Marketplace Exchange


The NH Insurance Department presentation on the effect of the Affordable Care Act on Health Insurance Marketplaces: NH Insurance Dept Health Reform and Markets

 The Affordable Care Act calls for “Exchanges,” which are the online marketplaces where individuals and small businesses may shop for health insurance.  Health insurance marketplaces opened on October 1, 2013 to allow people to comparison shop online for insurance plans that start January 1, 2014, to avoid the possibility of a fine. 

Through the Exchange, individuals are able to

    • Shop for a health insurance plan that best meets their needs.
    • Learn whether they are eligible for a commercial insurance premium tax credit and/or cost-sharing subsidy,
    • Determine eligibility and enroll in Medicaid.

Tax credits and cost-sharing subsidies are available only for insurance purchased through the Exchange. However, individuals can still purchase health insurance or enroll in Medicaid outside of the Exchange.

States may chose between a state-based exchange, a fully federally run exchange and a partnership exchange that allows the state to take on certain functions.  

    • In June of 2012, the legislature passed a bill prohibiting the state from setting up its own exchange so New Hampshire has a federally run Exchange.

To deal with the influx of those newly qualified for insurance, the federal law includes money for “navigators” whose jobs are to guide people through the application process for tax breaks and enrollment.

    • The New Hampshire Insurance Department was awarded a $5.3 million federal grant for insurance exchange-related education and outreach.
    • The grant would have paid for 28 navigators,  while current federal exchange funding only allows for 4.5 such positions, fewer than one person to cover each of the state’s 10 counties.
    • The New Hampshire Senate rejected a bill that would have allowed the department to accept federal money to publicize the exchange and pay guides to help people through the process.
    • However, New Hampshire residents in need of insurance will not have to fend for themselves after all.  The Center for Medicaid Services agreed that the operator of the state’s high-risk insurance pool would be an acceptable vehicle to accept the federal grant. The quasi-governmental agency’s mission is “facilitating the availability of health insurance to those who have difficulty obtaining it,” a goal shared by the Affordable Care Act.

In Carroll County the White Mountain Community Health Center has two Navigators and two Certified Application Counselors to help New Hampshire residents sign up for the Affordable Care Act’s Health Insurance Marketplace.

For other locations call 800-318-2596 or visit

Modified Adjusted Gross Income under the Affordable Care Act

2014 Enrollment Numbers: [Source]

40,262 people had completed their private plan Obamacare enrollments in the New Hampshire exchange by April 19.  Another 7,235 exchange applicants were eligible for the state’s existing Medicaid coverage by mid-April.

For private plan enrollments, New Hampshire has been greatly exceeding CMS projections every month since December.  The original projection for the New Hampshire exchange was 19,000 enrollees during the 2014 open enrollment; the final total is more than double that amount.

Anthem Blue Cross Blue Shield had 90 percent of the individual market share in New Hampshire prior to 2014, so it’s not especially unusual that they’re the only carrier that opted to participate in the exchange the first year.

Anthem has reported that more than 35,000 of the exchange enrollees are new customers for them.  Given the carrier’s long-term dominance in the market, we can assume that a significant majority of the Obamacare enrollments in New Hampshire are for people who were previously uninsured.  Anthem has also reported that almost 90 percent of their enrollees have paid their premiums.

Update for 2015

SHOP: Small Business Health Options Program (SHOP)

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