Getting Health Insurance / When things change
A dependent child needs to purchase their own health insurance at age 26
Before 26, a dependent can stay on his or her parent’s health insurance plan. This extension of coverage ends when the dependent turns 26.
Beginning on the dependent's 26th birthday, they qualify for a 60-day special enrollment period and can sign up for their own insurance. After this 60-day period, a dependent may not be able to get coverage until the next open enrollment period. Depending on income, a dependent may be…
Navigating the System / Getting care, what's covered
If you are having a health emergency, you do not need to get permission to access emergency care. Health plans do not require permission or authorization for a sick or wellness visit with a primary care provider.
Prior authorization from your insurance company is different from receiving a referral from a primary care doctor. Some services require prior authorization in addition to a referral. Prior authorization gives the clinical staff at an insurance company the chance to review treatment…
Managing your Cost / Understanding Your Costs
Prescription drugs
The amounts you pay for prescription drugs covered by your plan would count towards your out-of-pocket maximum. If you purchase a prescription that is not covered by your plan for whatever reason (it’s not on the plan’s formulary, it’s considered experimental, etc.), it would not count.
Not all health plans include prescription coverage, so you may be interested in a stand-alone prescription plan which is available for individual purchase. These plans have a separate…
Navigating the System / Getting care, what's covered
Most health plans cover some chiropractic care for acute or short-term conditions. New Hampshire statute requires health plans that cover chiropractic care cover a minimum of 12 visits. You may be required to pay a co-pay at the time of your visit, so be sure to check your Summary of Benefits and Coverage Document.
However, many insurance plans do NOT cover chiropractic care for maintenance and wellness treatments. If you are being treated for a chronic, long-term condition, refer to you…
Navigating the System / Getting care, what's covered
Yes. In fact, most health plans must cover a certain set of preventive services at no cost to you, when delivered by an in-network provider.
Screenings and Counseling
Screening for diabetes, cholesterol, obesity, various cancers, including prostate, HIV, and sexually transmitted infections (STIs)
Counseling for drug and tobacco use, healthy eating, and other common health concerns
Routine Immunizations
Recommended routine immunizations for adults and children…
Navigating the System / Prescription drugs
Retail pharmacy
Navigating the System / Provider networks and referrals
No, you are responsible to check if a provider is in your network. Every insurance company has different benefit plans and network requirements. It is also common for healthcare providers to move in and out of different health plan networks, making it hard for your doctor to know what providers are included your network. However, your provider’s office will often help you by contacting the insurance company to make sure the referral is in your network. Ask your provider for assistance if you…
Managing your Cost / Understanding Your Costs
Deductibles, co-insurance, and co-payments are different ways that you and your plan share the cost when you receive medical care. Learn more. The specifics of each of these cost sharing methods varies from plan to plan, but the following gives a general overview of how they work. See your plan document for specific information.
You pay a deductible each year (or policy period)
With your car or house insurance, when you have a claim you pay the first few (or several…
Navigating the System / Getting care, what's covered
There are many resources available to help you find behavioral health care or substance use disorder services.
If you or someone you know is in crisis and need help immediately
Call 911 in case of an emergency or life threatening situation.
If you’re in New Hampshire, you can call 2-1-1 for immediate help 24-hours a day, 7 days a week
The National Suicide Prevention Lifeline is available 24 hours a day at 1-800-273-TALK (8255). A trained counselor will help you with any problems you are…
Managing your Cost / Don't Overpay!
The out-of-pocket maximum is a limit on what you pay out on top of your premiums during a policy period for deductibles, coinsurance and copays. Once you reach your out-of-pocket maximum, your health insurance will pay for 100% of most covered health benefits for the rest of that policy period. The next policy period (plan year), it starts all over again - note: the policy year may not coincide with the calendar year.
Thinking ahead about the health care services that you may need in the…
Getting Health Insurance / Getting health insurance coverage
Individual policies
If your employer does not offer health insurance, or if the insurance offered does not meet your needs, you may want to purchase an individual policy.
Depending on your circumstances, you may be able to take advantage of subsidized health insurance through New Hampshire's Federally Facilitated Health Insurance Marketplace. Learn more at www.healthcare.gov. To help you understand your estimated costs through the marketplace, Learn more
Find a Broker
You can purchase an…
Getting Health Insurance / Getting health insurance coverage
Talk with your employer to see if health insurance coverage is a benefit that's offered to you. If it is, there are usually rules about when you are able to sign up:
When you’re hired: Typically, you have a short period of time after you are first hired to enroll.
During open enrollment: If you don’t enroll when you are first eligible, you will probably need to wait for the annual open enrollment period. When open enrollment happens each year depends on the plan year ― it’s not necessarily…
Navigating the System / Making the most out of your coverage
Spending a little time to prepare before you go to the doctor can help you get what you need from the visit.
Think about why you are going to see the doctor
Annual wellness check. Focus questions on how to keep healthy. If you bring up specific health problems, that may change the focus of the visit and how the doctor bills for the type of service. Be aware that the amount your insurance covers and the amount you will pay depends on the type of service provided.
First visit. Be on time…
Managing your Cost / Understanding Your Costs
An Explanation of Benefits (EOB) is a statement that your insurance company sends that summarizes the costs of health care services you received. An EOB shows how much your health care provider is charging your insurance company and how much you may be responsible for paying. This is not a bill. If you owe money, you will receive a separate bill from your health care provider. Individual EOBs are likely to differ from the example provided.
Depicted in EOB statement example above, are these…
Navigating the System / Provider networks and referrals
Out-of-network services typically cost you more
Your insurance plan has contracts with doctors, other health professionals, pharmacies, and facilities to provide needed care and services, known as benefits, for plan members. “In-network” is the term used to describe these contracted providers. The plan pays the in-network providers an agreed rate for care and services, usually at a discount. This reduced rate means that services typically are provided at a lower cost to you.
“Out-of-…
Getting Health Insurance / Getting health insurance coverage
Health coverage options are available for people in New Hampshire who have recently been laid off or lost their employer sponsored health insurance benefits. Get info on COBRA, NH State Continuation, Granite Advantage, Health Insurance Marketplace and where to find help!
Navigating the System / If you're uninsured
If you don't have health insurance, paying for care can seem overwhelming. If you need care, it is important that you get medical care before you get worse. There are many resources available to help you. Start now to get the coverage and care you need.
Getting Health Insurance / Getting health insurance coverage
Yes, you can get coverage! Now, because of the Affordable Care Act, insurance companies cannot deny you coverage or charge you more if you have pre-existing medical condition such as back pain, diabetes, or cancer.
Once you have coverage and have paid for any deductibles, co-insurance or co-payments required, your insurance company cannot refuse to pay for treatment for a pre-existing medical condition.
You can find more information on HealthCare.gov: https://www.healthcare.gov/health-care-…
Getting Health Insurance / Your options and why you need coverage
If you need care right away
If you need medical care before you can get your new coverage in place, there are resources to help. Learn more.
Getting new coverage
When you lose your health insurance, you need to find out what options you have to get coverage.
Navigating the System / Provider networks and referrals
When your doctor needs to refer you to a specialist for care, first talk with the doctor’s office staff to see if there is an in-network specialist contracted with your insurance plan. Remember that the doctor’s office may not know what providers are included in your insurance plan network. If in doubt, call your plan customer service directly.
If you find that your insurance network does not include the needed specialty provider, coverage for services depends on your insurance plan benefits…