In early 2010, Congress passed the Affordable Care Act (ACA). This legislation is also known as Obamacare. The ACA established a federal insurance exchange marketplace. Some states run their own marketplace. Others, like New Hampshire, use the federal government’s marketplace.
Because of the ACA, you’re now required by law to buy medical insurance. If you don’t, you may face fines and fees. Applying for insurance during the annual open enrollment period helps you see what plans may be available to you, weigh your options, and purchase insurance that suits you, your lifestyle, and your financial situation.
As of June 2015, five companies will be providing health insurance plans to individuals living in New Hampshire in 2016.
These companies include:
- Ambetter from NH Healthy Families, offered by Celtic Insurance
- Anthem Blue Cross Blue Shield of New Hampshire
- Community Health Options (CHO)
- Harvard Pilgrim Health Care of New England
- Minuteman Health
The ACA established that all health insurance plans offered through the marketplace must cover the following 10 essential services:
- check-ups, including doctors’ visits and annual physicals
- chronic disease management, such as diabetes care
- emergency care
- in-patient hospital services
- laboratory services
- maternity and newborn care
- mental healthcare, including services for substance abuse problems
- outpatient services
- pediatric care, including vision and dental coverage for children
- rehabilitative services
Children’s health insurance plans must include dental and vision coverage. Insurance plans for adults, however, don’t have to include either of those options. Instead, adults can purchase individual plans for dental or vision through the marketplace.
Health insurance plans in the marketplace are divided into five categories. Four of these categories, which are also called metal plans, offer different prices and financial responsibilities.
The four metal plans are:
- Platinum: Your plan covers 90 percent; you pay 10 percent.
- Gold: Your plan covers 80 percent; you pay 20 percent.
- Silver: Your plan covers 70 percent; you pay 30 percent.
- Bronze: Your plan covers 60 percent; you pay 40 percent.
People under the age of 30 may also apply for and purchase catastrophic coverage. The ACA established that these types of plans would be used only in the event of an emergency, so the coverage benefits are not favorable. In fact, a catastrophic health plan pays no more than 60 percent of your medical costs.
You can browse the available plans on Covering New Hampshire’s plan comparison page. Here, you can select several different plans from the ones offered in the state. You can see how their deductibles, co-pays, and out-of-pocket maximums compare. You won’t know your final premium amount until you actually apply, however.
Three factors determine your health insurance rate. These factors include:
- Geography: Insurance companies can alter their premium prices depending on where you live in the state.
- Age: It’s assumed older adults will need greater healthcare services, so their rates may be higher than that of a younger person.
- Tobacco use: People who smoke or use tobacco will pay more for their insurance than people who do not.
Each person’s results will be different, but some tools are available to help you estimate your costs. According to the Kaiser Foundation’s Health Insurance Marketplace Calculator, a 30-year-old from New Hampshire who makes $30,000 dollars a year and does not smoke or use tobacco can expect to pay $219 per month for the silver plan. This estimate does not include any possible financial aid.
You can also use Covering New Hampshire’s Assistance Calculator to research your estimated costs. The Kaiser Foundation’s calculator powers this calculator, so the results may be the same.
Some individuals applying through the marketplace will find out they qualify for financial assistance. This assistance can come in several forms:
- Medicaid coverage, a health insurance option for low-income individuals and families
- lower premiums, meaning your monthly cost will be lower so you have less out-of-pocket expenses
- lower out-of-pocket maximums, or the amount you will be responsible for paying
Remember, the only way to know exactly how much you’ll pay and what financial assistance you may be able to receive is to start the enrollment process. The marketplace uses your specific personal and financial information to give you a detailed plan and possible options.
The marketplace establishes income levels that are eligible for assistance. People with an annual income that falls within these ranges may qualify for lower premiums:
- $11,670 to $46,680 for 1 person
- $15,730 to $62,920 for 2 people
- $19,790 to $79,160 for 3 people
- $23,850 to $95,400 for 4 people
- $27,910 to $111,640 for 5 people
- $31,970 to $127,880 for 6 people
People with an annual income that falls within these ranges may qualify for lower premiums and lower out-of-pocket maximums:
- $11,670 to $29,175 for 1 person
- $15,730 to $39,325 for 2 people
- $19,790 to $49,475 for 3 people
- $23,850 to $59,625 for 4 people
- $27,910 to $69,775 for 5 people
- $31,970 to $79,925 for 6 people
New Hampshire’s open enrollment period for 2016 begins November 1, 2015. The earliest you can begin receiving coverage is January 1, 2016. The open enrollment period ends January 31, 2016. The longer you wait to enroll, the longer you will have to wait for coverage to begin.
If you do not sign up during open enrollment, you may be eligible to apply during a special enrollment period. This type of enrollment period is reserved for individuals who have a life status change or those who have an employment change. For example, if you were single but become married before the next open enrollment period, you may be eligible to reapply so you and your spouse can share the same health insurance plan. Also, if you lose your job before the next open enrollment period, you may be eligible for a special enrollment period.
Once you’re ready to apply, visit Covering New Hampshire’s enrollment page. You will be directed to Healthcare.gov to begin the application process. You can also use Cover New Hampshire’s page to find local assistance and guidance if you need help with your enrollment. You can also get help by calling the Marketplace Call Center at 1-800-318-2596.
If you aren’t sure if you’ll qualify for health insurance, it’s better to apply and know for sure than to assume you won’t and face fines. Most people who apply will qualify, and many will also qualify for aide. Once the open enrollment period opens, sign up to find out your options.