New Hampshire health insurance marketplace guide 2023

New Hampshire is one of seven states that operates a partnership exchange with the federal government. These exchanges are considered federally facilitated, they use Healthcare.gov’s enrollment platform and call center, and receive federal Navigator funding.

But the state also takes an active role, and operates Covering New Hampshire, a resource site for residents to learn about the exchange and the plans that are available. The Department of Insurance has an inclusive overview of exchange information on their website to serve as a resource for state residents, and maintains a monthly enrollment report that shows how many people have plans purchased through the exchange from each participating insurer. As of October 2022, there were 50,305 people enrolled in on-exchange plans in New Hampshire.

For 2023 coverage, there are three insurers that offer exchange plans in New Hampshire:

• Ambetter
• Harvard Pilgrim
• Matthew Thornton/Anthem

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 changed significantly for 2015, when the New Hampshire exchange grew to include policies from five carriers. Not all carriers offered plans in all counties, but there were an average of 38 plans available in each county, up from 10 in 2014.

Two of the new carriers that joined the New Hampshire exchange in 2015 were ACA-created CO-OPs: Minuteman Health, based in Boston, and Community Health Options (formerly Maine Community Health Options, or MCHO) that garnered 83 percent of the market share in neighboring Maine during the 2014 open enrollment. CHO had a limited presence in New Hampshire 2015, offering coverage in four NH counties: Coos, Carroll, Rockingham, and Strafford.

Harvard Pilgrim Health Care and Assurant also joined the New Hampshire exchange in 2015, although Assurant announced in mid-2015 that they would exit the entire market nationwide, and they no longer had any enrollees in the New Hampshire exchange as of September 2015.

For 2017, Community Health Options was no longer offering coverage in the exchange (they opted to focus entirely on Maine instead, and exited the New Hampshire market at the end of 2016), but plans continued to be available from Anthem, Ambetter, Minuteman Health, and Harvard Pilgrim.

But Minuteman Health was ultimately placed in receivership, and was not allowed to offer coverage past the end of 2017. They had intended to reopen as a new, for-profit insurer in 2018, but did not raise enough capital to make that possible. As a result, Minuteman Health enrollees had to switch to new plans for 2018, and residents did not have an opportunity to buy a for-profit version of Minuteman coverage (the New Hampshire Insurance Department published a list of FAQs about Minuteman’s departure from the market).

So for 2018, plans were available in the New Hampshire exchange from Anthem, Ambetter, and Harvard Pilgrim. All three insurers have continued to participate in the exchange ever since.

The open enrollment period for individual/family coverage runs from November 1 through January 15 in New Hampshire. Outside of open enrollment, a qualifying event is necessary to enroll or make changes to your coverage.

If you have questions about open enrollment, you can learn more in our comprehensive guide to open enrollment.

Health insurance premiums in New Hampshire’s individual market increased by about 4.8% for 2023, after declining for three consecutive years and then increasing by less than 1% for 2022.

The New Hampshire Insurance Department has noted that average full-price 2023 premiums in New Hampshire are the lowest in New England, and are 13% lower than they would have been without the state’s reinsurance program that took effect in 2021.

The following average rate changes were approved for 2023, applicable to full-price premiums (ie, these rate changes are calculated before subsidies are applied, and most exchange enrollees receive subsidies):

• Ambetter/Celtic: Average increase of 9.5%
• Anthem (Matthew Thornton): Average increase of 0.8%
• Harvard Pilgrim: Average increase of 2.65%

Across all plans, the weighted average rate increase is about 4.8%, although the state noted that the average benchmark premium (upon which subsidies are based) would increase by 4.6% for 2023. 

The cost of cost-sharing reductions (CSR) has been added to silver plan rates in New Hampshire, as has been the case since 2018. This results in disproportionately large premium subsidies, and after-subsidy rates on bronze and gold plans that are lower than they would have been if the federal government had continued to directly reimburse insurers for the cost of CSR.

And the American Rescue Plan’s subsidy enhancements have resulted in larger premium subsidies as well, which are still in effect for 2023 thanks to the Inflation Reduction Act. Due to these extra subsidies, coverage is more affordable than it used to be, and more people are subsidy-eligible.

State law prevents the New Hampshire Insurance Department from publishing health insurance rate information until open enrollment begins on November 1. But the Department is proactive in sharing the information that the federal government publishes at the beginning of August in terms of proposed rates for the coming year.

For perspective, here’s a look at how average premiums have changed in New Hampshire’s exchange over the years:

• In 2014, premiums were essentially actuaries’ best guesses, since there was no market experience on which to base them. The ACA had drastically reformed the individual market, enhancing coverage requirements and eliminating medical underwriting, which was previously the most significant factor in keeping premiums fairly low in the individual market.
• For 2015, average premiums decreased in New Hampshire, due in large part to the fact that the exchange went from having just one insurer in 2014 to having five in 2015. The benchmark plan (second-lowest-cost silver plan) changed as a result of the influx of carriers to the exchange, and the new benchmark plan in 2015 was about 17 percent less expensive than the benchmark plan in 2014. Avalere Health found that the average lowest-cost bronze plan in New Hampshire was 17 percent less expensive in 2015, and that the average lowest-cost silver plan was 18 percent less expensive. The silver drop was the largest in the nation, and the bronze drop was second only to Mississippi.
• For 2016, there were still five insurers, although Ambetter (Celtic) was new to the exchange and Time/Assurant exited the market. Average rate changes were fairly modest, ranging from a decrease of about 2 percent for some of Harvard Pilgrim’s plans to an increase of more than 16 percent for some Community Health Options plans. Before rates were finalized in New Hampshire, the worst-case scenario rate increase based on proposed rates was 18.5 percent. But once the rate review process was finalized, the overall weighted average rate hike was just over 6 percent—even if we assume that the majority of Community Health Options, Anthem, and Minuteman enrollees were in plans with the highest rate hikes. According to HHS data, the average benchmark premium (second lowest-cost Silver plan, which isn’t necessarily the same plan from one year to the next) in New Hampshire was 5.1 percent more expensive in 2016 than it was in 2015.
• For 2017, there were four insurers offering plans in New Hampshire’s exchanges. Average rates increased by 8.8% in 2017, ranging from an average of just 1.35 percent for Ambetter/Celtic, to an average increase of nearly 14 percent for Anthem (Matthew Thornton Health Plan). Minuteman Health (an ACA-created CO-OP) had initially proposed rate hikes that ranged from 18 to 60 percent, but ended up with an average rate hike of just 4.2%, resulting in the lowest-priced plans in the exchange at all metal levels.
• In 2018, Minuteman Health was no longer offering coverage in New Hampshire. The three remaining insurers implemented significant rate increases, but that was due in large part to the fact that the Trump Administration had stopped reimbursing insurers for the cost of cost-sharing reductions (CSR), so insurers added that cost to silver plan rates starting in 2018 (details below). Ambetter’s average rate increase for 2018 was 18.4%, Anthem’s was nearly 49%, and Harvard Pilgrim’s was nearly 46%.
• For 2019, insurers in New Hampshire proposed average rate decreases, likely due in part to the state’s plan to stop buying private coverage for Medicaid expansion enrollees and switch to Medicaid managed care instead. Once rate filings were approved, New Hampshire’s individual market ended up with an average rate decrease of 14.4%.But all three insurers indicated in their filings that they expected the health of their risk pools to deteriorate as a result of the repeal of the individual mandate penalty. Anthem’s filing also noted that the risk pool was expected to deteriorate due to “potential movement into other markets.” This is likely a reference to the fact that access to short-term health plans and association health plans was expanded by the Trump Administration (although New Hampshire limits short-term plans to six months and prohibits their renewal; their expansion is not as robust in New Hampshire as it has been in some other states). So although rates dropped in New Hampshire in 2019, they would have declined even more if the individual mandate penalty hadn’t been repealed, and if the Trump Administration hadn’t expanded access to short-term plans and association health plans.
• For 2020, two of the three insurers decreased their average premiums. At ACA Signups, Charles Gaba calculated a weighted average rate decrease of 0.8 % for 2020 in New Hampshire’s individual market (again, keeping in mind that this applies to full-price premiums; net rate changes for people who get premium subsidies can be much different). The New Hampshire Insurance Department created an at-a-glance resource showing which hospitals are in-network with each of the insurers that offer plans in the exchange for 2020, as well as a side-by-side comparison of the benefits offered by each plan.
• For 2021, overall rates decreased again, for the third year in a row. The state’s average benchmark rates were the seventh-lowest in the nation as of 2021. The state noted that consumers would likely see large rate decreases for 2021, thanks to the new reinsurance program (details below). But rate decreases stemming from reinsurance are only applicable to people who pay full price. Most people get premium subsidies, and the subsidies decline when overall premiums decline. That means after-subsidy premiums for most enrollees were not necessarily any lower in 2021 than they had been in 2020. According to SERFF data, the overall proposed rate changes for 2021 were approved mostly as-filed, with the following average rate changes implemented as of January 2021:
  • Ambetter/Celtic: Average decrease of 4.2 (SERFF tracking number CELT-132344232)
  • Anthem (Matthew Thornton): Average decrease of 15.37 percent (SERFF tracking number ATEM-132317439)
  • Harvard Pilgrim: Average decrease of 12.9 percent (SERFF tracking number HPHC-132215451)
• For 2022: After declining for three consecutive years, average premiums in New Hampshire’s individual/family market increased slightly for 2022, but only by about 0.7%. 

During the open enrollment period for 2022 coverage, 52,497 people enrolled in plans through New Hampshire’s exchange. This was the highest enrollment had been since 2017. 

As is the case in many states that use HealthCare.gov, enrollment in New Hampshire’s exchange peaked in 2016, then declined each year through 2020, and began to increase again in 2021 and 2022. Here’s an overview of enrollment since the exchange began operating in 2014:

• 40,262 people enrolled for 2014 (this greatly exceeded CMS projections).
• 53,005 people enrolled for 2015.
• 55,183 people enrolled for 2016.
• 53,024 people enrolled for 2017.
• 49,573 people enrolled for 2018.
• 44,581 people enrolled for 2019.
• 44,412 people enrolled for 2020.
• 46,670 people enrolled for 2021.
• 52,497 people enrolled for 2022.

(These numbers do not include Medicaid members who were enrolled in private plans via New Hampshire’s Premium Assistance Program (PAP) prior to 2019; PAP enrollees were in the same qualified health plans as other enrollees, but the policies were funded by Medicaid.)

Enrollment in states that use HealthCare.gov dropped for a variety of reasons from 2016 through 2020:

• The Trump administration sharply reduced funding for exchange marketing and enrollment assistance.
• The individual mandate penalty was eliminated.
• The rules were relaxed for short-term plans, making them more attractive as an alternative for healthy enrollees.
• Premiums have grown considerably, making coverage less affordable for those who don’t get premium subsidies.

But enrollment has increased since then, due in large part to the additional affordability enhancements created by the American Rescue Plan, as well as record-high Navigator funding provided by the Biden administration.