What Are Medicare Advantage Plans in New Hampshire?

Medicare Advantage plans are an alternative to Original Medicare, offered by Medicare-approved private insurance companies. These plans combine Part A (hospital insurance) and Part B (medical insurance), and most also include Part D (prescription drug coverage). Many plans offer additional benefits like dental, vision, hearing, fitness memberships, and telehealth services.

Medicare Eligibility

To enroll in a Medicare Advantage plan, you must first sign up for Original Medicare (Parts A and B). Most people qualify for Medicare enrollment at age 65, but you may also qualify earlier if you have a disability, ALS, or ESRD. Enrollment options include the Initial, General, and Special Enrollment Periods. Delays may lead to late enrollment penalties if you’re not eligible for premium-free coverage.

What Types of Medicare Advantage Plans Are Available in New Hampshire?

New Hampshire offers a variety of MA plan types:

• Health Maintenance Organizations (HMOs): Require in-network care and referrals to see specialists.
• Preferred Provider Organizations (PPOs): Allow out-of-network access at higher costs; typically no referrals are needed.
• Private Fee-for-Service (PFFS) Plans: Let you see any Medicare-approved provider who accepts the plan’s terms. Some plans have networks.
• Special Needs Plans (SNPs):
  • C-SNPs: Designed for chronic conditions like diabetes, cancer, or ESRD.
  • I-SNPs: For individuals in institutions or receiving nursing care.
  • Dual Eligible Special Needs Plans (D-SNPs): For those eligible for both Medicare and Medicaid, offering extra benefits at little to no cost.
• Medical Savings Accounts (MSAs): Pair a high-deductible health plan with a medical savings account funded annually by your insurer.

What Are Your Prescription Drug Options with Medicare Advantage?

Most MA plans include Part D drug coverage, but MSAs and some PFFS plans do not. If your MA plan lacks drug coverage, you may:

• Enroll in a standalone Part D plan (only available with some MA plans).
• Be subject to a late enrollment penalty if you don’t maintain creditable coverage.

Note: If your HMO or PPO doesn’t include drug coverage, you typically can’t enroll in a separate Part D plan.

How Do You Choose a Medicare Advantage Plan?

Before choosing a plan, understand Medicare Advantage costs by considering:

• Premiums: Some MA plans have $0 premiums; others may cover your Part B premium in full or part.
• Deductibles, Coinsurance & Copays: Know your out-of-pocket costs for care and prescriptions.
• Out-of-Pocket Maximums: MA plans cap annual expenses for covered services, which Original Medicare does not.
• Extra Benefits: Many plans offer dental, vision, hearing, telehealth services, gym memberships, and OTC benefits.

When and How Do You Enroll in a Medicare Advantage Plan?

You can enroll in Medicare during specific enrollment periods:

• Initial Enrollment Period: Starts 3 months before and ends 3 months after your 65th birthday month.
• Annual Open Enrollment (Oct 15–Dec 7): Join, switch, or drop an MA or Part D plan.
• General Enrollment Period (Jan 1–Mar 31): For new Medicare Part B enrollees; allows MA plan enrollment.
• Medicare Advantage Open Enrollment (Jan 1–Mar 31): Switch MA plans or return to Original Medicare.
• Special Enrollment Periods: Triggered by major life events like:
  • Moving out of your plan’s service area
  • Losing Medicaid or employer/union health coverage
  • Being diagnosed with a qualifying chronic condition

What If You Want to Change Your Medicare Advantage Plan?

You can switch your Medicare Advantage plan during:

• Annual Open Enrollment (Oct 15–Dec 7)
• Medicare Advantage Open Enrollment (Jan 1–Mar 31)

Your new coverage will replace your previous plan automatically.

What Are Medicare Resources in New Hampshire?

New Hampshire offers several programs for Medicare assistance:

• New Hampshire SHIP (State Health Insurance Assistance Program): Provides free, one-on-one Medicare counseling. Learn more.
• New Hampshire SMP (Senior Medicare Patrol): Helps prevent Medicare fraud and abuse. Learn more.
• New Hampshire Insurance Department: Regulates insurers and handles complaints. Visit site.

For low-income residents, New Hampshire Medicaid may help with medical costs. Visit nheasy.nh.gov or call 1-844-ASK-DHHS. Learn more about the differences between Medicare and Medicaid.

Understanding Medicare Advantage Star Ratings

The CMS star ratings system is how the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (MA) plans using a 5-star quality scale. These ratings help consumers compare the performance of different plans based on a standardized set of measures.

⭐ CMS Star Ratings Overview

• 1 star: Poor performance
• 2 stars: Below average
• 3 stars: Average
• 4 stars: Above average
• 5 stars: Excellent

These ratings are updated annually and reflect data collected from Medicare Advantage (Part C) and Medicare Advantage Prescription Drug Plans (Part D).

Other Medicare Plan Options to Help with Out-of-Pocket Costs

Medicare Supplement Plans, or Medigap, help cover expenses Original Medicare doesn’t pay, like deductibles and copayments.

• You must have Medicare Parts A and B to buy a Medigap plan.
• The best time to enroll is during the six-month Medigap Open Enrollment Period, which begins when you enroll in Part B.
• Medigap plans don’t include prescription drug coverage, so you’ll need a separate Part D plan.
• There are 10 standardized plans. Medicare Supplement Plan G had the highest enrollment in 2023, and Plans G and N are the fastest-growing.
• Plan F is not available to beneficiaries who became eligible for Medicare after 2020.

Premiums vary by plan and location, but all offer predictable costs, no referrals, and nationwide Medicare provider access. Learn more about Medicare Supplement in New Hampshire.

Next Steps

If a Medicare Advantage plan in New Hampshire meets your needs, compare available plans in your area. Review costs, benefits, and provider networks—then be ready to enroll during your next eligible enrollment period.