New Hampshire health insurance Marketplace guide

In order to sign up for private health coverage through the New Hampshire Marketplace, you must:

• Live in New Hampshire
• Be lawfully present in the United States
• Not be incarcerated
• Not be enrolled in Medicare ⁸

By those rules, the majority of Americans qualify to use the Marketplace.⁹ But a bigger question for most people is financial assistance, and there are a few additional parameters to qualify for subsidies in the Marketplace. 

To qualify for income-based Advance Premium Tax Credits (APTC) or cost-sharing reductions (CSR), you must:

• Not have access to affordable health coverage through an employer. If you have access to an employer’s plan but it seems too expensive, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies in the Marketplace. 
• Not be eligible for Medicaid or CHIP.
• Not be eligible for premium-free Medicare Part A. ¹⁰
• If married, file a joint tax return.¹¹
• Not be able to be claimed by someone else as a tax dependent.¹¹

Beyond those basic parameters, qualifying for Marketplace subsidies depends on your household income.

You can sign up for an ACA-compliant individual or family health plan in New Hampshire between November 1 and January 15, which is the annual open enrollment period.¹² 

For coverage to take effect on January 1, you need to complete your application by December 15. Applications submitted between December 16 and January 15 will have a February 1 coverage effective date.⁹

Outside of the annual open enrollment window, you may be eligible to enroll if you experience a qualifying life event, such as giving birth or losing other health coverage. And some people can enroll year-round even without a specific qualifying life event.

Enrollment in New Hampshire Medicaid/CHIP is available year-round.

To enroll in an ACA Marketplace plan in New Hampshire, you can: 

• Visit HealthCare.gov, New Hampshire’s health insurance Marketplace. HealthCare.gov is an online platform where you can compare plans, see your subsidy eligibility, and enroll in the plan that best meets your needs. 
• Purchase Marketplace coverage with the help of an insurance agent or broker, a Navigator, or certified application counselor.
• Enroll via an approved enhanced direct enrollment entity.¹³ (Confirm that you’re enrolling in Marketplace coverage, as that’s the only way you can take advantage of financial assistance if you’re eligible for it.)

You can reach HealthCare.gov’s call center by dialing 1-800-318-2596 (TTY: 1-855-889-4325). The call center is available 24 hours a day, seven days a week, except holidays.

Under the Affordable Care Act (ACA), there are income-based subsidies that can help lower your premium payments each month. These subsidies are available to New Hampshire residents who meet the eligibility requirements and enroll in Marketplace coverage.

As of early 2024, nearly three-quarters of New Hampshire Marketplace enrollees were receiving premium subsidies, and these subsidies reduced their health insurance premiums by an average of $352/month. After accounting for subsidies, the average enrollee’s premium — including those who paid full-price — was about $199/month.¹⁴

(Note that the numbers above are based on effectuated enrollment in early 2024; the chart below shows some different metrics and is based on total enrollments submitted during the open enrollment period for 2024.)

For individual/family market enrollees who aren’t eligible for premium subsidies, the state’s reinsurance program, which took effect in 2021, keeps full-price premiums lower than they would otherwise be.¹⁵

If your household income isn’t more than 250% of the federal poverty level, you may also be eligible for cost-sharing reductions (CSR), as long as you select a Silver-level plan. These subsidies are designed to reduce your deductibles and out-of-pocket expenses. As of early 2024, nearly a third of Marketplace enrollees in New Hampshire Marketplace were receiving CSR benefits.¹⁴

You can use both APTC and CSR benefits if you’re eligible for both and you select a Silver-level plan in the Marketplace (APTC can be used with plans at any metal level, but CSR benefits are only available on Silver plans). 

New Hampshire has expanded Medicaid eligibility under the Affordable Care Act, so adults under age 65 are eligible for Medicaid with household incomes up to 138% of the poverty level. From 2014 through 2018, New Hampshire purchased private Marketplace plans for people who were eligible for expanded Medicaid. However, the state opted to transition to regular Medicaid managed care starting in 2019, so the program now functions much the way it does in most other states.

Source: CMS.gov¹⁶

Four private insurers offer coverage through the New Hampshire Marketplace for 2025, including WellSense, which is new for 2025^{17 1} (the New Hampshire Insurance Department confirmed that WellSense plans will be available both on-exchange and off-exchange).

(Another carrier, Anthem Health Plans of New Hampshire, offers coverage only outside the exchange. But a separate Anthem entity, Matthew Thornton Health Plans, offers coverage in the New Hampshire Marketplace.¹⁷)

The following average rate changes have been approved for 2025 for the insurers that offer Marketplace coverage in New Hampshire (rate changes are calculated before subsidies are applied; most enrollees qualify for subsidies):

Source: New Hampshire Rate Review Submissions¹⁷ New Hampshire Insurance Department¹

The rate changes for 2025 were approved as filed, without any changes to the rate proposals during the rate review process.¹⁷

Here’s an overview of how average full-price (pre-subsidy) premiums have changed in New Hampshire’s individual/family health insurance market over the years:

• 2015: Average increase of 0.5%¹⁸ (accounting for four new insurers)
• 2016: Average increase of 6.2%¹⁹
• 2017: Average increase of 6.8%²⁰(insurer participation down to four)
• 2018: Average increase of 52%²¹(insurer participation down to three)¹⁹
• 2019: Average decrease of 11%²² (Medicaid Premium Assistance Program no longer in use)
• 2020: Average decrease of 0.7%²²
• 2021: Average decrease of 15.6%¹⁵ (reinsurance program took effect)
• 2022: Average increase of 3.3%²²
• 2023: Average increase of 4.8%²³
• 2024: Average increase of 0.7%²⁴

New Hampshire’s 2024 Marketplace enrollment reached a record-high, with 65,117 people enrolling in plans during the open enrollment period.²⁵

The previous record high enrollment in New Hampshire’s Marketplace came in 2016, when a total of 55,183 people signed up during open enrollment.²⁶

As illustrated below, New Hampshire Marketplace enrollment has been climbing since 2021, largely due to the American Rescue Plan’s enhancement of the ACA’s premium subsidies. The Inflation Reduction Act has extended these subsidy enhancements through 2025. 

The enrollment growth in 2024 was also due to the “unwinding” of the pandemic-era Medicaid continuous coverage rule. CMS reported that by April 2024, nearly 20,000 New Hampshire residents had transitioned from Medicaid to a Marketplace plan during the unwinding process.²⁷

Source: 2014,²⁸ 2015,²⁹ 2016,³⁰ 2017,³¹ 2018,³² 2019,³³ 2020,³⁴ 2021,³⁵ 2022,³⁶ 2023,³⁷ 2024³⁸

HealthCare.gov: This is New Hampshire’s Marketplace. Residents can enroll in individual/family health plans and receive income-based subsidies. You can contact HealthCare.gov at 800-318-2596.

New Hampshire Department of Health and Human Services: The New Hampshire Department of Health and Human Services administers Medicaid and CHIP, as well as other social services programs. You can reach them at 1-844-ASK-DHHS (1-844-275-3447) For TDD Access, use Relay NH 1-800-735-2964

New Hampshire Insurance Department: Regulates the New Hampshire insurance industry, and assists consumers and businesses with insurance-related questions and concerns.  

New Hampshire State Health Insurance Assistance Program: A local service that provides information and assistance with questions related to Medicare eligibility, enrollment, and claims.