Frequently asked questions about health insurance
coverage options in New Hampshire
New Hampshire’s partnership health insurance marketplace relies on the federal platform – HealthCare.gov – for application and enrollment, but the state operates Covering New Hampshire, which serves as a resource for individuals and families who purchase health insurance in the individual marketplace.
And although enrollments for exchange-certified small business health plans are now conducted directly through the insurance companies (instead of HealthCare.gov), New Hampshire is one of the states where there are still exchange-certified small business health plans available for purchase.
Open enrollment for 2021 coverage in New Hampshire ended on December 15, 2020, but the federal government is currently offering a one-time COVID-related enrollment window, which continues through August 15, 2021.
During this enrollment window, both uninsured residents and current marketplace enrollees can take advantage of the newly enhanced premium subsidies created by the American Rescue Plan (some current enrollees may find that a plan change enables them to maximize their benefits; others will just need to claim their larger subsidies via their marketplace accounts).
After August 15, New Hampshire residents with qualifying events, including loss of other minimum essential coverage, will still be able to enroll or make changes to their 2021 coverage. Open enrollment will begin again on November 1, 2021, for coverage effective January 2021.
New Hampshire’s exchange has three insurers offering coverage for 2021, down from five in 2016. As of early 2021, most of New Hampshire’s marketplace enrollees had coverage through Ambetter or Matthew Thornton/Anthem, with fewer than 5,000 enrollees in Harvard Pilgrim plans.
In New Hampshire, average premiums decreased sharply in 2019, slightly for 2020, and decreased sharply again for 2021. The rate decreases for 2021 are due in large part to the new reinsurance program that New Hampshire enacted as of 2021.
- Ambetter/Celtic: Average decrease of 4.2%
- Anthem (Matthew Thornton): Average decrease of 15.37%
- Harvard Pilgrim: Average decrease of 12.9%
During the open enrollment period for 2021 coverage, 46,670 people enrolled in plans through New Hampshire’s marketplace. This was about 5% higher than the year before, and was the first time enrollment had increased in New Hampshire’s marketplace since 2016.
During the first several weeks of the COVID/American Rescue Plan enrollment window in 2021 (when a qualifying event is not necessary in order to enroll), more than 2,300 New Hampshire residents enrolled in private coverage through the marketplace, and that was before the American Rescue Plan’s enhanced premium subsidies were available through HealthCare.gov. This enrollment volume was more than double the normal enrollment pace during that time of year, but a qualifying even would normally be necessary in order to enroll outside of open enrollment.
Both of the CO-OPs that offered plans in New Hampshire have stopped doing so.
Community Health Options left at the end of 2016, to focus entirely on the Maine market. The state’s other CO-OP, Minuteman Health, continued to offer plans through New Hampshire’s exchange in 2017, but was placed in receivership that year and did not offer plans for 2018.
People who had CHO coverage in New Hampshire in 2016 had to change to a plan from another insurer for 2017, and Minuteman Health enrollees had to pick a plan from another insurance company for 2018.
Read more about ACA’s CO-OP health plans.
New Hampshire operates a state-partnership exchange and expanded Medicaid coverage, both typical of states that have embraced the Affordable Care Act. New Hampshire expanded Medicaid as of July 2014 – six months after expansion became available in many other states, but well ahead of numerous other states, some of which still have not expanded Medicaid as of 2021.
According to U.S. Census data, the uninsured rate in New Hampshire was 10.7% in 2013, which was well below the national average of 14.5% at that point. By 2017, the uninsured rate in New Hampshire stood at 5% – still well below the U.S. average at that point. But it had grown to 6.3% by 2019, mirroring the national trend of increasing uninsured rates under the Trump administration.
Young adults can remain on their parents’ health plans until age 26 as a result of the ACA, and health insurance companies no longer base eligibility or premium costs on applicants’ medical history.
There were more than 42,000 people enrolled in plans through New Hampshire’s exchange as of 2020, all of whom had coverage for the ACA’s essential health benefits without any lifetime or annual caps on the amount of the benefits.
More than 30,000 of those enrollees were receiving premium subsidies to make their monthly premiums less costly (note that these subsidies are larger and more widely available in 2021, due to the American Rescue Plan), and more than 15,000 were receiving cost-sharing reductions that make their healthcare costs more affordable.
In 2010, New Hampshire’s U.S. Senators were split on the ACA. Democrat Jeanne Shaheen voted yes, while Republican Judd Gregg voted no. In the U.S. House, Carol Shea-Porter and Paul Hodes, both Democrats, voted yes.
Shaheen is still in the Senate, but Gregg was subsequently replaced by Kelly Ayotte, a fellow ACA opponent, who was in office until 2017. Ayotte was replaced in 2017 by Maggie Hassan, former governor of New Hampshire and a supporter of the ACA.
In the House, Ann Kuster replaced Hodes in 2013. She is an ACA supporter who wants to keep the law but improve upon it. Chris Pappas, also a Democrat, joined Kuster in the House as of 2019. Pappas supports measures to strengthen the ACA and then go beyond it towards a system of universal coverage, including the possibility of a public option and/or allowing people to buy into Medicare.
In the 2014 Senate race, Shaheen was one of relatively few Democrats who fully embraced the ACA and the changes it has brought about. She defended the law, saying it was “absolutely” an achievement of which she is proud. Shaheen won re-election against Republican opponent Scott Brown in 2014. And Hassan defeated Ayotte in the 2016 election, with support for the ACA and New Hampshire’s Medicaid expansion included in her platform.
Although the entire US Congressional delegation from New Hampshire is comprised of Democrats, the state legislature in New Hampshire currently has a Republican majority. Governor Chris Sununu, who replaced Hassan in 2017, is also a Republican, but has a more measured approach to the ACA than many in the GOP. Sununu would prefer that the federal government give states more latitude in designing their own health care regulations, but he was opposed to Senate Republicans’ 2017 effort to repeal the ACA, particularly the Medicaid funding cuts that would have been part of that legislation. Sununu also asked the Trump administration to take action to help stabilize the individual insurance markets in 2017.
New Hampshire expanded Medicaid coverage in 2014, but used an 1115 waiver to allow for a different approach to Medicaid expansion than the one outlined in the ACA. Senate Bill 413 was signed into law by then-Governor Maggie Hassan in March 2014, and called for Medicaid coverage expansion to begin that summer, with residents able to begin applying on July 1 (as opposed to the January 1, 2014 start date that was available nationwide, and which half the states used for Medicaid expansion).
The coverage gap in New Hampshire was eliminated once the state became the 26th to expand Medicaid coverage under the ACA.
As of November 2020, total New Hampshire Medicaid/CHIP enrollment was 64% higher than it had been in late 2013 (as of late 2019, total Medicaid enrollment in New Hampshire had only been 39% higher than it had been in 2013, but the COVID pandemic has driven Medicaid enrollment higher throughout the country, as people lost access to employer-sponsored coverage amid widespread job losses).
Until the end of 2015, Medicaid expansion in New Hampshire was following the program outlined in the ACA, and all legal residents with household incomes up to 138 percent of poverty were eligible to receive Medicaid coverage. But starting in January 2016, the state transitioned to a privatized version of Medicaid expansion (i.e., Premium Assistance Program), using Medicaid funds to subsidize private coverage. When the state had passed its Medicaid expansion bill, the legislature had a Republican majority, and the privatized approach to Medicaid expansion fit a more conservative mold.
By 2018, PAP membership hovered around 50,000 people. But New Hampshire opted to abandon the PAP approach and move to a traditional Medicaid managed care system for Medicaid expansion enrollees. The state received federal permission to implement the Granite Advantage Health Care Program in January 2019. So New Hampshire no longer purchases private plans in the exchange for Medicaid expansion enrollees; they are enrolled in the Granite Advantage Health Care Program instead.
New Hampshire also received separate federal permission from the Trump administration to implement a Medicaid work requirement. The work requirement took effect in January 2019, but was subsequently overturned by a federal judge. There are no Medicaid work requirements in effect anywhere in the country as of 2021, and the Biden administration has begun the process of withdrawing approval for Medicaid work requirements.
Read more about Medicaid coverage expansion in New Hampshire.
New Hampshire has state regulations pertaining to short-term health insurance that limit short-term plan duration to six months with no renewal. Enrollees are allowed to apply for a new short-term plan that takes effect after the first plan ends, but it has to be a new, separate plan, with a new deductible and out-of-pocket exposure.
But a short-term health insurance plan cannot be issued to anyone who has had more than 540 days of short-term coverage in the past two years. So a person can’t have more than a year and a half of short-term health insurance coverage in a given two-year period.
Read more about short-term health insurance in New Hampshire.
New Hampshire Medicare enrollment reached 310,769 by early 2021. New Hampshire is among the states with the highest percentage of the population enrolled in Medicare plans (New Hampshire’s population is also older than the U.S. average).
Eighty-three percent of New Hampshire Medicare enrollees qualify based on age alone, while the other 17% are eligible for Medicare enrollment as a result of a disability.
Read more about Medicare in New Hampshire, including details about Medicare Advantage availability and enrollment, Medicare Part D, and the state’s rules for Medigap plans.
- New Hampshire Insurance Department
- Covering New Hampshire (a resource for individuals and families that purchase their own health insurance)
- New Hampshire Medicaid program
- Medicare Right Center (a nationwide resource for people who need information about Medicare)
- New Hampshire State Health Insurance Assistance Program (a local resource for people who have questions about Medicare)
Before the ACA reformed the individual health insurance market, coverage was underwritten in nearly every state, including New Hampshire. This meant that pre-existing conditions could result in an applicant being rejected for coverage, or offered a plan with significantly higher premiums or policy exclusions.
The New Hampshire Health Plan (NHHP) was created in 2002 to provide an alternative for residents with pre-existing conditions who were not eligible to purchase private individual health insurance because of their medical history.
But the ACA brought significant changes to the individual health insurance market, including a ban on medical underwriting; all policies are now guaranteed issue, in all states. This meant that high-risk pools are no longer necessary the way they once were, since applicants with pre-existing conditions now have the same insurance choices as the rest of the population.
NHHP was originally slated to cease operations at the end of 2013, but the troubled rollout of Healthcare.gov meant that many members were unable to purchase new coverage by the start of 2014. As a result, NHHP continued to provide coverage until June 30, 2014. At that point, any remaining policies terminated, giving members a 60-day special enrollment period during which they could purchase a new plan (involuntary loss of other coverage is a qualifying event that triggers a special enrollment period).