- In 2019, there were 30 Medicare Advantage Plans available in New Hampshire.
- 12% of the total Medicare population in New Hampshire was enrolled in Medicare Advantage Plans as of 2018.
- In 2018, Original Medicare spent an average of $8,692 per beneficiary in New Hampshire, which is 14% lower than the national average.
- Available Medicare Advantage Plans range from 15 to 33 across New Hampshire’s 10 counties.
A major difference between Original Medicare and Medicare Advantage is that Medicare Advantage Plans aren’t managed by the federal government. Instead, they’re sold by private insurance companies that have been approved by the Centers for Medicare & Medicaid Services. Depending on where you live, you may be able to find a Medicare Advantage Plan that covers more services than Original Medicare. Most Medicare Advantage Plans also include prescription coverage.
Medicare Advantage Plans in New Hampshire
Types of Medicare Advantage Plans
New Hampshire’s Medicare Advantage program offers multiple types of insurance coverage, so if you don’t like the terms of one plan, you can always look for another that better fits your needs. Depending on where you live, you may be able to choose from HMO plans, PPO plans, private fee-for-service plans, and special needs plans.
Health Maintenance Organizations (HMO)
In an HMO, members are required to see providers who have joined the plan’s network. HMOs use these provider networks to keep costs as low as possible. Another way HMO plans manage costs is by requiring members to choose a primary care provider. A PCP is the medical professional responsible for overseeing your care. If you choose an HMO plan, you may have to ask your PCP every time you want a referral to a specialist.
Preferred Provider Organizations (PPO)
When you join a PPO, you typically pay less if you receive care from a provider who participates in the plan’s network; however, PPOs don’t prevent their members from seeking out-of-network care. You’ll just pay a larger share of the cost if you see a nonparticipating provider. Another advantage of PPO plans is that you don’t need to ask a PCP for a referral to see a specialist; therefore, you have more control over the providers you use.
Private Fee-for-Service Plans (PFFS)
If you choose a private fee-for-service plan, you can go to any provider who agrees to treat you and abide by the terms of the plan. What makes PFFS plans different from other Medicare Advantage Plans is that providers are paid a specific amount for each service they provide. If a provider won’t agree to accept the predetermined amount, then you’ll have to see another provider or pay the full cost of the service.
Special Needs Plans (SNP)
Enrollment in a special needs plan is limited to people who have chronic health issues or who meet certain conditions. Each plan is designed to meet the specialized medical needs of its members. For example, if you belong to an SNP for people with cancer, it may be structured to provide a high level of coverage for chemotherapy, radiation therapy, and other services needed to treat your symptoms. SNPs are typically reserved for members with severe or disabling chronic conditions, those dually eligible for Medicaid and Medicare, or individuals living in an institutional setting, such as a nursing home.
Enrollment and eligibility for Medicare Advantage Plans in New Hampshire
Medicare Advantage Eligibility
If you’re interested in Medicare Advantage, you must be eligible for Original Medicare. The Original Medicare program is open to adults aged 65 and older who accumulated a minimum number of work credits while they were working (or their spouses were working). You may also qualify for Original Medicare if you have end-stage renal disease or a disability. Another requirement for Medicare Advantage is that you can’t have Medigap coverage. Medigap is also known as Medicare Supplement Insurance.
Enrolling in Medicare Advantage
You can enroll in a Medicare Advantage Plan during specific periods:
- Initial enrollment: From three months before you turn 65 to three months after your 65th birthday month, you’ll be in your initial enrollment period. Sign up as early as possible during this seven-month long period to prevent coverage delays.
- Open enrollment: From October 15th to December 7th, you can join Medicare Advantage or switch Medicare Advantage Plans. Open enrollment happens every year.
- Medicare Advantage open enrollment: Your third opportunity to enroll is the Medicare Advantage open enrollment period. From January 1st to March 31st each year, you can switch Medicare Advantage Plans. You also have the option of switching back to Original Medicare.
Typically, you can’t enroll in Medicare Advantage outside of these enrollment periods, but you may be granted a special enrollment period if you have a qualifying life event. Such an event usually results in the loss of your health coverage. If you’re laid off from a job and had health coverage through your employer, for example, you would qualify for a special enrollment period.
Prescription drug coverage
Medicare Part D is a supplemental plan that covers prescription medications. In most cases, you can’t sign up for Part D if you have Medicare Advantage; the exception is if you have a PFFS plan that doesn’t cover prescription drugs. If you have a PFFS plan, you can reduce your overall medical expenses by enrolling in Medicare Part D, which has a separate premium and may have a separate deductible. Don’t enroll in Part D if your Medicare Advantage Plan already covers prescriptions; if you do, you’ll be switched from Medicare Advantage to Original Medicare.
Medicare Advantage Resources in New Hampshire
Because Medicare Advantage offers multiple plan types, all with different premiums, deductibles, and coinsurance requirements, it’s critical that you research each option carefully before committing to one. Several organizations are on hand to help, including ServiceLink, New Hampshire’s State Health Insurance Assistance Program. The Medicare Beneficiaries Savings Program may help you cover the costs of your Medicare coverage, while the New Hampshire Department of Insurance is available to investigate complaints regarding insurance fraud.
Medicare Beneficiaries Savings Program
The Medicare Beneficiaries Savings Program, managed by the New Hampshire Department of Health and Human Services, aims to help low-income residents cover their Medicare costs. Help is available to New Hampshire residents who qualify for Medicare and meet certain income and resource requirements. If you qualify for the program, you may get help paying all of your deductibles, coinsurance, and Part A and Part B premiums. In some cases, the program provides partial assistance to residents with higher incomes. Contact MBSP for more information on the eligibility requirements.
Contact Information: Website | 603-271-9700
New Hampshire Insurance Department
Medicare Advantage Plans are sold by private insurance companies that have been approved by Medicare. In addition to obtaining Medicare approval, these companies have to follow guidelines set by the New Hampshire Insurance Department. NHID employees investigate consumer complaints and make sure that every insurance company follows the rules, ensuring that state residents have adequate coverage. NHID also publishes educational guides on Medicare topics. If you have any trouble with the insurance company that administers your Medicare Advantage Plan, call NHID for assistance.
Contact Information: Website | 603-271-2261
In New Hampshire, ServiceLink operates the State Health Insurance Assistance Program. SHIP is a national program that makes trained counselors available to people who need information on Medicare benefits and enrollment. ServiceLink offers one-on-one counseling to help you understand your options, compare plans, and determine whether Medicare Advantage or Original Medicare is right for your needs. The organization also conducts group presentations to help Medicare-eligible individuals avoid fraud and scams.
Contact Information: Website | 866-634-9412
Learn More From Our Sources
- Medicare.gov | Your Medicare coverage choices | Last accessed June 2021
- Medicare.gov | Understanding Medicare Advantage Plans | Last accessed June 2021
- CMS.gov | Special Needs Plans | Last accessed June 2021
- SSA.gov | Medicare | Last accessed June 2021
- Medicare.gov | Joining a health or drug plan | Last accessed June 2021
- Medicare.gov | How do Medicare Advantage Plans work? | Last accessed June 2021