Medicare Advantage Plans in New Hampshire
Medicare Advantage plans in New Hampshire extend the coverage offered by Original Medicare. The goal is to meet more of a beneficiary's health care needs with one plan that is easier to manage. Each plan is offered by an insurance company authorized by the Centers for Medicare and Medicaid Services.
Each plan must provide the full benefits included in Medicare Part A and Part B. Private insurance companies administering Medicare Part C plans can add health and wellness benefits to make them more appealing.
Medicare Advantage plans are increasing in popularity throughout New Hampshire. In many cases, they are more affordable than Original Medicare because they have a maximum out-of-pocket spending limit that isn't offered with Medicare Parts A and B alone.
Top-rated Medicare Advantage Providers in New Hampshire
- Martin's Point: Martin's Point earned good quality star ratings in some counties for its HMO and HMO-POS plans.
- Humana: Humana's share of the Medicare Advantage plan market is about 12 percent.
- Harvard Pilgrim Health Care, Inc.: This smaller and more regional insurer has about 14 percent of the state's total enrollment.
- Anthem Blue Cross: The New Hampshire Blue Cross affiliate has offered a PPO with high-quality star ratings.
- Other national companies to look for in your area: Aetna and Cigna.
Popular Medicare Advantage Plan Types in New Hampshire
Best for network freedom: Medicare Advantage PPO
Preferred Provider Organizations (PPOs) give beneficiaries more control of their health care than an HMO.
The following features make these plans the best options for beneficiaries seeking freedom from network restrictions:
- More extensive provider networks than most HMOs
- Opportunity to see out-of-network providers at a higher cost
- No referrals are required for most plans
- No primary care physicians are required
Even when staying in the network to reduce out-of-pocket expenses, beneficiaries have more provider options with a PPO. While some $0 premium PPO plans are still available in select service areas, average premiums can go up to $100 or more.
Best for lowest out-of-pocket: Medicare Advantage HMO Plan
Health Maintenance Organizations (HMOs) have more restrictions for provider selection but are significantly more affordable than many PPO plans.
The following terms apply:
- Beneficiaries can only see network providers
- Every enrollee must select a primary care physician to manage their health care
- Specialist visits require prior plan approval or a referral
- Some medical procedures may require advance plan approval
The benefit of selecting an HMO is the cost. Most beneficiaries in New Hampshire have access to at least one $0 premium plan.
Best for low income or health conditions: Medicare Advantage D-SNIP
Special Needs Plans (SNPs) are limited to beneficiaries with one or both of the following:
- Covered chronic health condition
- Limited income
Each plan offers unique coverage with benefits of value to the enrollees. Some SNPs are dedicated to chronic health conditions like cancer or end-stage renal disease. Others are for all beneficiaries able to meet an income threshold.
Special Needs Plans are arranged as PPO or HMO plans. Not all plans are available in all service areas.
Medicare Enrollment Facts:
- The five largest counties in New Hampshire are Hillsborough, Rockingham, York, Merrimack, and Strafford.
- There were 295,698 Medicare beneficiaries in New Hampshire in 2018.
- 35,081 Medicare beneficiaries in New Hampshire enrolled in Medicare Advantage through a private health insurance agency in 2018.
- Many who do not select a Medicare Advantage plan will sign up for Medicare Supplement insurance health plans to help with out-of-pocket costs.
How much does Medicare Advantage in New Hampshire cost?
Prices are determined by the plan options in a beneficiary's service area, medical coverage included, and any extra benefits like Silver Sneakers membership and coverage for dental, vision, and hearing services. In 2022, the average monthly premium for a Medicare Advantage Prescription Drug Plan (MAPD) in New Hampshire was $44.36. Nationwide, the average 2022 MAPD premium is $62.66 per month.
Advantage health plans may also come with some out-of-pocket costs, including:
- Part B premium – The standard monthly Medicare Part B premium for 2023 is $164.90. The annual Part B deducible for 2023 is $226.
- Copays to see medical providers
- Out-of-network charges
- Plan deductibles
The best way to limit out-of-pocket costs is to stick with a $0 premium plan with limited coinsurance and deductibles. One advantage to enrolling in a Medicare Advantage plan in New Hampshire is the cap on out-of-pocket spending. Once you reach the maximum, the plan picks up all covered expenses for the remainder of the year. Original Medicare has no maximum on that spending.
How much do Advantage Plans cost in New Hampshire?
PPO Plan $0.00 to $44.36
HMO Plan $0.00
When can I enroll in a Medicare Advantage plan?
Initial Enrollment Period
Eligibility for Medicare Part C in New Hampshire starts three months before a beneficiary's 65th birth month. The opening of a seven-month initial enrollment period ends on the last day of the third month after the 65th birth month.
Open Enrollment Period – AKA Annual Election Period
The Medicare Open Enrollment Period runs from October 15 to December 7.
While changes are never required, beneficiaries can use this period for the following actions:
- Join Original Medicare, Medicare Part C, and/or Medicare Part D
- Switch from one Part C or D plan to another
- Move from Medicare Advantage back to Original Medicare
Medicare Advantage Open Enrollment Period
This is a second open enrollment period that applies only to beneficiaries already enrolled in Medicare Part C. From January 1 to March 31; they have the opportunity to switch to a new Advantage plan if desired.
Special Enrollment Periods – Special Circumstances
Special enrollment periods are issued individually at any point in the year. Beneficiaries must qualify for a particular period through qualifying life events. For instance, many receive special enrollment entitlements after moving to a new state or service area not covered by their current plan's limited provider network.
5-star Special Enrollment Period
Beneficiaries already enrolled in a New Hampshire Medicare Advantage plan can make a one-time switch to a five-star plan. This particular enrollment period occurs annually from November 30 to December 8.
Special Enrollment Periods if you get "Extra Help."
Extra Help is a unique Medicare program that helps low-income beneficiaries pay for out-of-pocket drug costs. Qualifying for that program also allows beneficiaries to make one change to their Medicare coverage during each of the following annual periods:
- January – March
- April – June
- July – September
Beneficiaries eligible for Medicaid and Medicare join, switch, or drop Part C or Part D plans once during each period. Those only qualified for Extra Help on prescription drug costs can only make changes to their Part D plan.
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Key Take Aways
- In New Hampshire, PPO Medicare Advantage plans are very popular for many Medicare beneficiaries.
- The plans offer complete Medicare Part A and Medicare Part B benefits plus additional coverage for wellness services. Many include prescription drug plans and medical coverage in one convenient policy.
- Advantage plans are increasing in popularity throughout New Hampshire. In many cases, they are more affordable than Original Medicare because they have a maximum out-of-pocket spending limit that isn't offered with Medicare Parts A and B alone.
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