With most of the Affordable Care Act’s major provisions now in effect, the nation’s health insurance marketplace has undergone a significant transformation. Obamacare impacts individuals, families and small business owners alike. Most Americans are required to have minimum essential coverage unless they qualify for an exemption; however, the law is designed to make health insurance more accessible and affordable with income-based financial assistance and one-stop shopping via state-based and federally facilitated exchanges. Meanwhile, the private marketplace remains a place to shop for quality, affordable health insurance plans that meet ACA requirements.
The following guide offers a glimpse at the various types of ACA-compliant health insurance in New Hampshire, including individual and family health plans, small group health plans, coverage for high-risk applicants, mini-COBRA continuation coverage, Medicaid, and CHIP.
Health and healthcare in New Hampshire
New Hampshire ranked 7th overall in United Health Foundation’s 2014 America’s Health Rankings.4 The state’s strengths include a low percentage of children in poverty, high immunization coverage among children, and a low infant mortality rate. Challenges faced by New Hampshire include a high prevalence of binge drinking, a high incidence of pertussis infections (whooping cough), and low per capita public health funding.
New Hampshire individual and family health insurance
When setting up its Obamacare health insurance exchange, New Hampshire opted for a state-federal partnership. As such, New Hampshire residents may find and apply for qualified health plans through the federal Health Insurance Marketplace website. Those who buy health insurance through New Hampshire’s partnership exchange may be eligible for income-based subsidies, including premium tax credits that may be applied to any metal plan and cost-sharing subsidies that apply to silver plans. Individuals who go without health insurance may face a tax penalty known as the shared responsibility payment.
The private marketplace also offers New Hampshire residents with access to qualified health insurance plans through websites such as HealthCare.com. Check out HealthCare.com’s tax subsidy calculator to see if you qualify for a premium tax credit. If you do, visit New Hampshire’s Health Insurance Exchange to shop and apply for health insurance coverage.
The U.S. Department of Health and Human Services reported that 40,262 individuals in New Hampshire selected a marketplace plan through the exchange from Oct. 1, 2013, through April 19, 2014.2 In 2015, the number of individuals in New Hampshire enrolled in a marketplace plan increased to 53,005 during the open enrollment period.3
|New Hampshire’s health insurance exchange:||healthcare.gov|
|New Hampshire department of insurance:||nh.gov/insurance|
New Hampshire small group health insurance plans
In New Hampshire, small business owners may set up group health insurance coverage through SHOP, which is located at the federal Health Insurance Marketplace website. They may also find group health insurance plans in the private marketplace through websites such as such as HealthCare.com. Small businesses that shop New Hampshire’s partnership exchange and have 25 or fewer employees may qualify for a Small Business Healthcare Tax Credit.
Self-employed individuals with no employees must apply for an individual health insurance plan on or away from the state’s exchange.
New Hampshire state COBRA variations for small groups
The Consolidated Omnibus Reconciliation Act (COBRA) allows those employed by businesses with 20 or more employees to continue their group health insurance plan for a limited time should they lose coverage due to qualifying events such as termination of employment due to reasons other than gross misconduct, a reduction in work hours, divorce or legal separation, and loss of dependency status. To learn more about the federal COBRA program, visit dol.gov/ebsa/cobra.html.
In some states, those who work for a small business and lose health insurance coverage due to a qualifying event may be eligible for health insurance continuation through mini-COBRA or a similar state continuation program. In a few states, these programs may also be extended to those who work for larger companies and exhaust their federal COBRA continuation coverage limit. Mini-COBRA generally works like the federal COBRA continuation coverage, but its terms may vary.
New Hampshire’s small group COBRA continuation variations are as follows4:
|Eligible group sizes||All employer group sizes with fully insured health insurance policies|
|Maximum continuation period – standard||18 to 36 months, depending on circumstances|
|Maximum premium Increase||102 percent – full group rate charged by the carrier, plus a maximum 2 percent administration fee|
|State legislation reference||N.H. State Continuation|
|More information||800-852-3416 – New Hampshire Insurance Department|
|Additional notes||A fully insured plan is one in which the employer contracts with an insurance company for an insurance policy and pays the premium for coverage.|
New Hampshire high-risk pools
It used to be that health insurance companies could deny applicants or charge them more based on health history and preexisting conditions. When the Affordable Care Act was passed in 2010, many states created federally funded preexisting condition insurance programs or accepted federal funding to assist with similar high-risk pool programs they already operated.5
The Affordable Care Act prohibits this practice for health insurance plans considered minimum essential coverage with effective dates beginning Jan. 1, 2014, and later. As such, the PCIPs and state high-risk pools created to provide health insurance for those once considered uninsurable are being phased out.
New Hampshire Medicaid
Medicaid is a state health insurance program for low-income individuals under age 65, pregnant women, children, disabled individuals, and seniors over age 65; it is partially funded by the federal government. In 2014, states were given the option to accept additional federal funding and expand their Medicaid program eligibility to those who make up to 133 percent of the federal poverty level (effectively 138 percent due to how it is calculated, according to HealthCare.gov).6
In March 2014, New Hampshire Gov. Maggie Hassan signed Senate Bill 413 into law, expanding the state’s Medicaid program to those earning up to 138 percent of the federal poverty level. 7
The information below is specific to New Hampshire’s expanded Medicaid program, the New Hampshire Health Protection Program:
|Governing agency||Centers for Medicare & Medicaid|
|Administrator||New Hampshire Department of Health and Human Services|
|How to apply||nheasy.nh.gov|
|Open-enrollment period||Year-round in all states|
New Hampshire CHIP
The Children’s Health Insurance Program is a partnership between the states and federal government. CHIP provides health insurance to uninsured children who meet certain eligibility guidelines.
The information below is specific to NH Medicaid, New Hampshire’s health insurance program for low-income children:
|Program name||NH Medicaid|
|How to apply||nheasy.nh.govAdditional application options:dhhs.nh.gov/dfa/apply.htm|
|Phone number||800-852-3345, ext 4344 or 603-271-4344|
|Eligibility8||NH children under age 19 who meet family size and income requirements|
1 United Health Foundation. 2014 America’s Health Rankings Annual Edition. “Annual State Health Rankings.” http://www.americashealthrankings.org
2 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2014/.
3 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2015/.
4 New Hampshire Insurance Department. “Guide to New Hampshire State Continuation.” N.D. http://www.nh.gov/insurance/consumers/documents/nh-state-cont.pdf.
5 National Conference of State Legislators. Coverage of Uninsurable Pre-Existing Conditions: State and Federal High-Risk Pools. Updated April 2014. Retrieved from http://www.ncsl.org/research/health/high-risk-pools-for-health-coverage.aspx.
6 Centers for Medicare & Medicaid Services. “Medicaid Expansion & What It Means for You.” HealthCare.gov. N.D. Retrieved from https://www.healthcare.gov/what-if-my-state-is-not-expanding-medicaid/.
7 Union Leader State House Bureau. “Medicaid Expansion Signed Into Law in NH.” New Hampshire Union Leader. March 27, 2014. Retrieved from http://www.unionleader.com/article/20140327/NEWS0621/140329239.
8 New Hampshire Department of Health and Human Services. “NH Medicaid – Health Coverage for Children Under Age 19.” N.D. Retrieved from http://www.dhhs.nh.gov/ombp/medicaid/nhmedicaid-children.htm.