Medicare in New Hampshire

Medicare is a federally operated and funded health insurance program. Eligible individuals have the choice between Original Medicare and Medicare Advantage coverage. Two parts comprise Original Medicare. Inpatient hospital stays, nursing home care and home health services fall under Part A, while Part B covers outpatient medical services, preventative care and medical supplies. Prescription medications in Original Medicare are covered under Medicare Part D. Medicare Advantage is an alternative in which seniors purchase policies from private health insurance providers. All plans must comply with Medicare regulations and requirements.

New Hampshire spent $2.2 billion on Medicare payments in 2021, the most up-to-date information available. However, the Centers for Medicare & Medicaid Services (CMS) reports that 2022 costs increased by 4.3% and that expenditure will continue to grow an average of 5.4% annually. Per beneficiary, this averages $9,369 annually in payments. 

In 2023, 322,558 individuals in New Hampshire enrolled in Medicare, representing 23% of the population. A total of 332,450 residents were eligible for Medicare Advantage coverage as of July 2023, but only 109,082, or around 33%, opted into it. This figure is 15% lower than the national rate at which people opt into Medicare, even though New Hampshire’s eligible enrollees are increasing quicker than national trends, with a 3.62% statewide growth in eligible enrollees compared to just 2.66% nationwide. The percentage of people who enrolled in Medicare Advantage increased by 17.31% in 2023 compared to the previous year, nearly double the 9.75% national trend. Overall, New Hampshire saw a 13.22% growth in the program’s enrollees.

This guide covers information about Medicare Advantage in New Hampshire to help seniors create care plans that work for them. There is also a list of local resources that may help seniors make an informed decision about a location.

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)

Overseen and administered by CMS, Original Medicare provides health insurance to seniors 65 and older and younger individuals with qualifying disabilities. Part A covers inpatient hospital stays, skilled nursing, nursing home care, home health care and hospice for a set deductible ($1,600 for 60 days of hospital admission) and a set daily fee for lengthy stays. Part B provides general coverage for medically necessary appointments and services, such as preventative care and durable medical equipment. Part B premiums are determined by income and start at $164.90 with a deductible of $233. Coverage is available nationwide from providers who accept Medicare.

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)

Some seniors may find that Medicare Advantage makes more sense for their situations. Beneficiaries receive the same benefits offered by Medicare Part A and Part B, with the exception of hospice care. Often, these plans also incorporate prescription coverages (Part D) along with wellness programs, medical transportation and other services. Typically, there are annual out-of-pocket cost limits, which can help seniors budget accordingly. Medicare Advantage is offered in several plan types. The four main ones are Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee-for-Service (PFFS) plan and Special Needs Plans (SNP). 

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 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 2023 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.