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NH Medicaid Health Plans Guide

Medicaid programs are slightly different in every state due to the different economic and healthcare needs of each demographic. In New Hampshire, the Medicaid program covers about one out of every 12 adults and one out of every three children. There are two plans to choose from, “New Hampshire Healthy Families,” and “Well Sense Health Plan.” This guide can help you determine whether or not you are eligible for NH Medicaid,  which plan is best for you, and how to apply and start saving!

Click below to learn more about NH Medicaid:

New Hampshire Medicaid Costs and Coverage

New Hampshire Medicaid beneficiaries can get comprehensive healthcare at very little or no cost based on household income. Some people will be responsible for small copays (can be as low as $1) for certain services, but most Medicaid beneficiaries will pay nothing for doctor visits and services.

Granite Advantage

Granite Advantage is the new name for what used to be the New Hampshire Health Protection Program (NHHPP). You can join Granite Advantage if you are do not qualify for traditional New Hampshire Medicaid or Medicare but are between the ages of 19 and 64, are not pregnant, and have a monthly income at or below 133% of the Federal Poverty Level:

  • Household of 1 - $1,346/month
  • Household of 2 - $1,825/month
  • Household of 3 - $2,304/month
  • Household of 4 - $2,782/month
  • Household of 5 - $3,261/month

To stay eligible and to stay enrolled in Granite Advantage, members who are physically able to are required to participate in 100 hours (just over four days) of “community engagement” each month. You’ll need to submit proof of your hours through your NH EASY account. Don’t panic - those 100 hours of activities can include a job, job training and searching, education (at any level), substance abuse treatment, involvement in the refugee resettlement program, and involvement in the NH employment program.

You can apply for Granite Advantage the same way you would apply for Medicaid. If you are accepted, you will receive care through either Well Sense or New Hampshire Healthy Families.

What Does NH Medicaid Cover for Dental?

In April 2019, the New Hampshire Senate voted to expand NH Medicaid dental benefits. As of May 15th, The bill still has to pass through the House, and there is not yet a plan for what benefits will be included. Currently, only children with NH Medicaid have access to dental benefits through “New Hampshire Smiles” including six-month cleanings and fluoride treatments, and medically necessary sealants, space maintainers, x-rays, root canals, fillings, crowns, dentures, surgeries, and sometimes orthodontics.

Prescription Drug Coverage

Most prescription drugs are covered at no or very low cost for New Hampshire Medicaid beneficiaries. Your doctor should prescribe you a generic version of the drug you need whenever possible and should look to the preferred drug list first. Without doing this, your doctor will need prior approval from the Medicaid program in order for you to have coverage for that drug.

If you’re in one of the managed care plans, pay attention to your plan’s preferred drug list. You can find the Well Sense preferred drug list here and the New Hampshire Healthy Families preferred drug list here.

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Picking a NH Medicaid Health Plan

New Hampshire residents have the ability to choose between Well Sense Health Plan and New Hampshire Healthy Families. Some people are required to select a health plan. If you receive notice that MCM (Medicaid Care Management) is optional for you, you can select a plan or wait until one is chosen for you. If you receive notice that MCM is mandatory for you, you will be automatically placed into one of the two plans. Voluntary members can change Health Plans at any time, and mandatory members can change during the first 90 days and then during the individual Open Enrollment Period (November 1 through December 15).*

If you have the option to choose your health plan, consider the following factors:

  • Do your current doctors work with the plan (find out here)?
  • Which benefits are most important to you?

*Be careful to not confuse the individual open enrollment period (Nov. 1-Dec.15) with the Medicare Annual Enrollment Period (October 15-Dec.7).

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Why Pick Well Sense NH?

Well Sense Health Plan works with over 2,000 doctors in New Hampshire. Well Sense also has accreditation from the National Committee for Quality Assurance in Massachusetts and New Hampshire and includes Boston Medical Center in their network. There are no monthly premiums and no deductibles

Well Sense NH offers extra benefits for members including:

  • No-cost bike helmets and car seats/booster seats for infants and toddlers
  • No-cost dental kits
  • Up to $100 back if you join WeightWatchers
  • Up to $200 back if you join a qualifying health club

New Hampshire Healthy Families

The New Hampshire Healthy Families plan is a great option as well. Some of the biggest benefits of choosing this plan are:

  • The inclusion of some over-the-counter drugs
  • Health coaches for help with ongoing conditions like diabetes, asthma, etc.
  • Transportation to and from medical appointments or mileage reimbursement
  • “CentAccount” program - earn money for performing healthy behaviors
  • “Coupon-Saver” program - discounts on grocery and household items
  • “Member Connections” at-home outreach for your medical and social service needs
  • Vision credit towards glasses
  • “Connections Plus” free cell phones for those in need.
  • “Start Smart for Your Baby” pregnancy program
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NH Medicaid Income Guidelines

While there may be some exceptions, most people have to earn less than the below numbers to qualify for New Hampshire Medicaid:

NH Medicaid Eligibility | Medicare Plan Finder

Submitting Your NH Medicaid Application with NH Easy

You can apply for Medicaid and other programs through NH Easy online, by phone at 1-800-852-3345, or by faxing your application to 603-271-8604. The easiest way to apply is with NH Easy. When you use NH Easy, you can access your account at any time to manage your benefits online. It can take from 20 to 45 minutes to complete your application depending on the number of people in your household and the complexity of your income. It will be easiest if you can complete it all at once, so gather all of your personal information ahead of time. Locate your family's social security numbers, income statements, child support statements, proof of medical expenses, asset information (vehicles, life insurance, bank accounts, houses, etc.), and current health insurance information.

How to get Both Medicare and Medicaid in NH

If you qualify for both Medicare and Medicaid, you CAN enroll in both programs. Medicaid qualifications are based on income, but Medicare qualifications are based on age and disability. You can qualify for Medicare if you are age 65 or older, if you have received Social Security Disability Income for at least 25 months, or if you are diagnosed with either ALS or ESRD. If you’re eligible for both programs, that means that you are eligible for a DSNP (Dual-Eligible Special Needs Plan). A DSNP is a special type of Medicare Advantage for people who get both Medicare and Medicaid. It provides additional health benefits for little or no cost. If you’re eligible, we can help you select the DSNP plan that works best for you. For more information, just give us a call at 833-438-3676 or send us a message.

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