Exchange grows from one carrier to five
For 2014, only one health insurance carrier — Anthem Blue Cross Blue Shield — applied to participate in the state-federal partnership exchange in New Hampshire, and currently offers 14 health plan options. But that is changing significantly in 2015. The New Hampshire Obamacare exchange will include policies from five carriers, offering about 50 different plans, when open enrollment begins on November 15.
Two of the new carriers entering the New Hampshire exchange are ACA-created CO-OPs: Minuteman Health, based in Boston, and Maine Community Health Options (MCHO) that garnered 83 percent of the market share in neighboring Maine during the 2014 open enrollment. MCHO will have a limited presence in 2015, offering coverage in four NH counties: Coos, Carroll, Rockingham, and Strafford. But it plans to expand further in 2016.
The other new carriers will be Harvard Pilgrim Health Care and Assurant.
The state finalized their review of plans and rates in August, and has submitted recommendations to HHS for final approval. The rates will be available on HealthCare.gov the second week in November.
All 26 hospitals in the state will accept coverage from at least three of the five carriers next year, a change that will likely be very popular with the state’s residents. Network issues have plagued the New Hampshire exchange in 2014, as Anthem only contracted with 16 of the state’s 26 hospitals in efforts to keep premiums as low as possible.
As a result, even though the exchange has just one carrier in 2014, premiums in New Hampshire are comparable to rates in states that have many carriers offering policies. But Anthem’s restrictions on its hospital and physician networks have been drawing fire, despite the low premiums that the narrow network allows.
For 2015, carriers plan to offer both narrow networks (with lower premiums) and broad networks (with higher premiums), so consumer choice will be improved in many ways in New Hampshire starting with the upcoming open enrollment period.
2014 enrollment numbers
40,262 people had completed their private plan Obamacare enrollments in the New Hampshire exchange by April 19. Another 7,235 exchange applicants were eligible for the state’s existing Medicaid coverage by mid-April.
For private plan enrollments, New Hampshire has been greatly exceeding CMS projections every month since December. The original projection for the New Hampshire exchange was 19,000 enrollees during the 2014 open enrollment; the final total is more than double that amount.
Anthem Blue Cross Blue Shield had 90 percent of the individual market share in New Hampshire prior to 2014, so it’s not especially unusual that they’re the only carrier that opted to participate in the exchange the first year.
Anthem has reported that more than 35,000 of the exchange enrollees are new customers for them. Given the carrier’s long-term dominance in the market, we can assume that a significant majority of the Obamacare enrollments in New Hampshire are for people who were previously uninsured. Anthem has also reported that almost 90 percent of their enrollees have paid their premiums.
Unique Medicaid expansion began mid-year
Residents were able to begin enrolling in New Hampshire’s expanded Medicaid program as of July 1, with policies effective August 15 (Medicaid enrollment during the winter and spring was only possible for people who qualified under the state’s pre-expansion guidelines).
The state estimated that roughly 50,000 people would be eligible for coverage under the expanded Medicaid program. By the end of September, three months after enrollment began for expanded Medicaid, 18,500 people had already enrolled.
Medicaid expansion in New Hampshire was a contentious issue, but ultimately Governor Maggie Hassan prevailed in her efforts to expand Medicaid, albeit in a privatized fashion. Gov Hassan signed Senate Bill 413 into law on March 27, 2014, paving the way for New Hampshire to become the 26th state to accept Medicaid expansion.
For the first couple years, the program will look much the same as Medicaid expansion looks in the other 25 states. The state will use federal Medicaid funds to provide New Hampshire Health Protection Program coverage to residents with incomes below 138 percent of poverty.
But by 2016, the state plans to transition the program’s insureds to subsidized, private coverage, following the “private option” Medicaid expansion path that has been popular in several other states.
Risk pool and grandmothered plans
In November 2013, New Hampshire’s Insurance Commissioner Roger Sevigny announced that the state-run high risk pool (New Hampshire Health Plan) would remain in effect “until the federal marketplace is fully available (it had previously been scheduled to cease operations on December 31). The risk pool ceased operations on June 30, 2014, another sign that Obamacare (along with HealthCare.gov) is now working quite well in New Hampshire.
New Hampshire allowed existing 2013 health plans to renew until late 2014, but residents also had the option to cancel their existing plan and switch to a new ACA-compliant policy instead. Anthem Blue Cross Blue Shield announced in May 2014 that they will accept the government’s offer to further extend pre-ACA policies that were carried over from 2013.
Policy-holders with pre-2014 plans that had been scheduled to terminate between October 1 and December 1 will be allowed to renew those plans for one additional year, into 2015. Those insureds will also have the option to enroll in an ACA-compliant plan instead if they prefer.
The New Hampshire Health Plan, which runs the state’s high-risk insurance pool, was approved in September 2013 for a federal grant to help facilitate education and outreach for the exchange. In addition, Planned Parenthood and Bi-State Primary Care were both awarded grants to serve as navigators for NH residents who have questions or need personal assistance with the enrollment process.
Legislation and exchange history
The exchange creation process in New Hampshire has been a legislative battle. In February 2013, Gov. Hassan announced that New Hampshire would operate its health insurance marketplace as a partnership with the federal government.
Prior to the 2012 elections, New Hampshire seemed firmly on a path to relying on the federally facilitated exchange. Former Democratic Gov. John Lynch had no effective means to push back against a Republican-dominated state Legislature that was united against a state-run exchange.
But the 2012 elections gave control of the state House to Democrats, put more Democrats in the Senate, and kept the governor’s office in Democratic hands. The political shift and a law that allowed the state to take on specific exchange functions enabled the state to adopt a partnership model.
New Hampshire is responsible for plan management and consumer assistance, and the federal government is managing all other marketplace functions. The NH Health Exchange Advisory Board holds monthly meetings, the minutes of which are available here.
New Hampshire health insurance exchange links
New Hampshire Department of Insurance: Health Benefit Partnership Exchange Advisory Board
Includes meeting agendas and documents from November 2012 until the present.
State Exchange Profile: New Hampshire
The Henry J. Kaiser Family Foundation overview of New Hampshire’s progress toward creating a state health insurance exchange.
New Hampshire Consumer Assistance Program
Assists consumers who have purchased insurance on the individual market or who have insurance through an employer who only does business in New Hampshire.
(800) 852-3416 / email@example.com
Covering New Hampshire – a statewide effort by the New Hampshire Health Plan to inform residents of their coverage options in the exchange and the resources that are available for those who need assistance.