Medicare in New Hampshire

Seniors aged 65 and over and individuals with certain disabilities may qualify for Medicare, which is a federally operated and funded health insurance program. As of 2020, there were 305,150 Medicare enrollees in New Hampshire, which works out to approximately 22% of the population. Original Medicare is estimated to have 241,480 enrollees, while Medicare Advantage has 63,670. New Hampshire spends an average of $9,256 per Medicare recipient per year, or about $2.4 billion annually.

Two parts comprise Original Medicare. Part A is free for seniors who paid into the plan through payroll taxes during their working years. It is also free for their spouses. The plan covers an array of services, including nursing home care, inpatient hospital stays and hospice care. It also covers home health care on a limited basis. Then there’s Medicare Part B, which has a standard premium of $170.10 per month in 2022 for most recipients. Part B covers medical supplies, outpatient medical services and preventative care such as regular physicals and screenings.

Medicare Advantage (Part C) provides private health insurance plans compliant with Medicare regulations and requirements. These plans include all the services of Medicare A and B, besides hospice care, which is a service exclusive to Part A. Seniors who need prescription coverage can add Part D to their Original Medicare plan and some Advantage plans. Supplemental plans — called Medigap — are provided by private insurers to reduce out-of-pocket costs for Original Medicare policyholders. Those enrolled in the Advantage Plans do not need Medigap. 

This guide has information to help New Hampshire seniors customize their Medicare insurance plan. There’s also a resource list to educate and empower seniors when it comes to choosing the right health coverage.

Options for Medicare Coverage in New Hampshire

There are multiple ways for New Hampshire seniors to obtain Medicare coverage. The federal government administers Original Medicare, but there are other options seniors can access through private insurers. Most seniors find Original Medicare a sufficient health insurance plan. However, there are add-ons and customizations available to ensure every senior has a health insurance plan that’s right for them.

Original Medicare (Parts A & B)

Original Medicare is administered by the Centers for Medicare & Medicaid Services (CMS) and is open to seniors aged 65 and over, along with those under 65 years old, but with certain disabilities or end-stage kidney disease. It includes two parts. Part A covers inpatient hospital care, nursing home and skilled nursing care, hospice and home health care. Part B, or medical coverage, pays for medically necessary goods and services such as durable medical equipment, mental health services and emergency medical transportation. 

Unlike most private Medicare plans, Original Medicare’s provider network isn’t limited to the beneficiary’s geographic region, making it easier to obtain services while traveling within the country. In most cases, Medicare doesn’t pay for health services the individual receives outside the United States. 

Under this program, seniors pay for services as they receive them. They must pay an annual deductible, which is $1,556 for Part A and $233 for Part B in 2022. After they’ve paid this amount, Medicare covers all eligible services at 80%. Beneficiaries pay the remaining 20% out of pocket.

Who Should Consider Original Medicare

Original Medicare may be a good option for those who:

• Travel frequently within the United States
• Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
• Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

Medicare Part C — known as Medicare Advantage — is an alternative to Original Medicare (Part A) that may be right for some New Hampshire seniors. Recipients get all the benefits of Medicare Part A, and Part B, except for hospice care. Also, many Medicare Part C plans cover prescriptions drugs (Part D), vision, dental, medical transportation and fitness programs. There are usually Medicare Advantage annual limits for out-of-pocket costs, which are helpful for seniors estimating yearly medical expenses.

Medicare Advantage has four plan types. Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) are perhaps the two best-known Medicare Part C plans, but there’s also the Private Fee-for-Service (PFFS) plan. Special Needs Plans (SNPs) are another option. Plan details vary depending on the provider.

Who Should Consider Medicare Advantage

The Medicare Advantage Plan may appeal to older adults who:

• Are healthy overall, so may benefit from lower premiums

• Want limits on their out-of-pocket expenses

• Prefer or are agreeable to a managed care plan
• Need dental care and prescription coverage
• Want to manage out-of-pocket health costs

The Top 10 Medicare Advantage Plans in New Hampshire

New Hampshire seniors can choose from many top-rated Medicare Advantage insurance plans. This table shows the highest-rated Part C providers ranked by the number of people enrolled. It also includes plan type and monthly cost range. Plus, there’s a Medicare Star Rating to help seniors select the right plan. The Medicare Advantage Plans in New Hampshire page has additional information about Medicare Part C, including eligibility and enrollment details and where to go for help.

Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later.

Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.

Who Should Consider Medicare Prescription Drug Coverage

Seniors who may benefit from prescription drug coverage include those who:

• Currently take prescription medication or expect to in the future
• Want to avoid late enrollment penalties
• Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.

For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2022 page.

Who Should Consider Medicare Supplement Insurance

Good candidates for Medigap may be those who:

• Have ongoing health issues and expenses
• Travel overseas often
• Want to access an expanded network of health care providers
• Expect to need health services not covered by Original Medicare

Medicare Resources in New Hampshire

Navigating Medicare’s enrollment process and private options can be challenging, but fortunately, New Hampshire residents have access to several agencies and programs to help them find the best coverage for their needs. Through the following resources, beneficiaries can get one-on-one help with understanding their benefits, enrolling in prescription drug coverage and researching Medicare Advantage and Medigap plans in their areas.