Medicare Advantage Plans in New Hampshire

checkmark Fact checked Contributing expert: Roseann Birch; Reviewed by: Leron Moore - Updated: Jul 06, 2021

 

While most people have some knowledge of the federal government's Original Medicare system, including Part A, which covers hospital expenses, and Part B, which handles outpatient medical care, Medicare Advantage plans may be a mystery. Seniors living in New Hampshire can choose to enroll in a Medicare Advantage plan instead of remaining on Original Medicare. All Medicare Advantage plans must provide the same level of care as Original Medicare, and many come with extra advantages, like hearing and vision benefits. Private insurance companies manage these plans, handling payments and setting premium amounts.

Key Points

  • 1 In 2019, there were 30 Medicare Advantage plans available in New Hampshire.
  • 2 12% of the total Medicare population in New Hampshire is enrolled in Medicare Advantage plans as of 2018.
  • 3 In 2018, Original Medicare spent an average of $8,692 per beneficiary in New Hampshire, which is 14% lower than the national average.
  • 4 Available Medicare Advantage plans range from 15 to 33 across New Hampshire’s 10 counties.

Medicare Advantage plans have a lot in common with employer-sponsored health programs, and some of the phrases and words used may be familiar, like networks, referrals, and out-of-pocket costs. However, there are probably more available choices than most seniors are used to, and it may take a little research to find the right plan for your situation.

Medicare Advantage Plans in New Hampshire

Types of Medicare Advantage Plans

Seniors living in New Hampshire can enroll in one of the following Medicare Advantage plans — HMOs, PPOs, PFFS, and SNPs. HMOs and PPOs are more common and have a greater availability throughout the state, while insurance companies may only offer PFFS plans and SNPs in certain regions or counties. Each plan must provide the same basic coverages you receive from Original Medicare. Most offer even more benefits, however, the downside to these benefits may be increased premiums or larger deductibles. Seniors looking to choose the best Medicare Advantage plan for their needs should consider the whole picture, including premium costs, deductibles, availability of network doctors, and extra perks.

Health Maintenance Organizations (HMO)

HMO plans may be one of the least costly options, but they also have the most restrictions for choosing doctors and other caregivers. HMO plans will have a network of doctors, hospitals, and other healthcare workers. A plan member must choose a primary care doctor from this approved network. All future medical services should come from this doctor, and if the member needs to see a specialist for any reason, they have to get a referral from their PC doctor. Unless it’s a life-threatening emergency, the insurance company will not reimburse any medical care from an out-of-network physician. This restriction may be undesirable for seniors who travel frequently. Most HMO plans have some provisions for prescription drug coverage.

Preferred Provider Organizations (PPO)

As the name implies, Preferred Provider Organization plans also have a network of healthcare professionals that they expect their members to use. However, in this case, you can visit doctors outside the network; it will just cost more. To enjoy the full benefit of your PPO plan, expect to visit in-network doctors and hospitals, but if you’re out of town and need medical care, you should receive some reimbursement from your insurance plan. You also don’t need to declare a primary care doctor or request a referral to see a specialist. As long as they’re in the network, you can visit them and receive maximum coverage. As with HMO plans, most PPOs also provide prescription drug coverage.

Private Fee-For-Service Plans (PFFS)

For seniors who prefer fewer restrictions on their health coverage, including which professionals they visit, PFFS plans may be the best solution. However, the increased flexibility that PFFS plans provide may also mean higher premiums, deductibles, and co-pays. Many PFFS plans don’t have a network at all, but if they do, it’s always less expensive to visit doctors within the network. And out-of-network doctors always have a choice of whether they want to abide by the PFFS plan’s payment terms. So, if you’re looking into this Medicare option, check first with your doctor to see if they’ll take the insurance plan. Of course, in emergencies, all doctors and hospitals must treat you. Some PPFS plans don’t include prescription drug coverage, but you can buy it as an add-on through Medicare Part D.

Special Needs Plans (SNP)

Seniors who have certain disabling chronic conditions, such as End Stage Renal Disease, diabetes mellitus, or chronic heart failure may want to look into a Special Needs Plan. These plans also have a network, but the network is expressly set up to include the health professionals and support staff needed for these types of medical disorders. There are also SNPs dedicated to people living in skilled nursing facilities and those who are considered dual-eligible (with Medicare and Medicaid coverage). Not all the counties in New Hampshire offer an SNP for their residents, and most of the time, these types of plans have higher premiums to account for the additional healthcare visits and supplies their members require. All SNPs include prescription drug coverage as part of their service.

Enrollment & Eligibility for Medicare Advantage Plans in New Hampshire

Eligibility

New Hampshire Medicare Advantage plans are generally available to anyone meeting these qualifications.

  • The individual must be 65 or older — or disabled — and eligible for both parts of Original Medicare.
  • They must reside in the county or region serviced by the plan.
  • If they have End Stage Renal Disease (ESRD), they can only apply for an SNP — no other plan type.

Enrollment Periods

The federal government has set aside several periods during the year when seniors can enroll in a Medicare Advantage Plan. Some of these are restricted to new enrollees, while others permit current members to drop or change a plan.

  • The Initial Election Period is unique to each person and occurs when they reach the age of 65. Seniors can enroll in Medicare Advantage plans at any time three months before their birth month to three months after their birth month. If you’re enrolling due to a disability, your seven-month date range starts three months before your 25th month of receiving benefits.
  • The Medicare Annual Election is a special time period for those wishing to change Medicare Advantage plans, or switch from Original Medicare or back to Original Medicare. Dates for this period are October 15th through December 7th, and any changes begin on January 1st of the following year.
  • The Medicare Advantage Open Enrollment Period is another opportunity for seniors to switch between Medicare Advantage plans or drop their current plan and return to Original Medicare. It takes place between January 1st and March 31st each year.
  • Many special enrollment periods also exist that may be triggered by a life-altering event or unusual circumstances. Plan ratings are posted every fall, and plan members are permitted to switch to a five-star-rated plan between December 8th and November 30th once each year. Also, seniors who’ve newly enrolled in a Medicare Advantage plan during their initial Medicare eligibility period can switch plans during the first three months — this provides an easy escape in case you’ve chosen a plan that doesn’t work for you.

Prescription Drug Coverage

Original Medicare recipients usually sign up for a Medicare Part D plan, which pays for their prescription drug costs. While most Medicare Advantage plans include prescription drug coverage, only SNPs are required to do so. When researching the plan options in New Hampshire, keep in mind that only PFFS plans let you purchase an add-on Medicare Part D plan. HMOs and PPOs will automatically drop you from their roster if you enroll in a Medicare Part D plan. If you take a great deal of medication or if your medicine is costly, you need to choose a Medicare Advantage plan that pays for prescription drugs. Each insurance company has a list — or formulary — of drugs they will cover, so make sure yours are included before signing up.

Medicare Advantage Resources in New Hampshire

Choosing a Medicare Advantage plan involves much more than looking at premium costs. Seniors need to compare drug formularies and tiers, deductibles, annual out-of-pocket limits, and regional availability. It can get quite overwhelming. Fortunately, the state of New Hampshire and other nonprofit organizations provide various resources to help seniors and their family members make suitable choices.

New Hampshire State Health Insurance Assistance Programs (SHIP)

Each state has free programs that provide unbiased assistance with choosing Medicare coverage. SHIP volunteers are trained and certified in all things Medicare. They can help seniors choose and apply to Medicare programs and explain claim denials and the often-complex Explanations of Benefits. In New Hampshire, SHIP counselors primarily work within the state’s Aging & Disability Resource Center, providing one-on-one consultations and Medicare workshops.

Contact Information: Website | 1-866-634-9412

New Hampshire Insurance Department

The state’s insurance department provides links to several documents on Medicare topics, including the next year’s rate guide, supplemental insurance rates, Part D resources, and a lengthy Q & A section. Advice on long-term care insurance and Medicare fraud is also available. The main office is located in Concord, but seniors all over the state can call in with questions.

Contact Information: Website | 603-271-2261

Community Action Program – Belknap/Merrimack Counties

Every month, seniors living in Concord, or its surrounding Merrimack County, can attend free Medicare workshops sponsored by Community Action. This nonprofit organization helps low-income people and those without family assistance maintain their independence. State-certified counselors lead the workshops, and registration is required.

Contact Information: Website | 603-228-6625

roseann headshot
Contributing Expert:

Roseann Birch, Medicare Consultant

With experience in the insurance field since 1986, Roseann Birch is a seasoned Medicare consultant who is passionate in educating and guiding seniors through their Medicare and Medicare Advantage journey.

leron headshot
Reviewed by:

Leron Moore, Medicare Consultant

With over 10 years of experience in the Medicare industry, Leron Moore has dedicated his career to effecting change, educating, informing, and resolving issues for Medicare patients and their families.