Types of Medicare Advantage in New Hampshire, Explained

If you're a New Hampshire resident exploring Medicare Advantage, it helps to understand the different plan types available in your area. A Medicare Advantage plan is a type of health insurance offered through a private company that contracts with Medicare to provide your Part A and Part B benefits. Knowing the differences between the four main types can help you choose the one that best fits your healthcare needs and budget.

HMO Plans in New Hampshire: Health Maintenance Organization

HMO plans are the most common type of Medicare Advantage plan available to New Hampshire residents. They require you to use doctors, hospitals, and other providers within the plan's network, except in emergencies. You'll typically need to choose a primary care physician (PCP) who coordinates your care and provides referrals to specialists.

If you don't already have a primary care doctor in NH, the plan will pair you with one when you enroll. “If you don't have a primary care physician and are enrolling in an HMO, the carrier will assign you one,” says Ron Hamilton, a licensed Medicare agent in North Carolina. “If, for some reason, you don't care for the PCP assigned to you, you can change at any time.”

HMO plans in NH tend to have lower premiums and out-of-pocket costs compared to other plan types, but they offer less flexibility in choosing providers. If you see a doctor outside the network (other than in an emergency), you'll usually pay the full cost yourself. For New Hampshire beneficiaries who are new to Medicare, an HMO can be a cost-effective starting point. To understand the key differences in network rules, see our HMO vs PPO Medicare Advantage comparison.

PPO Plans in New Hampshire: Preferred Provider Organization

A PPO plan gives New Hampshire residents more flexibility than an HMO. You can see any doctor or specialist — both in-network and out-of-network — without needing a referral. However, you'll pay less when you use providers within the plan's network.

Worth knowing for New Hampshire beneficiaries: even though PPOs don't require referrals from the plan itself, individual specialists may still ask for one. “Many people like PPO plans because they typically do not require a referral to see a specialist. However, that does not necessarily mean the specialist or doctor's office won't request one,” explains Julie Kovacevich, a licensed Medicare agent in Nevada. “Some physicians may still require a referral based on their own office policies, so it's always best to check directly with the provider before scheduling an appointment.”

PPO plans in NH typically have higher premiums than HMOs, but they're a good fit if you want the freedom to see specialists directly or if you travel frequently and need coverage outside your home area. They're also useful if your preferred New Hampshire providers aren't all in the same network.

PFFS Plans in New Hampshire: Private Fee-for-Service

A Private Fee-for-Service plan determines how much it will pay healthcare providers and how much you'll owe when you receive care. Providers in New Hampshire don't have to agree to the plan's terms, so not every doctor will accept a PFFS plan. Before scheduling an appointment, confirm that your provider accepts the plan's payment terms.

Because the payment structure is different from HMOs and PPOs, the rules can catch New Hampshire residents off guard. “Medicare being a PFFS (Private Fee For Service) benefit delivery model, no referral is required for therapies,” notes Roberto Alonso, a licensed Medicare agent in Florida. “But since the providers must accept Medicare's standard fees, terms, and conditions, and the treatment must be deemed medically necessary, I always advise my customers to have the provider's office confirm coverage with Medicare.”

PFFS plans may or may not include a provider network. If the plan has a network, you'll pay less for using in-network providers. These plans can include hospital coverage and other services, but the rules differ from Original Medicare and Medigap plans. If you're weighing a PFFS plan against Medigap, you may want to understand how to switch between Medicare Advantage and Medigap.

SNP Plans in New Hampshire: Medicare Special Needs Plans

Special Needs Plans are designed for New Hampshire residents with specific diseases or conditions, those who are eligible for both Medicare and Medicaid (dual-eligible), or those who live in certain institutions like nursing homes. SNPs tailor their benefits, provider networks, and drug formularies to meet the unique needs of their members.

“Special Needs Plans are designed for Medicaid-eligible clients or for clients with specific health issues like cardiac issues, diabetes, and similar conditions,” says Bill Holland, a licensed Medicare agent in Tennessee. “These plans have benefits specifically designed to meet the needs of certain populations.”

Because SNPs focus on specific populations, they can provide more targeted and coordinated care than other plan types. If you qualify for a SNP in NH, it may offer better coverage for the services you need most, including specialized support for conditions like heart disease.

For someone with a serious chronic illness, a Chronic Condition SNP (C-SNP) can be especially valuable. “For someone with chronic kidney disease, the best Medicare plan is often a Medicare Advantage C-SNP if one is available in your area, because it's designed specifically for people with conditions like CKD and may offer extra care coordination,” says Priscilla Ramos, a licensed Medicare agent in Ohio. “If a C-SNP isn't available, Original Medicare plus a Medigap Plan G plus a Part D drug plan often provides the most flexibility for seeing specialists and receiving treatment.”

Key Considerations for New Hampshire Residents Choosing a Plan

• Healthcare Needs: Assess your current health status and anticipate future needs to determine which plan aligns best with your situation.
• Provider Preferences: If maintaining access to specific New Hampshire doctors or specialists is important, ensure they're included in the plan's network.
• Financial Factors: Evaluate premiums, deductibles, copayments, and out-of-pocket maximums to understand the overall cost implications. New Hampshire plan pricing can vary by county.
• Additional Benefits: Many Medicare Advantage plans in NH offer extras like vision, dental, and hearing coverage at no additional cost.
• Plan Quality: Check Medicare Star Ratings to compare how plans in New Hampshire perform on measures like customer satisfaction and health outcomes.
• Travel Considerations: If you travel frequently, examine the plan's coverage area and policies regarding out-of-network care.

Verifying your New Hampshire doctors are covered is something a good agent will handle for you. “It's the agent's job to make sure the Advantage plan being considered is accepted by her current doctors. Every carrier provides access to its roster of in-network providers,” says Edward Fisher, a licensed Medicare agent in Michigan. “If the plan is an HMO, you must go to an in-network doctor or they won't pay. If the plan is a PPO, you can go outside the network, but you will pay a higher copay.”

By evaluating these factors, you can select the right Medicare Advantage plan for your situation in New Hampshire. If you later decide your plan isn't the right fit, learn how to switch from Medicare Advantage to Medigap. Review your options during the Medicare Advantage enrollment period, and consider working with a local Medicare agent who knows the NH market and can walk you through every plan available in your area.