By Marc Gilman
Questions? Call (800) 927-9326 or email
Key Takeaways
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New Hampshire has no Dual Eligible Special Needs Plans (D-SNPs) — one of only four states without them, alongside Alaska, Illinois, and Vermont.
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NH goes a step further than that: it’s one of only six states with no integrated Medicare-Medicaid plan of any kind — no D-SNP and no Medicare-Medicaid Plan (MMP) either.
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Nationally, D-SNPs cover 4.1 million of the roughly 12 million dual-eligible Americans — a coordination option simply not on the table for NH residents.
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A federal policy limiting “look-alike” Medicare Advantage plans normally moves affected dual-eligible members into a same-company D-SNP — a remedy that cannot work in New Hampshire because there’s no D-SNP to move them into.
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Without an integrated plan, coordinating Medicare and Medicaid in NH falls to the beneficiary, a family member, or an agent — manually, rather than through one plan that does it automatically.
What “Dual Eligible” Actually Means
Dual-eligible individuals are enrolled in both Medicare and Medicaid at the same time — Medicare as primary coverage, Medicaid providing supplemental help with costs Medicare doesn’t fully cover. Nationally, this describes about 12 million people. Depending on income and asset level, dual eligibility can be “full” (Medicaid covers a broad range of costs) or “partial” (Medicaid covers specific things like Part B premiums through a Medicare Savings Program).
In most states, insurers address this population through D-SNPs — Medicare Advantage plans built specifically for dual-eligible beneficiaries, designed to coordinate Medicare and Medicaid benefits under one plan. As of recent CMS data, D-SNPs are available in 46 states and cover 4.1 million dual-eligible Americans.
New Hampshire Doesn’t Have Them
This is the detail that surprises a lot of people, including some who’ve searched for D-SNP options online and come up confused: New Hampshire is one of only four states — along with Alaska, Illinois, and Vermont — where D-SNPs simply aren’t sold.
It goes further than that. Federal researchers analyzing dual-eligible coverage specifically exclude New Hampshire, Alaska, North Dakota, South Dakota, Vermont, and Wyoming from certain plan-integration studies for one reason: these six states have no integrated Medicare-Medicaid plan contract of any kind — no D-SNP, and no Medicare-Medicaid Plan (MMP) either. That’s a genuinely small group of states, and New Hampshire is in it.
Why This Matters: The “Look-Alike” Policy Can’t Work the Same Way Here
There’s a federal policy worth understanding, because it reveals exactly how New Hampshire’s situation differs structurally from most of the country. Since 2022, CMS has stopped renewing contracts for non-SNP Medicare Advantage plans where 80% or more of enrollees are dual-eligible — plans that function like D-SNPs in practice without being licensed or regulated as one. These are called “look-alike” plans, and CMS has been proposing to lower that threshold further, to as low as 50–60%.
When a plan crosses that threshold, the standard remedy is to transition its dual-eligible members into another Medicare Advantage plan from the same parent company — including a D-SNP, if one is available. Beneficiaries can still choose a different plan or Original Medicare instead.
Here’s the New Hampshire-specific problem: that standard remedy can’t fully apply here, because there’s no NH D-SNP to transition anyone into. Any look-alike enforcement touching a New Hampshire plan would send affected members straight to a different standard Medicare Advantage plan or Original Medicare — skipping the D-SNP option that beneficiaries in most other states would have.
So What Do Dual-Eligible NH Residents Actually Get?
Without an integrated plan, coordination happens through separate systems rather than one plan managing both:
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Medicare coverage — through Original Medicare, a standard Medicare Advantage plan (like a PPO), or a Chronic Condition SNP (C-SNP) if a qualifying diagnosis applies. None of these are built specifically around dual-eligible status.
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NH Medicaid — administered separately by the NH Department of Health and Human Services, through Medicare Savings Programs (MSP) for partial duals, or full Medicaid coverage for those who qualify.
NH’s Medicaid income and asset limits for the long-term-care-relevant Medicare Savings Programs are notably strict: as low as $591/month income for a single person, with an asset limit around $2,500 (New Hampshire allows an asset disregard up to $7,500). Qualifying for full Medicaid alongside Medicare in NH means the state will cover your Part B premium, and depending on the level of coverage, potentially deductibles, coinsurance, and Part A premiums as well.
One more NH-specific detail worth knowing: estate recovery here is broader than in many states. It applies not just to probate assets but also to jointly-held property, living trusts, and transfer-on-death accounts — though New Hampshire won’t pursue recovery if the beneficiary is survived by a spouse or a child who is under 21 or disabled.
Why This Is Especially Relevant Right Now
New Hampshire’s Medicare Advantage market is genuinely in flux for 2026. According to the NH Insurance Department, approximately 77,000 Granite Staters are directly affected by carrier withdrawals and reductions this year:
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Martin’s Point is fully withdrawing from New Hampshire
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Anthem is exiting the individual Medicare Advantage market entirely
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Aetna is exiting Belknap, Carroll, Cheshire, Grafton, Merrimack, Strafford, and Sullivan counties, continuing only in Hillsborough and Rockingham
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Coös County will be left with only WellSense and Humana
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Humana is introducing new plans in several counties while discontinuing one in Carroll
If your plan is among those withdrawn or significantly changed, you qualify for a Special Enrollment Period to choose a new plan or return to Original Medicare. For dual-eligible residents already navigating two separate systems without the benefit of an integrated plan, this kind of market disruption adds another layer worth getting help with rather than sorting out alone.
What To Do Next
If you or a family member is dual-eligible in New Hampshire, the coordination that an integrated plan would normally handle for you — in most of the rest of the country — simply isn’t available here. That makes working with someone who actively tracks both your Medicare and Medicaid situation more important, not less, especially with the 2026 market changes adding real uncertainty for tens of thousands of NH residents.
If you want help sorting out what you or a loved one actually qualifies for, or navigating a 2026 plan change, reach out and we’ll work through it together.
Questions? Call (800) 927-9326 or email
