At a glance: Medicare health insurance in New Hampshire
- More than 300,000 New Hampshire residents are enrolled in Medicare – almost 22 percent of the state’s population.
- As of 2018, only 12 percent of New Hampshire Medicare beneficiaries were enrolled in Medicare Advantage plans
- Medicare Advantage availability in New Hampshire ranges from 15 to 33 plans, depending on the county.
- 22 insurers offer Medigap plans in New Hampshire; legislation under consideration in 2020 would allow an enrollee to switch to a different Medigap plan (offered by their current insurer) during their birthday month.
- The same legislation would also prohibit New Hampshire Medigap insurers from charging higher premiums when enrollees are under 65.
- There are 26 stand-alone Part D prescription plans available in New Hampshire in 2020, with premiums that range from about $13 to $84 per month. More than half of all New Hampshire Medicare beneficiaries have stand-alone Part D plans.
- Per-enrollee Original Medicare spending in New Hampshire is significantly lower than the national average.
Medicare enrollment in New Hampshire
As of late 2019, there were 301,571 New Hampshire residents with Medicare overage. That’s more than 22 percent of the state’s population, versus less than 19 percent of the total US population enrolled in Medicare.
Most Americans become eligible for Medicare when they turn 65. But younger Americans gain Medicare eligibility after they have been receiving disability benefits for 24 months. 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. Plan availability varies by county, but residents in New Hampshire all have at least 15 plans from which to choose, and Medicare beneficiaries in Rockingham and Hillsborough counties can select from among 33 Medicare Advantage plans in 2020.
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 late 2019, however, there were 57,296 New Hampshire residents (up from fewer than 40,000 a year earlier) with private Medicare coverage — 19 percent of the state’s Medicare population — while the other 243,745 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, more than half (56 percent) 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).
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).
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 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. 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 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 plans varies from one insurer to another.
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 t 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.
But bipartisan legislation (SB646) has passed New Hampshire’s Senate in 2020 that would add to the state’s Medigap consumer protections. If enacted, the bill would put New Hampshire among a handful of states that ensure some sort of ongoing access to Medigap plans without medical underwriting. It would require 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 to notify members each year of the opportunity to change their coverage, and would have 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.
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.
But the same 2020 legislation (SB646) that calls for an annual opportunity to switch plans (described above) would also prohibit Medigap insurers from charging higher premiums to enrollees under the age of 65. The bill has passed the New Hampshire Senate and is under consideration by the House.
Disabled Medicare beneficiaries have the option to enroll in a Medicare Advantage plan instead of Original Medicare, as long as they don’t have kidney failure (as of 2021, Medicare Advantage plans will be available to beneficiaries with kidney failure). Medicare Advantage plans are otherwise available to anyone who is eligible for Medicare, and the premiums are not higher for those under 65. 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 $6,700 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.
Medicare Part D in New Hampshire
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 in order to have coverage for prescriptions. 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 26 stand-alone Part D plans for sale in New Hampshire in 2020, with premiums that range from about $13 to $84/month.
In New Hampshire as of late 2019, there were 163,930 people with stand-alone Part D coverage, amounting to about 45 percent of the state’s total Medicare population. Another 41,747 Medicare beneficiaries 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 late 2019; at the end of 2018, about 56 percent of the state’s total Medicare population had stand-alone Part D plans, but as enrollment in Advantage plans increased, more people obtained their prescription coverage via Advantage plans with integrated Part D coverage.]
Medicare spending in New Hampshire
Original Medicare’s average per-beneficiary spending 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.
You can read more about Medicare in New Hampshire in our state Medicare guide. You can also contact New Hampshire’s Service Link Aging and Disability Resource Center with questions related to Medicare coverage in New Hampshire.
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 healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.