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Medicare in New Hampshire

New Hampshire has guaranteed access to Medigap plans for disabled enrollees since the 1990s

Key takeaways

Medicare enrollment in New Hampshire

As of September 2020, there were 308,049 residents with coverage through Medicare in New Hampshire. That’s more than 22 percent of the state’s population with Medicare benefits, versus less than 19 percent of the total U.S. population with Medicare coverage enrollment.

Most Americans become eligible for Medicare enrollment when they turn 65. But younger Americans gain Medicare eligibility after they have been receiving disability benefits for 24 months, or if they have ALS or kidney failure. In New Hampshire, 17 percent of Medicare beneficiaries are eligible due to disability rather than age (nationwide, it’s 15 percent). On the high and low ends of the spectrum, 22 percent of Medicare beneficiaries in Alabama, Kentucky, and Mississippi are under 65, while just 9 percent of Hawaii’s Medicare beneficiaries are eligible due to disability.

Medicare Advantage in New Hampshire

Private Medicare Advantage plans are an alternative to Original Medicare. Advantage plans are offered by private health insurance companies, whereas Original Medicare is administered directly by the federal government; both are overseen by CMS, the Centers for Medicare and Medicaid Services.
Medicare Advantage plan availability varies by county, but residents in New Hampshire all have at least 26 plans from which to choose for 2021, and Medicare beneficiaries in Rockingham and Hillsborough counties can select from among 35 Medicare Advantage plan options for 2021.

Time to sign up for Medicare?Nationwide, about a third of all Medicare beneficiaries were enrolled in Medicare Advantage plans as of 2018, but just 12 percent of New Hampshire’s Medicare population had Advantage coverage that year. As of September 2020, however, there were 68,554 New Hampshire residents (up from fewer than 40,000 in late 2018) with private Medicare coverage — 22 percent of the state’s Medicare population — while the other 239,495 beneficiaries had coverage under Original Medicare. So while Medicare Advantage enrollment is lower than the national average in New Hampshire, it’s growing rapidly.

Although about a third of all Medicare beneficiaries nationwide choose Advantage plans, their popularity varies widely from one state to another. In Minnesota, nearly half of the state’s Medicare population is enrolled in Advantage plans, whereas only 1 percent of Alaska Medicare beneficiaries have Advantage plans (and those are via employer-sponsored coverage, as there are no Medicare Advantage plans available for individuals to purchase in Alaska).

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Original Medicare coverage is provided directly by the federal government, and enrollees have access to a nationwide network of providers. But people with Original Medicare need supplemental coverage (from an employer-sponsored plan, Medicaid, or privately purchased plans) for things like prescription drugs and out-of-pocket costs (out-of-pocket costs are not capped under Original Medicare, and outpatient prescription drugs are not covered at all).

Original Medicare includes Medicare Parts A and B. Medicare Advantage includes all of the benefits of Medicare Parts A and B, and the plans usually also have additional covered benefits, such as integrated Part D prescription drug coverage and coverage for things like dental and vision care. But Medicare Advantage insurers establish their own provider networks, which are generally localized and more limited than the nationwide network for Original Medicare. Out-of-pocket costs for Medicare Advantage are often higher than they would be if a beneficiary had Original Medicare plus a Medigap plan, with deductibles, copays, and coinsurance that differ from the out-of-pocket costs under Original Medicare. There are pros and cons to either option, and the right solution is different for each person.

Medicare’s annual election period (October 15 to December 7 each year) allows Medicare beneficiaries the chance to switch between Medicare Advantage and Original Medicare (and add, drop, or switch to a different Medicare Part D prescription plan). And people who are already enrolled in Medicare Advantage also have the option to switch to a different Advantage plan or to Original Medicare during the Medicare Advantage open enrollment period, which runs from January 1 to March 31.

Medigap in New Hampshire

Original Medicare does not limit out-of-pocket costs, so most enrollees maintain some form of supplemental coverage. Nationwide, more than half of Original Medicare beneficiaries get their supplemental coverage through an employer-sponsored plan or Medicaid. But for those who don’t, Medigap plans (also known as Medicare supplement plans, or MedSupp) will pay some or all of the out-of-pocket costs (ie, coinsurance and deductible) they would otherwise have to pay if they had only Original Medicare. There were 98,155 New Hampshire residents with Medigap coverage as of 2018, according to data compiled by the National Association of Insurance Commissioners. That’s about 38 percent of the state’s Original Medicare beneficiaries (Medigap plans cannot be used with Medicare Advantage plans).

Although Medigap plans are sold by private insurers, the plans are standardized under federal rules, with ten different plan designs (differentiated by letters, A through N). The benefits offered by a particular plan (Plan A, Plan F, etc.) are the same regardless of which insurer sells the plan.

But premiums vary significantly from one insurer to another. Insurers in New Hampshire can choose whether to base premiums on the age the enrollee was when they signed up (issue age rating) or to have premiums increase as enrollees get older (attained age rating). Insurers can also choose to use community rating — charging everyone the same rate regardless of age — but that’s not a common approach unless a state requires it, and New Hampshire does not. Attained age rating is the most common approach for Medigap insurers nationwide, but the two Medigap insurers with the largest market share in New Hampshire (Anthem and UnitedHealthcare) both use issue-age rating.

In New Hampshire in 2020, there are 19 insurers approved to offer Medigap plans, although the state’s Medigap enrollment in 2018 was spread across just ten of those plans — with two-thirds of the total market share held by Anthem and UnitedHealthcare. All 19 Medigap insurers offer Plans A, F, G, and N; availability for the other plan options varies from one insurer to another.

In October 2020, the state of New Hampshire unveiled a new Medigap rate comparison tool that residents can use to see pricing, benefits information, and plan availability (it does not appear to provide rate information for disabled Medicare beneficiaries who are under age 65, but rates for applicants under age 65 can be obtained via the federal Medicare plan finder tool).

Unlike other private Medicare coverage (Medicare Advantage and Medicare Part D plans), there is no annual open enrollment window for Medigap plans. Instead, federal rules provide a one-time six-month window when Medigap coverage is guaranteed-issue. This window starts when a person is at least 65 and enrolled in Medicare Part B (you must be enrolled in both Part A and Part B to buy a Medigap plan). Once that initial enrollment window ends, Medigap insurers in nearly all states can use medical underwriting to determine an applicant’s eligibility for coverage, unless one of the limited guaranteed-issue rights applies.

Bipartisan legislation (SB646) was considered in New Hampshire that would have added to the state’s Medigap consumer protections. The bill passed in the Senate but died in the House. If it had been enacted, it would have put New Hampshire among a handful of states that ensure some sort of ongoing access to Medigap plans without medical underwriting. It would have required Medigap insurers to let a member switch to any of the insurer’s other Medigap plans during the month of the member’s birthday. Insurers would have had to notify members each year of the opportunity to change their coverage, and would have had to allow the coverage change regardless of whether it would result in an increase or decrease in benefits. The expected impact of the bill in terms of premiums and plan offerings is discussed at the bottom of this version of the text, but ultimately, it was not enacted so nothing has changed about New Hampshire’s Medigap rules for the time being.

Medigap in New Hampshire if you’re under 65

People who aren’t yet 65 can enroll in Medicare if they’re disabled and have been receiving disability benefits for at least two years, and 17 percent of New Hampshire Medicare beneficiaries are under age 65. Federal rules do not guarantee access to Medigap plans for people who are under 65, but the majority of the states have implemented rules to ensure that disabled Medicare beneficiaries have at least some access to Medigap plans. New Hampshire was among the first states to require Medigap insurers to offer plans to people under age 65, with a rule that took effect in the late 1990s. The state’s requirements were reiterated in a 2005 bulletin issued by the New Hampshire Insurance Department.

All Medigap plans in New Hampshire are available to disabled enrollees under age 65, as long as they enroll during the six-month window that begins when they’re enrolled in Medicare Part B. Premiums are higher than the age-65 rates for these enrollees — substantially so for some insurers, and modestly higher for others. Disabled Medicare beneficiaries have another Medigap open enrollment period when they turn 65. At that point, they can switch to a plan with the lower premiums that apply to people who are aging into Medicare, rather than qualifying due to disability.

SB646 (described above) would have also prohibited Medigap insurers from charging higher premiums to enrollees under the age of 65. The bill has passed the New Hampshire Senate, but failed in the House. So Medigap rates are still higher for enrollees under age 65 in New Hampshire.

Disabled Medicare beneficiaries have the option to enroll in a Medicare Advantage plan instead of Original Medicare (as of 2021, this includes people with kidney failure, who were unable to enroll in most Medicare Advantage plans prior to 2021). But as noted above, Advantage plans have more limited provider networks than Original Medicare, and total out-of-pocket costs can be as high as $7,550 per year for in-network care, plus the out-of-pocket cost of prescription drugs.

Although the Affordable Care Act eliminated pre-existing condition exclusions in most of the private health insurance market, those rules don’t apply to Medigap plans. Medigap insurers can impose a pre-existing condition waiting period of up to six months if you didn’t have at least six months of continuous coverage prior to your enrollment (although not all of them choose to do so). And if you apply for a Medigap plan after your initial enrollment window closes (assuming you aren’t eligible for one of the limited guaranteed-issue rights), the Medigap insurer can consider your medical history in determining whether to accept your application, and at what premium.

New Hampshire Medicare Part D

Original Medicare does not provide coverage for outpatient prescription drugs. Well over half of Original Medicare beneficiaries nationwide have supplemental coverage via an employer-sponsored plan (from a current or former employer or spouse’s employer) or Medicaid, and these plans often include prescription coverage.

But Medicare beneficiaries who do not have drug coverage through Medicaid or an employer-sponsored plan need Medicare Part D enrollment in order to have coverage for prescriptions. Medicare Part D can be purchased as a stand-alone plan, or integrated with a Medicare Advantage plan. Part D was created under the Medicare Modernization Act of 2003, which was signed into law by President George W. Bush.

There are 28 stand-alone Medicare Part D plans for sale in New Hampshire for 2021, with premiums that range from about $7 to $99/month.

In New Hampshire as of September 2020, there were 162,154 people with stand-alone Part D coverage, amounting to about 53 percent of the state’s total Medicare population. Another 52,513 beneficiaries of Medicare in New Hampshire had Part D prescription coverage as part of their Medicare Advantage plans.

[Medicare Advantage enrollment grew considerably in New Hampshire from late 2018 to mid-2020; as enrollment in Advantage plans has increased, more people obtain their prescription coverage via Advantage plans with integrated Part D coverage.]

Medicare spending in New Hampshire

Average per-beneficiary spending for Medicare in New Hampshire was 14 percent lower than the national average in 2018, at $8,692; only 12 states had lower average per-beneficiary Original Medicare spending. The spending amounts are based on data that were standardized to eliminate regional differences in payment rates, and did not include costs for Medicare Advantage. Nationwide, average per-beneficiary Original Medicare spending stood at $10,096.

Per-beneficiary Medicare spending was highest in Louisiana, at $11,932, and lowest in Hawaii, at just $6,971.

How does Medicaid provide financial assistance to Medicare beneficiaries in New Hampshire?

Many Medicare beneficiaries receive financial assistance through Medicaid with the cost of Medicare premiums and services Medicare doesn’t cover – such as long-term care.

Our guide to financial assistance for Medicare enrollees in New Hampshire includes overviews of these benefits, including Medicare Savings Programs, long-term care coverage, and eligibility guidelines for assistance.

Medicare in New Hampshire: Resources for beneficiaries and their caregivers

You can contact New Hampshire’s Service Link Aging and Disability Resource Center with questions related to Medicare coverage in New Hampshire.

The New Hampshire Insurance Department oversees and regulates health insurance companies in New Hampshire as well as the brokers and agents who sell policies in the state. They can provide assistance, answer questions, and address complaints from consumers regarding the entities they license and regulate.

The Medicare Rights Center is a nationwide service, with a website and call center, that can provide information and assistance to Medicare beneficiaries.

This overview of Medicaid programs for Medicare beneficiaries in New Hampshire is a helpful resource for beneficiaries with limited financial resources.

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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 Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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