Introduction to Medicare Part C in New Hampshire (Medicare Advantage)

If you are 65 years of age and relying upon Medicare Parts A and B alone to cover your medical needs, you might be making an expensive mistake. There are gaps in Traditional Medicare coverage which can get expensive if you don’t have them covered with some sort of supplemental insurance plan. Medicare Advantage is one such plan. It is designed to give you some of the most comprehensive health coverage available, so that you can enjoy your retirement years without the hassle of growing medical expenses.

Federal Regulations for Medicare Advantage

Unlike most Medicare supplements, Medicare Advantage effectively replaces your Traditional Medicare benefits (instead of merely supplementing them). Because of this, the government has passed laws which clearly state that your Medicare Advantage plan must offer the same (or better) coverage than what Medicare offers. It is likely, however, that your Advantage plan will cover much more than Traditional Medicare. We’ll delve into ancillary coverage options later in this article.

Medicare Advantage Enrollment In New Hampshire

Medicare Advantage is far from the most popular Medicare supplement insurance in New Hampshire. Around 10% of seniors 65+ are enrolled in a Medicare Advantage program. However, there are still a great variety of different plans available, should you choose to go that route. You can see which plans are the most popular below:

Plan Type Enrollment Percentage
HMO Plans 59%
Local PPO Plans 13%
Special Needs Plans 11%
Regional PPO Plans 9%
Private Fee-For-Service Plans 5%
Other (Cost Plans, MSA’s, etc.) 3%

Plan Coverage & Cost

There are dozens of different factors which can influence your monthly premium for a Medicare Advantage policy. Age is certainly a factor, along with gender, health habits, and where you live. Below, you can find price estimates which seniors like you are currently paying in your area:

Most Popular Medicare Advantage Plans in New Hampshire

If you are looking for the best Medicare Advantage programs in New Hampshire, check out Medicare’s Overall Star Rating report. Medicare uses the information that they collect on all Medicare related businesses and rates them for performance by assigning a star rating similar to those for crash tests. For companies offering healthcare service, like Medicare Advantage plans, Medicare rates five different areas. Those areas include how well the company supports preventive strategies like vaccinations, screenings, and lab tests, how well chronic disease is managed, member experience with the company, complaints and changes in performance level, and customer service. The report is updated annually. Have a look to find your best picks in New Hampshire.

Helpful Medicare Advantage Tips & Tricks

Doctor/Provider Network Restrictions

The type of Medicare Advantage plan which you sign up for is determined in part by what sort of provider network your plan is associated with. HMOs, for example, have very restrictive provider networks. This means that you will have a very short list of doctors and facilities where you are permitted to receive medical care. Additionally, seeking care outside of your provider network may come with severe restrictions and financial penalties. PPO plans and PFFS plans are much more inclusive (but, as mentioned earlier, are also more expensive).

Where you generally need to get your care and services from for:

  • HMO Plans – If you are considering joining an HMO, your choice of healthcare providers and facilities will generally be limited to those within the HMO network. Your primary care physician is responsible for determining if you need to see a specialist or undergo testing and he or she refers you to the appropriate HMO resource.
  • PPO Plans – PPOs also operate extensive networks but there are significant differences between a PPO and an HMO. With a PPO you have more control over which healthcare provider you see. For example, you can see a specialist without a referral from your primary care physician. If you want, and you don’t mind paying a higher copay, you can select a doctor outside the network providing he or she accepts Medicare and your insurance plan.
  • PFFS Plans – Private Fee For Service plans have no restrictions on who you select other than the physician must accept Medicare and the plans terms. Unfortunately, many healthcare providers will not accept PFFS plans even though they do accept Medicare. Generally, PFFS plans have lower payment schedules to physicians than other types of plans making them less than competitive in some markets. Always confirm that the provider accepts your plan when making an appointment.
  • Special Needs Plans – If you qualify for a Special Needs Plan (SNP), your choice of healthcare providers will generally be limited to those in your group. Healthcare providers in your group are members of Medicare’s SNP Network and are selected for their expertise in your specific condition.

Doctor/Providers List

Finding a doctor who accepts your Medicare Advantage plan:

  • HMO Plans – If you are considering an HMO Medicare Advantage plan, you’ll never have to worry about finding a doctor who accepts your plan. You can only use healthcare providers and facilities that are in the HMO network and your primary care doctor, who you may or may not be able to choose, is responsible for referring you to the appropriate HMO resource.
  • PPO Plans – Most PPOs allow you to use providers that are outside of their network which may cause you a little work in confirming they accept your plan. For in-network providers, PPOs normally will have online directories of physicians and facilities that belong to the PPO’s network. These listings typically include a short bio and some even have patient reviews. If you already have a doctor who is outside the network, just call and confirm that he or she will accept your plan. If they do, your Medicare Advantage plan will provide the coverage.
  • PFFS Plans – PFFS plans are the ones that present the greatest challenge. Some PFFS plans have directories of physicians that accept the plan but it is up to you to confirm that when you make an appointment. Many providers will not accept the terms of a PFFS even though they accept Medicare. Always confirm acceptance even if you are using a provider who accepted the plan the last time you used him or her.
  • Special Needs Plans – If you are in a Special Needs Plan you have a similar situation as a member of an HMO. The only healthcare providers that you can see are those that are assigned to your group. The collection of Medicare SNP Network providers are specialists in treating your specific condition.

Finding a doctor in New Hampshire that accepts your Medicare Advantage plan isn’t as difficult as it may seem. Most plans will have a directory of providers showing their specialty, location, and a brief bio. In some instances, you may need to find a doctor who accepts your plan and also accepts Medicare. To find Medicare doctors you can use Medicare’s physician search tool.

Drug, Vision and Dental Coverage

Original Medicare almost completely ignores dental health. Unless you need dental work as a result of oral cancer or damage to your jaw, there is no dental coverage. Many, but not all, Medicare Advantage plans do offer dental benefits but it’s important to compare plan to plan. Benefits can run from a simple annual exam covering x-rays and cleaning to a more comprehensive plan including fillings and periodontal work.

Eye care is another area where Medicare offers only disease related exams and nothing else. Most Medicare Advantage plans do have an eye care package. These are typically limited to an annual eye exam, lenses, and contacts. However, participating optical shops often offer discounts for other services like frames, to plan members.

Enrollment Options & Best Time To Enroll

If you can enroll in a Medicare Advantage plan during your first 6 months of turning 65 and enrolling in Traditional Medicare, you should. This enrollment period is known as your IEP (Initial Enrollment Period) and you will be met with the fewest number of possible restrictions by enrolling within this timeframe. You may also enroll later without being denied coverage if you qualify for a Special Enrollment Period, or if you are in good health. Seniors with serious pre-existing conditions, such as End Stage Renal Disease, might want to sit down with their insurance agent and discuss options before applying. It can be difficult to get covered by a Medicare Advantage policy outside of your IEP if you have a serious health condition. For more information, consult your state’s department of insurance, or take a look at our Medicare Advantage Enrollment Options page.

  • Initial Enrollment Period: 6-month timeframe when you first enroll in Medicare to purchase a Medicare Advantage plan.
  • Annual Enrollment Period (AEP): This timeframe runs from October 15th through December 7th every year, and during this time you can change or cancel your Medicare Advantage and part D drug plan.
  • Special Enrollment Period (SEP): During special circumstances, you may be eligible to purchase/change a plan outside of the Annual Enrollment Period. Things such as moving out of the plans’ service area, losing group health or employer coverage, a company no longer offering plans in the area, etc. are all events that could trigger a SEP.

What Medicare Advantage Plan Is Best For Me?

To get the best Medicare Advantage plan for you in New Hampshire, it’s important to think about what your medical needs will be in the future. If you know what you want, and that’s more difficult than you might think, you can research the plans that will best fit those needs. Don’t confine your comparisons of plans to just premium or copay costs. Take into consideration financial stability, reputation, and the length of time the company has served your area.

Getting it right the first time is important. Unlike other insurances, if you want to change plans you may have to wait thanks to special enrollment periods. Do your homework and you’ll find a plan you like and can afford.

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