With the passage of the 2010 Patient Protection and Affordable Care Act each state has been forced to revise its insurance regulations in order to comply with federal requirements. Children may no longer be excluded from health coverage on the basis of pre-existing conditions and they may remain on their parents’ policies up to age 26. This is true regardless of the child’s status as a student or if they have married.
In the short-term, the states have worked with the U.S. Department of Health and Human Services to form temporary high risk insurance pools for adults with pre-existing conditions to purchase health policies. This expediency will be replaced on January 1, 2014 when health care exchanges become active in each state, providing a competitive market place for purchasing medical insurance.
General Insurance Regulations
Insurers in New Hampshire are required to offer guaranteed renewability. Currently, a nine-month exclusion may be added to any health policy for a pre-existing condition with a three-month look back period, but when the exclusionary period has expired, the condition must be covered. Rates may be raised according to health status, but coverage cannot be denied for that reason or on the basis of age.
Health Care Exchange
There has been no significant activity in New Hampshire toward the creation of a health care exchange. The state has until January 1, 2013 or the federal government will assume responsibility for the project.
Pre-Existing Condition Insurance
The Pre-Existing Condition Insurance Plan in the state is run by the New Hampshire Individual Plan Benefit Association. The provisions of the coverage include benefits for both primary and specialty care, hospital stays, and prescriptions. Monthly premiums vary by region, but range from $153 to $1023 for non-smokers. Medical deductibles are $1000 to $2000 with $500 to $2500 drug deductibles. Out-of-pocket limits range from $3000 to $5000.
Medicaid
Income expressed as a percentage of the Federal Poverty Level is the criteria used to determine Medicaid eligibility as well as monies distributed under the Children’s CHIP-funded Medicaid Expansions. In New Hampshire, children under one year of age qualify for Medicaid at 185% FPL and 300% for CHIP assistance. Children ages 1 through 19 are Medicaid eligible at 185% FPL.
Pregnant women qualify for Medicaid at 185% FPL, parents at 51%, and non-elderly Social Security disability recipients at 76% FPL.
(Additional aid to low-income families is available at 185% FPL through the Healthy Kids program)
Medicare
About 15% of the population of New Hampshire draws Medicare benefits with more than 226,000 people accessing the available prescription drug plans.
The Bureau of Elderly and Adult Services (BEAS) offers a Nursing Facility Care Services program for enrollees who need, but cannot afford nursing assistance.
