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New Hampshire health insurance exchange / marketplace

53k NH enrollees for 2015; Lower prices and 5 carriers - up from 1; healthcare reform on the legislative session agenda

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  • March 21, 2015

2015 enrollment totals

53,005 people in New Hampshire had enrolled in private plans through the exchange by February 22, when the second open enrollment period – and its extension – ended.  Only 71 percent of them are receiving premium subsidies – the lowest percentage of any state where HHS is running the exchange.

The official HHS target for New Hampshire was 50,000 enrollees during the 2015 open enrollment period, so the exchange exceeded that target by more than three thousand people.

An additional 9,294 people in New Hampshire enrolled in Medicaid or CHIP through the exchange between November 15 and February 22.  Medicaid enrollment continues year-round.

Open enrollment for 2015 has ended, although there’s a special enrollment period from March 15 to April 30 for people who were unaware of the ACA’s penalty for being uninsured.  Other than that, you can only purchase a 2015 plan – on or off the exchange – if you have a qualifying event.  The next open enrollment period starts on November 1, for coverage effective January 1, 2016.

The New Hampshire Department of Insurance is an active participant in overall functionality of the New Hampshire exchange, which operates as a partnership between the state and HHS.  The Department of Insurance has published an inclusive overview of exchange information on their website to serve as a resource for state residents.

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, offering 14 health plan options.  But that has changed significantly for 2015.  The New Hampshire Obamacare exchange now includes policies from five carriers.  Not all carriers offer plans in all counties, but there are an average of 38 plans available in each county, up from 10 in 2014.

Two of the new carriers participating in 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 are Harvard Pilgrim Health Care and Assurant.

And premiums are falling

One result of the increased competition is a sharp reduction in average premiums. The benchmark plan (second-lowest-cost silver plan) has changed as a result of the influx of carriers to the exchange, and the new benchmark plan  is about 17 percent less expensive than the benchmark plan in 2014.  This is among the sharpest drops in the country, and highlights the importance of competition in holding down premiums.

Avalere Health found that the average lowest-cost bronze plan in New Hampshire is 17 percent less expensive in 2015, and that the average lowest-cost silver plan is 18 percent less expensive.  The silver drop is the largest in the nation, and the bronze drop is second only to Mississippi.  All in all things look good for New Hampshire health insurance premiums in 2015.

Healthcare legislation in the 2015 session

There are a variety of healthcare reform bills being introduced in the 2015 legislative session in New Hampshire.  They run the gamut from establishing a state-based single payer healthcare system to allowing individuals and small businesses to buy coverage from outside the state.  There’s also a possibility that lawmakers will revisit the question of Medicaid expansion (Medicaid is currently expanded in New Hampshire under the ACA), although the current expansion law doesn’t sunset until 2016, so that issue could be postponed until next year’s session.

Because of the King v. Burwell case that is scheduled to be heard by the Supreme Court in March, Democratic Representative Ed Butler has plans to introduce a bill that would address the problems that would arise if the Supreme Court rules that subsidies are illegal in the federally-run exchange.

New Hampshire has a federally-run exchange, but the crux of King v. Burwell is that subsidies are only allowed in state-run exchanges.  Establishing a state-run exchange would be time-consuming and expensive, but if SCOTUS rules against the subsidies in the federally-facilitated marketplace and the state takes no action, tens of thousands of New Hampshire residents would lose their subsidies in mid-2015.

Increased network options

All 26 hospitals in the state will accept coverage from at least three of the five carriers in 2015, a change that will likely be very popular with the state’s residents.  Network issues 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 had just one carrier in 2014, premiums in New Hampshire were 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.

In November, the New Hampshire Department of Insurance published a detailed explanation of 2015 network size and scope based on county and carrier for all of the carriers offering plans in the exchange.  Provider network details are also available on each carrier’s website.

There’s a mix of broad and narrow networks available in New Hampshire for 2015, so shoppers can find the price and network combination that most appeals to them.  Anthem is continuing to offer nearly the same network it had in 2014, and Harvard Pilgrim’s network is also relatively narrow.  Assurant’s network is more broad, and although their plans were higher-priced than Anthem in 2014 and only available outside the exchange, they still got 9 percent of the individual market in 2014.  Assurant believes that their broad network – which includes providers in other states – will help to draw enrollees in the exchange in 2015.  And although Maine Community Health Options is not available in all areas of the state in 2015, they have a broad hospital network in anticipating of expanded coverage in 2016.

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 greatly exceeded CMS projections in 2014.  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, and that had grown to nearly 24 thousand people by November 19.

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 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.

Covering New Hampshire, an organization dedicated to educating consumers in New Hampshire and helping them enroll in coverage, is focusing additional efforts on targeting young men during the 2015 open enrollment, since they were under-represented during the 2014 open enrollment period.

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.

And in 2011, lawmakers passed a bill (enacted into law without Lynch’s signature) that prohibited any sort of penalties for New Hampshire residents who fail to obtain health insurance – in direct conflict with the ACA’s individual mandate and shared responsibility penalty.  The law has no real impact however, because the IRS (a federal agency, not under state control) is responsible for assessing the ACA’s penalties, and because the ACA is a federal law that cannot be superseded by state law.

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 /

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.