in the state and how the overall score was determined.
New Hampshire took 8th place in the 2017 edition of America’s Health Rankings (out of the 50 states and not including DC). The state ranked in the top spot for the Community & Environment metric, 5th place for Clinical Care, and 7th place for Policy. It came in 20th place for both Behaviors and Health Outcomes. The Rankings note that “New Hampshire has the lowest infant mortality rate in the U.S. at 4.2 deaths per 1,000 live births, and yet if it were an OECD country, it would rank No. 28 [out of 34 countries] and be tied with Hungary.”
Trust for America’s Health provides yet another look at overall public health in New Hampshire in their 2017 listing of Key Health Data About New Hampshire. Their summary includes socioeconomic health indicators, access to care, and the prevalence of various illnesses and health outcome predictors.
You can also see how the ten counties in New Hampshire compare with one another in terms of health factors and outcomes, using this interactive map created by the Robert Wood Johnson Foundation. No single area of the state stands out as better or worse than any other; high and low ranking counties are dispersed throughout the state.
How has Obamacare helped New Hampshire residents?
New Hampshire operates a state-partnership exchange and expanded Medicaid, both typical of states that have embraced the Affordable Care Act. New Hampshire expanded Medicaid as of July 2014 — six months after expansion became available in many other states, but well ahead of numerous other states, many of which still have not expanded Medicaid as of 2018.
According to US Census data, the uninsured rate in New Hampshire was 10.7 percent in 2013, which was well below the national average of 14.5 percent at that point. By 2016, the uninsured rate in New Hampshire stood at 5.9 percent — still well below the US average of 8.6 percent.
Medicaid expansion has made coverage available for people earning up to 138 percent of the poverty level (about $16,753 for a single person in 2018). Additionally, the New Hampshire exchange makes affordable coverage available to people earning up to 400 percent of the poverty level ($48,240 for a single person in 2018; the 2017 poverty level guidelines are used in 2018, as it’s always based on the poverty level numbers for the year prior to the coverage effective date).
Young adults can remain on their parents’ health plans until age 26 as a result of the ACA, and health insurance companies no longer base eligibility or premiums on applicants’ medical history.
New Hampshire enrollment in qualified health plans
In late 2013, the Kaiser Family Foundation estimated that the potential market for New Hampshire’s health insurance exchange was 137,000 people and that about 81,000 of them would qualify for premium subsidies. By June 2015, nearly 45,000 people were enrolled in qualified health plans (QHPs) through the state’s exchange, and nearly 63 percent of them were receiving premium subsidies.
The New Hampshire exchange had just one carrier – Anthem Blue Cross Blue Shield – in 2014. Anthem had 90 percent of the market share in the state prior to 2014, so the fact that only one carrier participated in the first year didn’t substantially change things for most customers in New Hampshire. But starting in 2015, there was far more competition and plan choice in the New Hampshire exchange, with five carriers participating in the exchange in both 2015 and 2016. That had dropped to three insurers by 2018, as both of the CO-OPs have stopped offering coverage in the state.
New Hampshire uses Medicaid funds to purchase private plans in the exchange for the Medicaid expansion population, though the Premium Assistance Program (PAP). 41,423 people had PAP coverage as of March 2018, and 42,189 were enrolled in non-PAP private plans. Enrollment in non-PAP plans was lower than it had been a year earlier — 47,520 had been enrolled in non-PAP plans as of March 2017.
New Hampshire and the Affordable Care Act
In 2010, New Hampshire’s U.S. Senators were split on the ACA. Democrat Jeanne Shaheen voted yes, while Republican Judd Gregg voted no. In the U.S. House, Carol Shea-Porter and Paul Hodes, both Democrats, voted yes.
Shaheen is still in the Senate, but Gregg was subsequently replaced by Kelly Ayotte, a fellow ACA opponent, who was in office until 2017. Ayotte was replaced in 2017 by Maggie Hassan, former governor of New Hampshire and a supporter of the ACA. In the House, Ann Kuster replaced Hodes in 2013. She is an ACA supporter who wants to keep the law but improve upon it.
In the 2014 Senate race, Shaheen was one of relatively few Democrats who fully embraced the ACA and the changes it has brought about. She defended the law, saying it was “absolutely” an achievement of which she is proud. Shaheen won re-election against Republican opponent Scott Brown in 2014. And Hassan defeated Ayotte in the 2016 election, with support for the ACA and New Hampshire’s Medicaid expansion included in her platform.
At the state level, the legislature is dominated by Republicans, with a Republican majority in both the Senate and the House. Governor Chris Sununu, who replaced Hassan in 2017, is a Republican, but has a more measured approach to the ACA than many in the GOP. Sununu would prefer that the federal government give states more latitude in designing their own health care regulations, but he was opposed to Senate Republicans’ 2017 effort to repeal the ACA, particularly the Medicaid funding cuts that would have been part of that legislation. Sununu also asked the Trump Administration to take action to help stablize the individual insurance markets in 2017.
As governor, Hassan prevailed in expanding Medicaid under the ACA, although New Hampshire is one of five states utilizing a unique approach to Medicaid expansion that involves subsidizing private health insurance for low-income residents. But lawmakers in New Hampshire are considering a switch to regular Medicaid managed care instead. Arkansas also uses a privatized approach to Medicaid expansion, but Iowa announced in July 2015 that they would switch from buying private plans for Medicaid beneficiaries to a more standard approach to Medicaid expansion as of January 2016.
New Hampshire Medicaid/CHIP enrollment
New Hampshire expanded Medicaid in 2014, but used an 1115 waiver to allow for a different approach to Medicaid expansion than the one outlined in the ACA. Senate Bill 413 was signed into law by Governor Hassan in March 2014, and called for Medicaid expansion to begin that summer, with residents able to begin applying on July 1.
The Kaiser Family Foundation estimated that about 39 percent of the uninsured population in New Hampshire would be eligible for Medicaid starting in July 2014. The coverage gap in New Hampshire was eliminated once the state became the 26th to expand Medicaid under the ACA.
As of August 8, 2014, the state reported that 9,399 people had enrolled in expanded Medicaid in the preceding five-and-a-half weeks, with coverage set to go into effect on August 15. That number was significantly more than the 7,235 people who had enrolled in Medicaid through the New Hampshire exchange by mid-April, before the expanded eligibility guidelines went into effect.
By August 2015, total New Hampshire Medicaid/CHIP enrollment had grown 47 percent since 2013 — the 12th biggest change nationwide. Enrollment largely plateaued after that, with net enrollment growth 45 percent higher in early 2018 than it had been in late 2013.
Until the end of 2015, Medicaid expansion in New Hampshire was following the program outlined in the ACA, and all legal residents with household incomes up to 138 percent of poverty were eligible to receive Medicaid coverage.
But starting in January 2016, the state transitioned to a privatized version of Medicaid expansion (i.e., Premium Assistance Program), using Medicaid funds to subsidize private coverage. As of March 2016, New Hampshire’s PAP enrollment through the exchange stood at 43,732. By March 2018, PAP enrollment was at 41,423.
Does New Hampshire have a high-risk pool?
Before the ACA reformed the individual health insurance market, coverage was underwritten in nearly every state, including New Hampshire. This meant that pre-existing conditions could result in an applicant being rejected for coverage, or offered a plan with significantly higher premiums or policy exclusions. The New Hampshire Health Plan (NHHP) was created in 2002 to provide an alternative for residents with pre-existing conditions who were not eligible to purchase private individual health insurance because of their medical history.
But the ACA brought significant changes to the individual health insurance market, including a ban on medical underwriting; all policies are now guaranteed issue, in all states. This meant that high-risk pools are no longer necessary the way they once were, since applicants with pre-existing conditions now have the same insurance choices as the rest of the population.
NHHP was originally slated to cease operations at the end of 2013, but the troubled rollout of Healthcare.gov meant that many members were unable to purchase new coverage by the start of 2014. As a result, NHHP continued to provide coverage until June 30, 2014. At that point, any remaining policies terminated, giving members a 60-day special enrollment period during which they could purchase a new plan (involuntary loss of other coverage is a qualifying event that triggers a special enrollment period).
Medicare enrollment in New Hampshire
New Hampshire Medicare enrollment reached 266,210 in 2015, nearly 20 percent of the state’s population compared with 17 percent of the total U.S. population enrolled in Medicare. New Hampshire is tied with six states for the highest percentage of population enrolled in Medicare.
As of 2013, the percentage of New Hampshire Medicare enrollees who qualified based on age alone was 82. The balance was eligible for Medicare as a result of a disability.
New Hampshire ranked 40th in terms of overall Medicare spending with $1.9 billion per year in 2009. Annually, Medicare spends about $7,602 per enrollee in the state compared with an average of $8,970 nationwide.
New Hampshire Medicare recipients can select a Medicare Advantage plan instead of original Medicare if they wish to gain some additional benefits. Only 7 percent of New Hampshire beneficiaries choose Medicare Advantage instead of traditional Medicare coverage in 2015, but that had grown to 10 percent by 2017. Only three states, Wyoming, Vermont, and Alaska, have a smaller population enrolled in Medicare Advantage.
Fifty-seven percent of New Hampshire Medicare recipients are enrolled in Medicare Part D plans, which provide stand-alone prescription drug coverage. Forty-four percent of all Medicare enrollees have Medicare Part D plans, but Medicare Part D is designed to work with Original Medicare, rather than Medicare Advantage (most Medicare Advantage plans have built-in Part D coverage). So a state like New Hampshire, with lower-than-average Medicare Advantage enrollment, would be expected to also have higher-than-average Medicare Part D enrollment.
State-based health reform legislation
S.B.313, under consideration in New Hampshire in 2018, calls for restructuring the state’s Medicaid expansion program to use Medicaid managed care — as most of the country does — instead of the Premium Assistance Program. The new program would be called the New Hampshire Granite Advantage Health Care Program, replacing the current New Hampshire Health Protection Program. The legislation also calls for a work requirement for Medicaid, although in May 2018 CMS approved a work requirement that the state had proposed in late 2017; it will take effect in 2019.
Scroll to the bottom of the page for a summary of other recent health reform-related bills in New Hampshire.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
More New Hampshire coverage
News, history, and enrollment info for your state marketplace
New Hampshire Health Insurance
Health Ranking: #7
State Health Department Web Site: http://www.dhhs.state.nh.us/
The New Hampshire health insurance landscape includes many avenues through which individuals and families may buy health care insurance plans. Residents without access to employer-sponsored coverage can shop for health care plans in the private marketplace and through the federal marketplace exchange. Those who are eligible may apply for public health plans such as Medicaid and CHIP.
HealthCare.org offers free health insurance quotes for Obamacare individual insurance plans, and also provides access to short term health insurance, small employer health plans and Medicaid information.
New Hampshire and the Affordable Care Act
When the Affordable Care Act took effect and required most Americans to buy health insurance coverage, New Hampshire elected to participate in the federal marketplace, also known as the federal exchange. When residents enroll in ACA-compliant health plans sold through the health insurance exchange, they can apply for income-based financial assistance that helps lower their monthly health insurance premiums and out-of-pocket expenses for healthcare.
Only marketplace plans are eligible for income-based premium tax credits and cost-sharing subsidies. Individuals and families can find both marketplace, on-exchange plans and private, off-exchange plans at HealthCare.org. For those who qualify for financial assistance, HealthCare.org will connect them to the right exchange to complete their enrollment.
The Small Business Health Options Program (SHOP) provides a way for employers with 50 or fewer full-time employees to offer healthcare benefits that meet federal health insurance standards.
Medicaid expansion in New Hampshire
New Hampshire is one of many states to have expanded Medicaid to single, low-income adults since Obamacare took effect. Residents that want to apply for Medicaid must meet certain eligibility criteria set by the state.
New Hampshire CHIP
New Hampshire Children’s Health Insurance Program (CHIP) provides low-cost health insurance for eligible children.
Get free quotes on New Hampshire health insurance plans from leading companies, and apply for health care coverage directly online.
New Hampshire currently is and has been for the past twenty years one of the 10 states in the United States with the best health conditions. In 2014, the United Health Foundation ranked it as the 7th healthiest state in the country. The state’s ranking is down from its 2008 position. However, New Hampshire’s lifestyle is very healthy, and it’s one of the healthiest locations to raise your family in the United States.
There isn’t much New Hampshire can do to improve, as they are doing mostly everything right already. Even despite the state’s low public health funding per capita (way below the national average), the state’s healthiness has been incredible, and the efficiency and adequacy of its Health System is one of the best in the country.
New Hampshire Health Insurance
Learn About Your Health Insurance Options
This guide will walk you through what you need to know for the 2018 Affordable Care Act enrollment. Whether you are enrolling in an insurance plan through Healthcare.gov, a state exchange or a health insurance broker, these FAQs lay out general and New Hampshire-specific information to help you understand your choices.
The official 2018 open enrollment period is from Nov. 1 through Dec. 15.
How to Apply
Healthcare.gov is New Hampshire’s official portal for buying a health exchange plan under the Affordable Care Act, also known as “Obamacare.” Some people prefer to buy health insurance directly from an insurance company or through a broker. Thanks to strict regulation, you will pay the same price for a plan regardless of where you buy it or whether you sign up via phone, online or by filling out paper forms.
When you sign up for coverage on Healthcare.gov, be prepared to fill out a form that could take 30 minutes or longer. To complete the process quickly, have this information handy:
- Social Security numbers for everyone in your household
- Your employer’s name and address
- Your most recent pay stub or recent records of your wages
- Information about other types of income you receive, such as alimony, unemployment benefits or a pension
The New Hampshire Insurance Department exists to help residents resolve issues with their insurance company, locate a doctor or other provider within their network, appeal a denial of service, and resolve billing problems with insurers and providers.
The office can be reached at:
New Hampshire Insurance Department
21 South Fruit St., Suite 14
Concord, NH 03301
Frequently Asked Questions About the Affordable Care Act
Do I have to buy health insurance?
Yes. The Affordable Care Act’s individual mandate requires U.S. citizens to enroll in a health insurance plan or pay a fine.
However, certain factors, like a hardship that prevents you from purchasing coverage, may exempt you from paying the fine. And if you have a plan through your work or coverage through Medicare Part A or C, the Children’s Health Insurance Program or most Medicaid plans, you won’t need to buy additional health coverage.
U.S. News generally recommends getting health insurance of some kind. Many premiums have changed since last year. So, even if your current plan is still available, research whether another plan might be a better value.
What is the penalty if I don’t have insurance?
Not carrying insurance will cost $695 per adult plus $347.50 per child for up to $2,085 per family, or 2.5 percent of your family’s income, above the tax-filing threshold – whichever is more.
What are my options for buying an Affordable Care Act health plan?
You’ll find health plans in as many as four coverage levels, commonly called metal tiers: platinum, gold, silver and bronze. Platinum plans charge high premiums but offer the best cost-sharing benefits, covering an average of 90 percent of health expenses incurred. On the other hand, bronze is the least expensive plan type but only covers an average of 60 percent of incurred health expenses.
Those younger than 30 and those with a hardship or affordability exemption may also purchase catastrophic plans. These plans are the most limited form of health insurance coverage available in the “Obamacare” market.
Am I eligible to buy insurance on the Affordable Care Act marketplace?
You are eligible to buy coverage if you are a U.S. citizen, a U.S. national or an immigrant lawfully living in the U.S.
Those who are incarcerated or who are living in the U.S. illegally are not eligible to purchase coverage. You may purchase insurance through the exchanges if you are eligible for employer-sponsored coverage, though you likely wouldn’t be eligible for subsidies.
Do I qualify for a health insurance subsidy?
Your expected income and household size determine whether you can receive subsidies.
If you qualify for the premium tax credit, you can use it to reduce the cost of your monthly premium upfront, receive the amount when you file your taxes or opt for a mix of the two. When you enroll in a marketplace insurance plan, you can choose what you’d prefer. The lower your income is, the larger your credit will be. Read the IRS’ Q&A on the premium tax credit to learn more.
Cost-sharing subsidies, which reduce what you pay for deductibles, copayments and coinsurance, are still available in 2018. Those who are eligible for cost-sharing subsidies must pick a marketplace silver plan to use them. In October 2017, the Trump administration announced it would end cost-sharing subsidy reimbursements to insurers, but insurers expected the move and many have raised 2018 premiums, particularly for silver plans, to compensate, according to the Kaiser Family Foundation.
Even if you don’t qualify for a subsidy, you can still purchase a plan on Healthcare.gov.
I hardly ever get sick. Can I opt for a catastrophic plan to save money?
It depends on your age and your financial situation. Catastrophic plans, which have cheaper premiums but high deductibles, are only available to adults younger than 30 and those who qualify for a hardship or affordability exemption.
If I am a smoker, are my rates higher?
It depends where you live. In most states, an insurer can charge policyholders who use tobacco as much as 50 percent more. Some states, including California, the District of Columbia, Massachusetts and Rhode Island, have prohibited tobacco penalties. Visit Healthcare.gov to learn how tobacco surcharges work in your state.
I had a stroke last year. Can I still get covered?
Under the Affordable Care Act, insurers are not allowed to deny coverage based on pre-existing medical conditions.
I’m unemployed. Where do I get coverage?
If you are unemployed, you might qualify for Medicaid or a subsidy to help cover the expense of a private health insurance plan. You could also apply for an exemption. Which programs or subsidies you are eligible for depend on your household size and income, not your employment status. If you are receiving unemployment compensation, you will need to report the expected amount when applying for coverage.
Do I have to be on the same plan as my spouse?
No. The Affordable Care Act does not require that spouses be on the same plan. However, if you are looking to qualify for tax credits to help you pay for your insurance, your total household income will be considered.