Medicare Advantage is a private health insurance program that serves seniors and individuals with disabilities throughout New Hampshire. Also known as Medicare Part C, it provides beneficiaries with the services provided by Original Medicare Parts A and B; however, Medicare Advantage often includes additional insurance that covers the cost of prescription medications and services such as optometry and dental care. It’s important to note that Medicare Advantage plans differ in coverage offered and cost, depending on the insurance provider.
Throughout the U.S., 39% of Medicare beneficiaries are enrolled in Medicare Advantage, according to the Kaiser Family Foundation. In New Hampshire, enrollment rates are far below average, with only 21% of Medicare beneficiaries participating in a Medicare Advantage plan. While Vermont’s enrollment rate is even lower at just 13%, Maine is right at the national average with an enrollment rate of 39%.
New Hampshire seniors can choose between several Medicare Advantage plans that offer varying types of coverage. These include HMO, PPO and PFF plans, as well as SNPs. In the guide that follows, we explain the different types of plans and when seniors can enroll, as well as how they can obtain prescription drug coverage. Additionally, we’ve provided some New Hampshire’s Medicare resources, which can help seniors determine which plan is the best fit for their needs.
Medicare Advantage offers several plan types, and the availability of each one varies by state. In New Hampshire, these plans include Health Maintenance Organizations (HMOs), Private Fee-For Services Plans (PFFSs), Preferred Provider Organizations (PPOs) and Special Needs Plans (SNPs).
Health Maintenance Organizations (HMOs)
Seniors who are looking for a low-cost Medicare Advantage plan might consider a Health Maintenance Organization, or HMO. These plans come with lower premiums, but they do have some limitations and restrictions. HMOs offer enrollees specific provider networks for their health care services. If a beneficiary receives care within the network, the cost of their care is covered according to their policy. However, seeking care from a provider outside of their network usually results in the patient being responsible for the full cost of their treatment. HMOs also typically require that members choose an in-network primary care physician, and get referrals before seeing specialists.
Preferred Provider Organizations (PPOs)
PPOs offer a little more flexibility than HMO plans. While participants do have a recommended network of health care providers to seek care from, they are permitted to receive care from providers outside of their network. However, coverage rates are generally much better when care is obtained within the plan’s network. Most PPOs require beneficiaries to choose a primary care physician who can provide them with referrals in the event they need to receive care from a specialist. PPOs can be a good option for seniors who want to keep costs reasonable but have the flexibility to see specialists outside of their network when required.
Private Fee-for-Service Plans (PFFPs)
PFFPs offer participants the chance to receive care from any health care provider they choose, without concern for obtaining care within the insurer’s network. In these plans, the insurance company pays a predetermined amount for each service, and providers may charge the member for a portion of the cost. While this type of plan offers greater flexibility, premiums are usually higher than with PPOs or HMOs. Seniors who receive regular therapies or specialist care, or those who are particular about which physicians they receive care from, may want to consider a PFFP.
Special Needs Plans (SNPs)
SNPs are tailored to meet the needs of individuals in specific groups, such as those in nursing homes, or with certain disabilities and chronic illnesses. These plans take into account the increased amount of care its participants need and have been developed to accommodate these needs at an affordable cost. Additionally, SNPs must include prescription drug coverage, unlike HMOs and PPOs. It’s important to note that SNPs aren’t available to all Medicare beneficiaries. To qualify, seniors must fit into the group a plan serves, which may entail having certain disabilities, or having or a specific disease or condition, such as end-stage renal disease, chronic obstructive pulmonary disease, cancer or an autoimmune disorder.
Prior to enrolling in Medicare Advantage, seniors must first be enrolled in Original Medicare. Anyone who is eligible for Medicare Parts A and B is also eligible to enroll in Medicare Advantage. However, certain Medicare Advantage plans, such as SNPs, may have additional eligibility requirements.
Medicare Advantage has specific enrollment periods. One can only join a Medicare Advantage plan during the following periods:
Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.
Seniors who participate in Medicare Advantage plans in New Hampshire are not eligible to enroll in Medicare Part D. There is no option in the state for these two plans to be combined; however, there are many Medicare Advantage plans in the state that include prescription drug coverage. Some plans may require beneficiaries to pay an additional fee for this inclusion while others roll drug benefits into the total price of the plan.
While Medicare Advantage is an excellent option for seniors who require affordable health insurance, understanding the ins and outs of each type of plan and how to enroll can be challenging for many seniors. Listed below are state and local resources throughout New Hampshire that can help seniors understand the different Medicare Advantage plans and select the one that is best suited to their needs.
New Hampshire’s Bureau of Elderly and Adult Services provides social services and support to adults aged 60 and older. This state department has trained, certified Medicare specialists on staff who can help seniors understand their options when it comes to Medicare Advantage and other benefits.
The New Hampshire Insurance Department provides a variety of resources and information about Medicare and Medicare Advantage, as well as long-term care insurance and other insurance plans that are applicable to senior citizens.
Seniors who have concerns about their insurance provider or questions regarding Medicare Advantage plans can seek assistance by calling the department’s consumer hotline at 1-800-852-3416.
The New Hampshire Medicaid Program operates under the supervision of the Department of Health and Human Services. This program administers Medicaid plans for low-income individuals throughout the state. Its staff offers assistance to those who are dually eligible for Medicare and Medicaid, helping to coordinate benefits, answer questions about medical bills and access health care and other services that are covered by their benefit plans.
Questions about benefits in New Hampshire can be directed to the New Hampshire Medicaid Program by calling 1-800-852-3345.
Seniors who are enrolled in Medicare or Medicare Advantage plans may qualify for the New Hampshire Medication Bridge program. This program, which is sponsored by the Foundation for Healthy Communities, helps individuals who are not eligible for Medicaid pay for the cost of long-term prescription medications. In addition to providing prescription medication assistance, the Medication Bridge Program helps seniors and other individuals understand Medicare and Medicare Advantage benefits and other social assistance programs that might be suited to their needs.
The New Hampshire Medication Bridge program can be accessed by calling the Foundation for Healthy Communities at 603-225-0900.
Veterans and their immediate family members can seek assistance with Medicare Advantage claims, appeals and information about available plans by contacting their nearest Office of Veterans Services.
Veteran’s Affairs offices are located throughout the state. Seniors can learn more by calling the New Hampshire State Office of Veterans Services at 1-800-622-9230.
The City of Concord Human Services department offers a variety of social services and supports, including Medicare and Medicaid assistance for low-income seniors and individuals throughout the city.
The Loaves and Fishes Ministry is a social assistance program that helps low-income families and individuals with short-term financial needs. Most often, the program provides cash to help those in need pay for utilities, food or clothing; however, the program does accept other requests on a case-by-case basis and in temporary times of need may be able to provide assistance with Medicare Advantage premiums or other health care expenses.
To request assistance, seniors may call the ministry’s helpline at 1-800-978-6395 and leave a message. The ministry returns all calls within 24 hours.
The Manchester Senior Services department provides a broad range of assistance services for elderly persons in the city and the surrounding areas. This includes Medicare and Medicaid counseling services that are designed to help seniors understand their benefits, file claims and manage appeals whenever needed.
Medicare or Medicaid benefits counseling or assistance through the Senior Services department is available at the William B. Cashin Senior Activity Center, which is located at 151 Douglas Street in Manchester. Alternatively, seniors may call 603-624-6533 for more information.