Who should you contact if you have questions about your health insurance coverage?

Here's a list of ten questions you should ask before picking a health care plan.

Many people face the confusing proposition of choosing health insurance. To help wade through the piles of paperwork, here's a list of ten questions you should ask before picking a health care plan:

1: What Type of Plan Is It?

Find out if it is an indemnity health plan or a managed care system. With indemnity health plans, also known as fee-for-service plans, you pay a percentage of the medical costs, and the insurance company pays the remaining percentage. Typically, you are allowed to choose your own doctors.

With managed care -- meaning either a health maintenance organization (HMO) or a preferred provider organization (PPO) -- you have minimal out-of-pocket expenses. With an HMO, you or your employer pays a fixed monthly fee for health-care services, but you can only go to a doctor who is under contract with the HMO. Through a PPO, you or your employer gets a discount if you use physicians within the plan. You may go to a doctor outside the PPO system, but you'll pay more.

2: How Much Will I Have to Pay for Medical Care?

Find out the amount of the premium. Next, ask whether you will be charged a co-payment, a small flat fee, perhaps $10, charged for health care services.

Some plans have a deductible instead, an amount that you have to pay before the policy starts to cover any medical costs. Find out about this, and find out the percentage of costs that will be covered by the plan once you've met the deductible.

3: Will I Be Able to Use My Current Doctors?

Ask about any limits on choosing your doctors or hospitals. Ask for a list of the doctors and hospitals that are covered to decide if the plan is right for you.

4: What Benefits Are Included?

Ask if the plan covers dental, vision care, or other special services that you might need. Ask about prescriptions, too.

Ask what benefits are not covered by the plan, too.

5: Are Routine Examinations Covered?

Ask about mammograms, pap tests, immunizations and other routine check-ups.

6: Will I Have to Call My Doctor Before Going to the Emergency Room?

Some plans require you to contact your doctor within 24 hours of going to a hospital emergency room, or your costs won't be covered.

7: What Are the Plan's Restrictions on Pre-Existing Conditions?

If you or someone in your family has a chronic condition, the policy may not cover related medical costs for a period of months -- or ever. Ask for how long pre-existing conditions are excluded.

8: What Happens When I'm Away from Home?

If you need to go to the doctor while traveling, how much -- if any -- of the costs will the plan cover? How do you get reimbursed?

9: Is the Insurer Financially Stable?

Find out how long the company has been in business. You don't want to get a really good deal with low premiums, only to find out that you can only see a doctor during very limited hours.

10: How Does the Company Handle Disputes Over Claims?

All insurance plans have procedures for appealing denied claims. Many require that you take your dispute to an arbitrator, or an independent person who hears both sides and makes a decision about the claim. Ask what the company's average turn-around time is for resolving claim disputes.

Health coverage options are available for people who have recently been laid off or lost their employer sponsored health insurance benefits:

  • Granite Advantage Health Care Program: Medicaid Expansion coverage for no or low income individuals, ages 19-64
    • Children’s Medical Assistance (ages 0-18)
    • Medicaid for pregnant women
    • Medically frail
  • Health Insurance Marketplace (HealthCare.gov)
  • COBRA/NH State Continuation

Granite Advantage/Medicaid (Low or No Income):
You can enroll in the Granite Advantage Program or other Medicaid Programs if you are low or no income and need health coverage. There are also Medicaid programs available for children, pregnant women, and the medically frail.

  • Learn more about the Granite Advantage Program
  • Enroll in the Granite Advantage Program or Medicaid coverage through NH Easy or HealthCare.gov.
  • There are several Medicaid Managed Care plans to choose from. Do your research to make sure that the plan you choose includes your preferred medical providers.

Health Insurance Marketplace (HealthCare.gov)
You can purchase medical and dental plans for yourself and/or your family on HealthCare.gov.

1. How do I know if I qualify for the Marketplace outside of the Open Enrollment Period?

  • HealthCare.gov provides Special Enrollment Periods (SEP) for people who may have recently lost their employer sponsored health insurance coverage.
  • You can apply for the SEP 60 days before they know their coverage will end and 60 days from the date you lost coverage.
  • If you do not apply 60 days from the date your health insurance terminated, you will not be able to take advantage of the SEP.

2. How do I apply for insurance on HealthCare.gov?

  • Visit HealthCare.gov to complete an application or call the Marketplace at 1-800-318-2596 (TTY: 1-855-889-4325).

3. What types of health plans are available on HealthCare.gov?

  • Anthem, Ambetter by NH Healthy Families, and Harvard Pilgrim sell individual health plans on HealthCare.gov.
  • There are different “metal levels” or tiers, depending on how much you are willing to spend each month on premiums versus how much you are willing to pay out of pocket for medical services. Learn more.
  • Take some time to do your research. Make sure that the plan you choose includes your preferred medical providers and prescription drugs. You can do this research on HealthCare.gov or through the NH Insurance Department’s website.

4. Can I get help with enrolling in a plan?

  • Yes, HealthCare.gov offers a "Find Local Help" tool that you can use to look up free help in your community, including enrollment assisters and insurance agents.
  • Free enrollment assistance is also available through a Federal Navigator by calling 1-877-211-NAVI or by visiting NH Navigator.

5. Is there financial assistance available to help me afford my premiums?

  • Yes, three-quarters of NH residents insured through the Marketplace qualified for financial assistance. There are two types of assistance available, depending on your income level:
    • Premium Tax Credits are available to offset premium costs, based on a sliding scale up to 400% of the Federal Poverty Level.
    • Cost Sharing Reductions lower the amount of out-of-pocket costs, such as deductibles, copayments, and coinsurance, a person or family must pay. These discounts are available for households with an income up to 250% FPL, but only for Silver level plans bought on HealthCare.gov.
  • After completing an application on HealthCare.gov, you will learn how much assistance you qualify for, based on your tax household income.

6. What steps do I need to take to start my new insurance plan?

  • You must pay your first month’s premium by the insurance company’s due date to start your coverage. There are grace periods, but it may be helpful to set a reminder each month to pay your premium. If you do not pay your premium, your plan can be terminated.

COBRA & NH State Continuation
When your insurance coverage is terminated, your insurance company is required to notify you of your rights. If your employer had 20 or more employees, you can select COBRA or NH State Continuation. If your employer had fewer than 20 employees, you can select NH State Continuation.

  • COBRA:
    • If your employer had 20 or more employees then you may be eligible for COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985) which allows you and your dependents to continue on the group health (medical and dental) benefit plan at the employer's full price, plus a 2% administrative fee.
    • In the event that you lose your group health coverage (medical or dental) you may be eligible to continue your benefits for up to 18 months or longer with COBRA. The options available to you are based on whether you were insured under a:
      • Self-funded plan sponsored by your employer or
      • An insurance plan provided by your employer through an insurance company (also referred to as a fully-insured plan).
  • N.H. State Continuation
    • If your group health plan is a fully insured health insurance policy and you are a resident of N.H. then you may be eligible for NH State Continuation which allows for you and your dependents to continue on the group health (medical and dental) insurance plan at the employer's full price, plus a 2% administrative fee. This option is available to all sized employers who are fully-insured.
  • Find more resources on COBRA and NH State Continuation on the Insurance Department’s website.

Need Help?

  • If you need help with Medicaid, call Medicaid Program Client Services at (800) 852-3345, ext. 4344 (TDD Access Relay (800) 735-2964). Hours are 8:00 A.M. – 4:30 P.M., Monday through Friday.
  • If you need enrollment assistance, reach out to a Navigator, enrollment assister, or insurance agent through the Find Local Help tool on HealthCare.gov.
  • Contact your employer and their insurance company for more information about COBRA/NH State Continuation.
  • Contact the NH Insurance Department with any other questions or concerns you may have at 1-800-852-3416 or by email at .