It’s currently the open enrollment period, when people choose what health insurance they’ll have for the next year. But the process can often be overwhelming.
“It's confusing for everybody,” Peter Ames said.
He’s the Executive Director at Foundation for Health Communities, which administers the New Hampshire Navigator program. That program helps people learn about and enroll in Medicaid and the state’s health insurance marketplace.
“Reach out and ask for help, and right now is the opportunity to do so,” Ames said.
For NHPR’s How To New Hampshire series, we are going over some basic questions about how to enroll in health insurance this month.
What are the basics?
- A premium is the monthly payment people make to keep their health insurance coverage, like a membership fee. Once locked in, the cost of that premium stays the same throughout the year.
- A deductible is the amount you have to pay up front for medical services before your insurance provider begins to cover the costs under your plan. Ames gives this example: “If your deductible is $2,000, you are fully exposed for the first $2,000 of care. So if you go into a hospital [with] a $5,000 bill, that first $2,000 is fully on the patient to pay.”
- A copay is the charge you pay for a specific visit to a doctor or behavioral health provider. It’s usually between $25 and $75.
- Coinsurance is how a health insurance company splits some of the expenses that aren't covered by a copay.
“So if you pay your copay, but the total bill is $1,000… part of the overall bill is your responsibility,” Ames said. “And then the insurance picks up the other part.”
Your responsibility is the coinsurance. Some plans split it so there’s a 20% coinsurance fee from the consumer, and 80% is paid by the insurance. Plans usually give a maximum amount of money you can spend on your coinsurance fee.
What’s the Health Insurance Marketplace?
The Health Insurance Marketplace is where people can find health insurance plans to enroll in. The Affordable Care Act created the Marketplace, and all the plans listed there have to meet certain criteria for benefits included.
“So you know these plans are vetted for quality, that they're comprehensive… and available to anybody who wants to go purchase them,” Ames said.
The Marketplace plans are also the only health insurance plans that have tax subsidies available.
Health insurance plans are so complicated. Can someone help me walk through the Marketplace plans?
Yes! The New Hampshire Navigator program is federally funded and it exists to help people looking to apply for and enroll in the Health Insurance Marketplace.
“I think anybody who has dealt with health insurance or used their health insurance knows that it's really hard to figure out all the different components,” Ames said. “And that's why the New Hampshire Navigator program was built – to have trained experts to help consumers figure out the right path for them.”
It’s completely free to use, and Ames said when you get in touch, you’ll hear from trained experts in the Marketplace insurance plans who can help you understand what plan is the right fit for you and your family. You can get help by going to the New Hampshire Navigator website, or you can call 1-877-211-6284.
“They are unbiased. They don't have a dog in the fight,” Ames said. “They just want to find the best plan that is the right fit for that consumer.”
Do New Hampshire navigators help with Medicaid enrollment?
Yes, navigators can help people figure out if they are at the right income level to get Medicaid and can help them enroll.
“There's a lot of paperwork that comes with any government program, and we can help line up all those pieces for them so that they're not chasing everything they need to pull together,” Ames said. “We can walk them through that to make sure that they have confidence that they're fully enrolled, their plan is turned on and they can get the care that they need.”
I read in the news that tax subsidies are going away. Is that true?
Tax subsidies are built into the Marketplace plans based on income level to help offset the monthly premiums for individuals. The enhanced premium tax credits are the subsidies that could expire at the end of December if Congress doesn’t vote to extend them.
“These were additional subsidies put in place during COVID when a lot of folks were losing their jobs, losing their coverage” Ames said. “It put a lot more money in the system to provide broader economic access to the Marketplace products.”
If these tax credits go away, Ames said people of all income levels, including higher incomes, will see a reduction or complete elimination of their subsidies.
There are also premium tax subsidies for lower income levels, and those will continue to be available, no matter how Congress votes. However, the subsidies might be lower than what people received in the past few years.
Should I wait to enroll in a Marketplace plan to find out where the enhanced premium tax credits land?
Ames said he’s advising people not to wait to enroll.
“They can always reenroll to get the benefit of any tax changes that Congress passed so there's really no downside in enrolling right now,” Ames said.
If people wait to enroll, Ames said he’s concerned people will have a gap in their coverage. If you want your coverage to start on Jan. 1, you have to enroll by Dec. 15. But if you do need to wait or need more time before enrolling, open enrollment goes until Jan. 15.
Regardless of whether I get my insurance from the Marketplace, my employer, or somewhere else – what should I do to figure out what plan is best for me?
Ames recommends people of all income levels and circumstances consider three things as they look at their insurance option:
- Anticipated income for 2026. This will help determine your eligibility for premium tax subsidies, which lower and offset the cost of monthly premiums.
- Anticipated medical needs for the next year. Emergencies happen, but Ames said to write down any chronic conditions, planned surgeries or routine medications you have. An insurance navigator at the Marketplace or your employer can help you determine what plan will work best with your existing medical needs.
- Preferred provider network. Think about if you have an existing relationship with a doctor or provider that you want to stick with. Health insurance plans have limited networks, sometimes geographic networks, and you should note which plan would allow you to keep going to your current provider.
