New Hampshire health insurance

Health insurance in New Hampshire

● New Hampshire uses a partnership health insurance marketplace with enrollment through HealthCare.gov.

● Open enrollment in New Hampshire for 2021 health plans is November 1-December 15, 2020. Residents with qualifying events can still enroll or make changes to their medical coverage for 2020.

● Short-term health insurance plans are available in New Hampshire with initial plan terms of up to six months.

● Three insurers are offering 2020 coverage in New Hampshire's individual health insurance marketplace, and will continue to do so in 2021 with a third consecutive year of decreasing premiums.

● Fewer than 45,000 New Hampshire residents enrolled in 2020 coverage through the state health insurance marketplace.

● New Hampshire used a waiver to implement its own version of Medicaid coverage expansion, but the state stopped purchasing private health plans for Medicaid enrollees as of 2019, and transitioned to standard Medicaid coverage instead.

● Both of the New Hampshire CO-OPs have stopped offering coverage.

● In New Hampshire, short-term insurance plan duration is limited to six months with no renewal.

This page is dedicated to helping consumers quickly find health insurance resources in the state of New Hampshire. Here, you'll find information about the many types of health insurance coverage available. You can find the basics of the New Hampshire health insurance marketplace and upcoming open enrollment period; a brief overview of Medicaid expansion in New Hampshire; a quick look at short-term health insurance availability in the state; details about Medicare in Hampshire; as well as a collection of health insurance resources for New Hampshire residents.

New Hampshire's health insurance marketplace

New Hampshire's partnership health insurance marketplace relies on the federal platform – HealthCare.gov – for application and enrollment, but the state operates Covering New Hampshire, which serves as a resource for individuals and families who purchase health insurance in the individual marketplace.

And although enrollments for exchange-certified small business health plans are now conducted directly through the insurance companies (instead of HealthCare.gov), New Hampshire is one of the states where there are still exchange-certified small business health plans available for purchase.

44,412 people enrolled in private plans through New Hampshire's health insurance marketplace during the open enrollment period for 2020 coverage. Although that was only a slight decline from 2019 (when 44,581 people enrolled), it was the fourth straight year of declining enrollment, and was down from more than 55,000 enrollees in 2016. Across most of the states that use HealthCare.gov, enrollment has generally trended downward since the Trump administration took office.

Three insurance companies – Ambetter, Anthem, and Harvard Pilgrim – are offering 2020 individual health plans through New Hampshire's exchange. Average premiums decreased sharply in 2019, slightly for 2020, and are expected to decrease sharply again for 2021. The rate decreases for 2021 are two in large part to the new reinsurance program that New Hampshire is enacting as of 2021.

Most residents in New Hampshire can select from among all three insurance companies, but Harvard Pilgrim's service area does not include Carroll County, so residents there can only choose between Anthem and Ambetter.

New Hampshire open enrollment period and dates

Open enrollment for 2021 coverage in New Hampshire runs from November 1, 2020 to December 15, 2020. This window serves as an opportunity for New Hampshire residents who don't get coverage from an employer or a government-run program (Medicare, Medicaid, CHIP) to enroll in individual market coverage or make a change to their existing plan for the coming year. Outside of the open enrollment window, people need to have a qualifying event in order to sign up for a health plan (on-exchange or directly through an insurer) or make changes to their coverage.

Medicaid expansion in New Hampshire

New Hampshire expanded Medicaid coverage 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 coverage expansion to begin that summer, with residents able to begin applying on July 1 (as opposed to the January 1, 2014 start date that was available nationwide, and which half the states used for Medicaid expansion). The coverage gap in New Hampshire was eliminated once the state became the 26th to expand Medicaid coverage under the ACA.

As of May 2020, total New Hampshire Medicaid/CHIP enrollment was 50 percent higher than it had been in late 2013 (as of late 2019, total Medicaid enrollment in New Hampshire had only been 39 percent higher than it had been in 2013, but the COVID pandemic has been driving Medicaid enrollment higher throughout the country, as people lose access to employer-sponsored coverage amid widespread job losses).

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. When the state had passed its Medicaid expansion bill, the legislature had a Republican majority, and the privatized approach to Medicaid expansion fit a more conservative mold.

By 2018, PAP membership hovered around 50,000 people. But New Hampshire opted to abandon the PAP approach and move to a traditional Medicaid managed care system for Medicaid expansion enrollees. The state received federal permission to implement the Granite Advantage Health Care Program in January 2019, and also received separate federal permission to implement a Medicaid work requirement (the work requirement took effect in January 2019, but was subsequently overturned by a federal judge and is not in effect as of 2020; there are no Medicaid work requirements in effect anywhere in the country as of 2020). So New Hampshire no longer purchases private plans in the exchange for Medicaid expansion enrollees; they are enrolled in the Granite Advantage Health Care Program instead.

New Hampshire CO-OP failures

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.

People who had CHO coverage in New Hampshire in 2016 had to change to a plan from another insurer for 2017, and Minuteman Health enrollees had to pick a plan from another insurance company for 2018.

Short-term health insurance in New Hampshire

New Hampshire has state regulations pertaining to short-term health insurance that limit short-term plan duration to six months with no renewal. (Enrollees are allowed to apply for a new short-term plan that takes effect after the first plan ends, but it has to be a new, separate plan, with a new deductible and out-of-pocket exposure.

But a short-term health insurance plan cannot be issued to anyone who has had more than 540 days of short-term coverage in the past two years. So a person can't have more than a year and a half of short-term health insurance coverage in a given two-year period.

New Hampshire health ratings

In 2019, New Hampshire was ranked 10th out of the 50 states and the District of Columbia by The Commonwealth Fund's Scorecard on State Health System Performance, up from 11th in 2018.

New Hampshire took 6th place in the 2019 edition of America's Health Rankings (out of the 50 states and not including DC).

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.

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 later replaced by Kelly Ayotte, a fellow ACA opponent, who was in office until 2017. Ayotte was replaced in 2017 by Maggie Hassan, a former New Hampshire governor and ACA sostiere. In the House, Ann Kuster replaced Hodes in 2013. She's an ACA sostiere who wants to keep the law but improve it. Chris Pappas, also a Democrat, joined Kuster in the House from 2019. Pappas supports measures to strengthen the ACA and then go further towards a universal coverage system, including the possibility of a public option and/or allow people to buy into Medicare.

In the 2014 Senate race, Shaheen was one of the relatively few Democrats who fully embraced the ACA and the changes it brought. She defended the law, saying it was "absolutely" a result she is proud of. 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 Medicaid expansion included on his platform.

At the state level, the legislature currently has a democratic majority. 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 the federal government to give states more freedom to design their own health regulations, but opposed the 2017 Senate Republicans' effort to repeal the ACA, particularly cuts to Medicaid funding that would be part of that legislation. Sununu also called on the Trump Administration to act to help stabilize individual insurance markets in 2017.

How did Obamacare help New Hampshire?

New Hampshire operates a state partnership exchange and extended Medicaid coverage, both typical of states that have adopted the Affordable Care Act. New Hampshire expanded Medicaid in July 2014 - six months after the expansion became available in many other states, but long before numerous other states, some of which have not yet expanded Medicaid as of 2020.

According to U.S. Census data, the uninsured rate in New Hampshire was 10.7% in 2013, which was well below the national average of 14.5% at that point. In 2017, the uninsured rate in New Hampshire stood at 5% - still well below the US average at that point - although it had risen to 5.7% by 2018, reflecting the national trend of raising uninsured rates under the Trump administration.

Young adults can stay on their parents' health plans until the age of 26 as a result of the ACA, and health insurance companies no longer base eligibility or premium costs on applicants' medical history. There are more than 42,000 people enrolled in the plans through the New Hampshire exchange in May 2020, all with coverage for the ACA's essential health benefits with no life limit or annual benefits. More than 30,000 of these subscribers receive premium grants to make their monthly premiums cheaper, and more than 15,000 receive cost-sharing reductions that make their health care costs more affordable.

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 a candidate being rejected for coverage or offering a plan with significantly higher premiums or policy exclusions. The New Hampshire Health Plan (NHHP) was created in 2002 to provide an alternative to residents with pre-existing conditions who were not eligible to purchase private individual health insurance because of their medical history.

But the ACA has brought significant changes to the individual health insurance market, including a ban on medical underwriting; all policies are now guaranteed problem, in all states. This meant that high-risk pools are no longer needed as they used to be, since applicants with pre-existing conditions now have the same insurance choices as the rest of the population.

NHHP was originally scheduled to cease operations in late 2013, but the troubled launch of Healthcare.gov meant many members were unable to purchase new coverage by early 2014. As a result, NHHP continued to provide coverage until June 30, 2014. At that point, all remaining policies are terminated, giving members a special 60-day enrollment period during which they can purchase a new plan (the inadvertent loss of other coverages is a qualifying event that triggers a special enrollment period).

Medicare coverage and enrollment in New Hampshire

Enrollment in New Hampshire Medicare reached 306,195 by mid-2020. New Hampshire is among the states with the highest percentage of the population enrolled in Medicare plans (new Hampshire's population is also older than the U.S. average).

83% of New Hampshire Medicare enrollees qualify by age, while the other 17% are eligible to enroll in Medicare due to a disability.

New Hampshire Health Insurance Resources

● New Hampshire Department of Insurance

● New Hampshire coverage (a resource for individuals and families who buy their own health insurance)

● New Hampshire Medicaid program

● Medicare Right Center (a nationwide resource for people who need information about Medicare)

● New Hampshire State Health Insurance Assistance Program (a local resource for people who have questions about Medicare)

Health care reform legislation in New Hampshire

S.B,313, enacted in New Hampshire in 2018, has called for restructuring the state's Medicaid expansion program to use Medicaid-run care - as most of the country does - instead of the Premium assistance program. This was implemented in 2019.