Individual Health Insurance - Publicly-Funded Programs

As a self-employed individual with no employees to insure, a publicly-funded program may be an option for you:

• Medicaid
• Medicare
• NH Healthy Kids

Each has its own eligibility criteria, so research these options carefully.

MEDICAID

Medicaid is a health payment program funded jointly by the state of New Hampshire and the federal government. The program is coordinated by the NH Division of Family Assistance at the NH Department of Health & Human Services:

• Children under age 19 (through NH Healthy Kids)
• Pregnant women of any age whose income is 185% of the federal poverty income limits
• Low-income families with children
• Blind individuals
• Refugees
• Non-citizens
• Seniors
• Disabled adults

There are three types of eligibility requirements:

• General
• Financial
• Medical

Determinations of a person's eligibility for Medicaid services are made by several different DHHS units. For general information, visit Medicaid eligibility.

MEDICARE

Medicare is a federal health insurance program for:

• People age 65 or older,
• People under 65 with certain disabilities, and
• People of all ages with End-Stage Renal Disease

If you are over 65, this should be your primary choice – even if you are still working full- or part-time.

The Medicare programs include:

Part A Hospital Insurance. Part A is paid for through payroll taxes while working. Most people don’t pay a premium for Part A. Part A helps cover inpatient care in hospitals, including critical access hospitals, skilled nursing facilities, hospice care, and some home health care. Medicare does not pay for custodial or long-term care. You must meet certain conditions to receive Part A benefits.

Part B Medical Insurance. Part B helps cover doctors’ services and outpatient care. It also covers other medical services that Part A doesn’t cover, such as some physical therapy and occupational therapy services and some home health care. It pays for covered services and supplies when they are medically necessary. Most people pay a monthly premium for Part B.

Part D Prescription Drug Coverage. Medicare prescription drug coverage is insurance provided through private companies. You choose a plan and pay the monthly premium.

For more information, visit Medicare on-line.

Medicare Supplemental Insurance (Medigap)
Medicare supplemental insurance is private health insurance that pays all, or a portion, of the costs not covered by Medicare. There are several standard Medigap insurance programs.

If you are on the original Medicare program, you may want to consider buying this type of insurance. If you are in a Medicare + Choice Plan, you don’t need a Medigap policy.

For more information, contact your insurance agent or broker or AARP.

NH HEALTHY KIDS

NH Healthy Kids is health insurance for children under the age of 19. There are three programs: Gold, Silver, and Buy-In. They also offer coverage for pregnant women 19 and older. Each level has its own eligibility, benefits and cost. The amount you pay depends on your family’s income. Many New Hampshire families qualify for free coverage.

Healthy Kids Gold

• Free range of health and dental coverage. Benefits are provided through the NH Department of Health & Human Services
• Income guidelines apply
• No cost to family

Healthy Kids Silver

• Managed care plan using the Harvard Pilgrim Healthcare network of health care providers
• Dental services through the Northeast Delta Dental network of dentists
• To be eligible, your child must be uninsured for six consecutive months prior to enrollment. This requirement may be waived for good cause (for example, loss of a job or domestic violence)
• Cost is based on your income and family size. A co-payment is required for some services

Healthy Kids Buy-In

• Families not eligible for state-sponsored coverage through NH Healthy Kids may be able to buy into the Silver program
• Available for:
  • families with children under age 19 with higher incomes,
  • non-citizen children who are legal residents but otherwise not eligible,
  • children over the age of 19 who are still enrolled in high school, and
  • children who have been uninsured for three consecutive months prior to enrollment
• Cost is a flat rate per child, per month

Pregnant Women

• Free health and dental coverage. Benefits are provided through NH Department of Health and Human Services
• Income guidelines apply
• No premiums or co-payments

For more information about NH Healthy Kids, eligibility guidelines, cost, and application form visit the NH Healthy Kids Web site