Health Insurance Marketplace in New Hampshire
Choosing the Right Health Insurance Plan
There are 5 categories of Marketplace insurance plans: Bronze, Silver, Gold, Platinum, and Catastrophic.
Plans range from bare bones “bronze” plans which cover 60% of pocket medical costs to “platinum” plans which have greater coverage but come with higher premiums. In general higher premiums mean lower out-of-pocket costs and a wider insurer network of doctors and hospitals.The plans are as listed below:
NOTE: All cost sharing is of out of pocket costs. Please see ObamaCare health benefits for services that are covered at no out of pocket charge on all plans. The maximum out-of-pocket costs for any Marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan.
Bronze Plan: The bronze plan is the lowest cost plan available. It has the lowest premiums and in exchange has the lowest actuarial value. The actuarial value of a bronze plan is 60%. This means that 60% of medical costs are paid for by the insurance company, leaving the other 40% to be paid by you.
Silver Plan: The Silver plan is the second lowest cost plan, it has an actuarial value of 70%. This means that 70% of medical costs are paid for by the insurance company, leaving the other 30% to be paid by you. The Silver plan is the standard choice for most reasonably healthy families who historically use medical services.
Gold Plan: The Gold plan is the second most expensive plan, it has an actuarial value of 80%. This means that 80% of medical costs are paid for by the insurance company, leaving the other 20% to be paid by you.
Platinum Plan: The Platinum plan is the plan with the highest premiums offered on the insurance exchange. The Platinum plan as an actuarial value of 90%. This means that 90% of medical costs are paid for by the insurance company, leaving the other 10% to be paid by you. This plan is suggested to those with high incomes and those in poor health. Although coverage is more expensive up front the 90% coverage of costs will help those who use medical services frequently.
Catastrophic plans – which have very high deductibles and essentially provide protection from worst-case scenarios, like a serious accident or extended illness — are available to people under 30 years old and to people who have hardship exemptions from the fee that most people without health coverage must pay.
New Hampshire has not chosen to expand its Medicaid program at this time. Read “What if my state isn’t expanding Medicaid?” to learn more. You can find out whether you qualify for Medicaid under New Hampshire’s current rules 2 ways: Contact your state Medicaid agency right now or fill out an application for coverage in the Health Insurance Marketplace.
Who can help you (the Navigators)
To find a navigator or certified application counselor in New Hampshire, go to Find Local Help at HealthCare.gov. There, you enter your city and state or zip code to get a list of helpers available in your area.
If you need more detailed analysis, identification of issues, solutions, and implementation of your health insurance plan please let us know with the form below and we’ll get right back to you.
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Accountable Care Organizations in New Hampshire
ACOs are profit-driven health innovators primarily serving Medicare patients who are financially rewarded by the government and private insurance companies for delivering medical services that lead to better health outcomes for less money.
- Trustees Of Dartmouth College NH – Health Care Innovation Award
- The National Health Care for the Homeless Council NH- Health Care Innovation Award
- Feinstein Institute For Medical Research NH- Health Care Innovation Award
- State of New Hampshire NH – Incentives for the Prevention of Chronic Diseases in Medicaid Demonstration
Health care facilities where Innovation Models are being tested
- North Country ACO Littleton, NH – Advance Payment ACO Model
- Wentworth-Douglass Hospital Dover, NH – BPCI Initiative: Model 2
- Ammonoosuc Community Health Services – Franconia Franconia, NH – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Ammonoosuc Community Health Services – Littleton Littleton, NH – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Ammonoosuc Community Health Services – Whitefield Whitefield, NH- Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Coos County Family Health Services-Gorham Gorham, NH – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Coos County Family Health Services-Page Hill Berlin, NH – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Coos County Family Health Services – Pleasant Berlin, NH – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Lamprey Health Care – Nashua Nashua, NH – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Families First of the Greater Seacoast Portsmouth, NH – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Manchester Community Health Center Manchester, NH – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Lamprey Health Care – Newmarket Newmarket, NH – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Mid-State Health Center – Bristol Bristol, NH – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Mid-State Health Center – Plymouth Plymouth, NH – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Jeanne McAllister RN, BSN, MS, MHA Concord, NH – Innovation Advisors Program
- Stephen Liu MD, MPH, FACPM Lebanon, NH – Innovation Advisors Program
- Dartmouth Hitchcock ACO Lebanon, NH – Pioneer ACO
The Insurance Exchange/Marketplace
What has been done, not been done, or left up to the federal government to do.
Establishing the Exchange in New Hampshire
On June 18, 2012, Governor John Lynch (D) signed HB 1297 into law, which prohibits the state from participating in or enabling a state-based health insurance exchange. However, HB 1297 allows for state agencies or departments to “operate specific functions of a federally-facilitated exchange.”1 Given this authority, newly-elected Governor Maggie Hassan (D) informed federal officials on February 13, 2013 that New Hampshire would pursue a state-federal partnership exchange. The state will retain control over plan management and consumer assistance functions.2
In 2011, Governor Lynch allowed two bills opposing the implementation of federal health reform to become law without his signature.3,4 SB 148 prohibited the enforcement of the individual mandate in the Affordable Care Act and HB 601 established the Joint Health Care Reform Oversight Committee to oversee all recommendations for legislation implementing federal health reform and required the Insurance Commissioner to obtain approval from the Committee before implementing any provisions.
Contracting with Plans: The New Hampshire Insurance Department (NHID) has legislative authority to certify Qualified Health Plans (QHPs); however, standards and rules relating to QHPs are subject to approval by the Joint Health Care Reform Oversight Committee. NHID will develop a QHP-specific checklist to ensure that QHP certification standards are met and staff will evaluate issuers and plans against the standards to identify which plans will be recommended to the Center for Consumer Information and Insurance Oversight (CCIIO) for certification. Carriers will submit their QHP applications to NHID through the System for Electronic Rate and Form Filing (SERFF) starting March 28, 2013. NHID will develop policies and procedures for quality monitoring of Exchange activities, provided that the state receives federal funding designated for this purpose.5
Risk Adjustment, Reinsurance, and Risk Corridors: In December 2012, Governor Lynch indicated that New Hampshire was interested in administering its reinsurance program; however, Governor Hassan intends to use federal services to run the state’s program.6
Consumer Assistance and Outreach: HB 1297 authorized the creation of a 12-member Health Exchange Advisory Board, for which the Governor, Insurance Commissioner, and Health and Human Services Commissioner each nominated four individuals who were all confirmed by the Executive Council. The Advisory Board, which began meeting in November 2012, is tasked with representing the interests of businesses and consumers in the exchange.7
NHID will work closely with the New Hampshire Department of Health and Human Services (NHDHHS) to design and implement the state’s consumer assistance program, and senior leadership from both agencies will comprise the New Hampshire Consumer Assistance Partnership Exchange Leadership Team. Pending federal grant funding, New Hampshire will hire a consultant to develop policies and procedures for regulation of the Navigator program. NHID will develop the training curriculum and will provide program oversight. NHID also plans to use federal funds to establish a separate In-Person Assistance program and will contract with a consultant to execute program planning and management. NHID plans to release a Request For Proposals (RFP) for the Navigator program consultant in March and an RFP for IPA program implementation in late April or early May.8
NHID plans to hire a communications consultant that will assist in developing and implementing outreach and education activities that will promote the Exchange and the IPA program. Communications efforts are expected to include television, radio, print, and online advertising; social media platforms; grassroots and small business outreach; and partnerships with community entities such as libraries, schools, and faith-based organizations.
Essential Health Benefits (EHB): The Affordable Care Act requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. States must decide whether to benchmark their EHB plan to one of ten plans operating in the state or default to the largest small-group plan in the state. New Hampshire compared potential plans and the legislative Joint Health Care Reform Oversight Committee recommended Matthew Thornton Blue (Anthem BCBS) as the benchmark plan.9 The state will use the Federal Employee Dental and Vision Plan (FEDVIP) for the pediatric dental and vision supplements.
While the State of New Hampshire Insurance Department received a $1 million federal Exchange Planning grant, little of the money was spent. The passage of HB 601 ordered the return of $666,000 in unused funds effective July 2011 and directed the Insurance Commissioner to decline certain exchange planning grant funds in the future. The Department has since requested permission to use the remaining funds; however, the Executive Council declined to authorize the spending in December 2011.10 In February 2013, the state was awarded a Level One Establishment grant for $894,406 to hire consultants to support plan management operations, including activity management and technical assistance, and to perform preliminary research for consumer assistance functions.11 Also in February 2013, New Hampshire applied for an $8.6 million Level One Establishment grant to hire contractors to plan and implement consumer assistance operations.
In February 2011, New Hampshire applied for an Early Innovator grant as part of the multi-state New England consortium; however, the state itself was not included as a recipient when the award was granted.12,13
Expansion of Medicaid
From 2014 to 2017, the federal government will pay for 100% of the difference between a state’s current Medicaid eligibility level and the ACA minimum. Federal contributions to the expansion will drop to 95% in 2017 and remain at 90% after 2020, according to the ACA.
As the ACA was originally written, states would lose all Medicaid funding if they refused to expand their program to the ACA minimum.
However, the Supreme Court in June 2012 ruled that the federal government could not withhold Medicaid funding for states that chose not to expand their programs. The decision effectively allowed state officials to opt out of the expansion, and some have said they will do just that.
New Hampshire is participating in Medicaid expansion.
On March 7, 2013, New Hampshire received conditional approval from the U.S. Department of Health and Human Services (HHS) to establish a partnership exchange. Final approval is contingent upon the state demonstrating its ability to perform all required Exchange activities on time, complying with future regulations, and achieving expected milestones.14
For more information on New Hampshire’s health insurance exchange planning, visit:http://www.nh.gov/insurance/consumers/fedhealthref.htm
1. HB 1297. 2012 Legislative Session.http://www.gencourt.state.nh.us/legislation/2012/HB1297.html
2. Letter from Governor Hassan to Secretary Sebelius. February 13, 2013.http://www.statereforum.org/sites/default/files/130213_maggie_hassan_letter.pdf
3. House Bill 601. June 22, 2011. http://www.gencourt.state.nh.us/legislation/2011/HB0601.html
4. Governor Lynch press release. July 14, 2011.http://www.governor.nh.gov/media/news/2011/071411-hb601.htm
5. New Hampshire Blueprint: Consumer Assistance and Plan Management. February 15, 2013. Available at http://www.nh.gov/insurance/consumers/documents/nhsp_exch_bpapp.pdf
6. Letter from Governor Hassan to Secretary Sebelius. February 13, 2013. Available athttp://cciio.cms.gov/Archive/Technical-Implementation-Letters/nh-marketplace-letter.pdf
7. Press release. First Meeting of the Health Exchange Advisory Board. October 31, 2012.http://www.nh.gov/insurance/media/pr/2012/documents/pr_103112.pdf
8. Project Narrative: New Hampshire’s Cooperative Agreement to Support Establishment of the Affordable Care Act’s Health Insurance Exchanges. February 2013. Available at:http://www.nh.gov/insurance/consumers/documents/cap_grantappl02.15.13.pdf
9. State of New Hampshire. Letter from John B. Hunt to HHS. September 25, 2012.http://www.statereforum.org/sites/default/files/ehb_ltr_9.25.12.pdf
10. Langley, Karen. ‘Spending for Health Exchange nixed’ Concord Monitor. December 15, 2011. 11. Massachusetts Application for the Cooperative Agreement to Support Innovative Exchange Information Technology Systems. New England States Collaborative Insurance Exchange Systems. December 22, 2010.
11. New Hampshire Affordable Insurance Exchange Grants Awards List. Available athttp://cciio.cms.gov/archive/grants/states-exchanges/nh.html
12. New England Consortium Early Innovator Grant application. December 22, 2010.
13. Early Innovator Grant Awards. HHS announcement. February 16, 2011.http://www.healthcare.gov/news/factsheets/exchanges02162011a.html (Accessed August 22, 2011)
14. Letter from Secretary Sebelius to Governor Hassan. March 5, 2013. Available athttp://cciio.cms.gov/resources/files/nh-blueprint-letter-3-5-2013.pdf