What are Medicare Advantage Plans in New Hampshire?
What You Need to Know
Most Medicare Advantage plans offer drug coverage, as well as extra benefits such as dental, vision, hearing and more.
Your costs for a Medicare Advantage plan depend on the monthly premium, annual deductibles, and per-visit fees.
You can only enroll, switch, or drop Medicare Plans during certain periods.
Are you thinking about Medicare and wondering about your options in New Hampshire? Medicare Advantage (MA) plans, sometimes called Medicare Part C, are an alternative to Original Medicare. These plans bundle Medicare Part A (hospital coverage) and Medicare Part B (outpatient services) into one plan. Most MA plans also include Medicare Part D (prescription drugs).1 Medicare Advantage plans are offered by private insurance companies.
What Types of Medicare Advantage Plans Are Available?
- Health maintenance organization (HMOs): In 2021, 62% of MA plans are HMO plans.2 You must see healthcare providers within the HMO’s network, except for emergency care.3 To see a specialist, you will need a referral from your primary care physician (PCP).
- Preferred provider organization (PPOs): These plans have networks of preferred providers. You can access service outside the plan’s network, but your share of the costs will be higher.4 With PPOs, you don’t need a referral to see a specialist and you don’t have to choose a PCP
- Special needs plans (SNPs): These plans provide coverage for people with certain health needs5. There are three types of SNPs:
- Chronic condition SNPs (C-SNPs) for people with chronic illnesses such as cancer, diabetes, end-stage renal disease, and other conditions.
- Dual eligible SNPs (D-SNPs) for people who qualify for both Medicare and Medicaid.
- Institutional SNPs (I-SNPs) for people who live in nursing homes or receive home health care.
- Private fee-for-service (PFFS) plans: When you choose this plan, you can go to any doctor, hospital, or other provider that accepts the plan. Some PFFS plans have networks of providers who agree to always treat members.6 If you want to access services outside of that network or if the plan does not have a network, you need to ask the provider if they accept the plan beforehand.
- Medical savings account (MSA) plans: These plans combine a high-deductible health plan with a medical savings account.7 The high-deductible plan covers costs only after you meet a high yearly deductible. The medical savings account is a bank account that is used solely to pay medical expenses. The MSA plan deposits money into this account annually. Unused funds can be rolled over from year to year.
Medicare Advantage plans have an annual cap on out-of-pocket costs, unlike Original Medicare.
What Are Prescription Drug Options with Medicare Advantage?
In 2021, 89% of MA plans offer prescription drug coverage.8 This excludes MSA plans and some PFFS plans that don’t cover prescriptions. For MSA and PFFS plans that don’t come with prescription drug coverage, you can sign up for a separate Medicare Part D prescription drug plan.
If you enroll in an HMO or PPO that does not cover drugs, you cannot join a standalone Part D plan.
How Do You Choose Medicare Advantage Plans?
If you’re choosing an MA plan in New Hampshire, here are some things to consider when comparing costs and coverage:
- Monthly premiums: Your monthly costs will depend on your plan’s monthly premium and your monthly Part B premium.9 In 2021, the standard premium for Part B is $148.50.10 Some plans will pay this for you. If a plan says it has a zero premium, find out if that includes the Part B premium.
- Other out-of-pocket costs: In addition to premiums, many plans have deductibles. This is the amount you are responsible for before the plan starts to pay. After meeting the deductible there may be additional coinsurance or copayments. All MA plans limit the total amount you pay out-of-pocket each year, which is called a maximum.
- Plan Benefits: Most MA plans provide extra benefits. For example, in 2021, 98% of MA plans cover telehealth.11 Fitness, dental, vision, and hearing aid benefits may also be included.
When and How to Enroll in Medicare Advantage?
You can join, change, and drop MA plans only during certain time periods.
- Initial Enrollment Period: This is when you first become eligible for Medicare. It is seven months long and starts three months before the month you turn 65, includes the month of your 65th birthday and continues three months after that.
- Open Enrollment Period (October 15 to December 7): You can join, change, or leave Original Medicare, MA plans and Part D plans during this time.
- Medicare Advantage Open Enrollment Period (January 1 to March 31): This enrollment period allows you to switch from one Medicare Advantage plan to another or drop your MA plan and return to Original Medicare.
- General Enrollment Period (January 1 to March 31): If you have Part A coverage and you get Part B for the first time during this period, you can also join an MA plan.
- Special Enrollment Period: The federal Medicare program allows you to change your MA coverage under special circumstances, such as when you:
- Move out of your plan’s service area
- Lose healthcare coverage, such as Medicaid
- Gain health insurance under an employer or union
- Lose coverage due to changes in your current plan
- Experience a special circumstance such as the diagnosis of a chronic condition that would be better served with a C-SNP
Know Your Premium
If you choose a zero-premium plan, you may still be responsible for the Part B premium.
Who Has Signed up For Medicare Advantage in New Hampshire?
How Much Do Medicare Advantage Plans Cost in New Hampshire?
The average monthly premium paid in 2021 by New Hampshire MA Plan enrollees is $26.11.13 This is similar to the national average of $21 per month. Note that this premium is in addition to the Medicare Part B Premium ($148.50 in 2021).14
What If You Want to Change Your Medicare Advantage Plan?
If you are unhappy with your current Medicare Advantage plan, you can switch to another MA plan or to Original Medicare during the Open Enrollment Period and Medicare Advantage Open Enrollment Period.
What Are Alternatives to Medicare Advantage in New Hampshire?
In New Hampshire, the primary alternative to Medicare Advantage is Original Medicare. If you choose this option, you may want to buy a Medigap policy from a private insurance company to help pay for uncovered expenses. For prescription drug coverage, you will need to sign up for a Medicare Part D plan.
What Are Medicare Resources in New Hampshire?
- If you need help navigating Medicare and MA plans, contact the New Hampshire State Health Insurance Assistance Program. This program provides free one-on-one insurance counseling.
- To file a complaint about an MA Plan, you have two options. Contact the New Hampshire Insurance Department or complete a complaint form on the Medicare.gov website.
- If you are unable to afford your medical costs, you may be eligible for Medicaid. Contact the New Hampshire Department of Health and Human Services to find out if you qualify.
To learn more about Medicare Advantage, speak to a licensed professional or the government’s Medicare Plan Finder. This online tool shows you costs, coverage and benefits so you can compare your options to find a plan that best meets your health needs.