Cost and Coverage of Medicaid in New Hampshire

We are an online resource to help answer your questions, check your eligibility and assist you in applying for Medicaid. When you receive our guide, you will also be advised about whether you qualify for additional benefit programs.

Cost and Coverage of Medicaid in New Hampshire

Medicaid coverage provides free or low-cost health services to low-income families in New Hampshire. Medicaid services are available to qualifying New Hampshire families who meet general, financial and medical requirements. NH Medicaid coverage includes hospital care, physician visits, vision appointments, child dental services and rural health clinic visits.

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Moreover, types of Medicaid insurance in NH also includes prescription drug coverage, family planning, psychotherapy and many other important health services. How much is Medicaid in New Hampshire? Medicaid cost estimates vary depending on the household income of each applicant. Read below to find information pertaining to Medicaid insurance costs and coverage in New Hampshire, including:

Medicaid Coverage Patient Rules and Procedures in New Hampshire

In New Hampshire, a variety of Medicaid services are provided to qualifying applicants. However, what services are covered by Medicaid depend on whether the beneficiary follows patient responsibilities and procedures. If patient responsibilities are not followed, the beneficiary may need to pay for his or her medical costs. Patient responsibilities include the following:

  • New Hampshire Medicaid coverage requires all recipients to keep records of any received services
  • The recipient must show his or her New Hampshire Medicaid ID card before receiving any medical services
  • NH Medicaid coverage requires applicants to keep all scheduled appointments or cancel and reschedule appoints well in advance
  • The patient must follow all in-network, referral and participating provider insurance rules
  • The Medicaid coverage recipient must inform the Family Services Specialist at a local District Office if the recipient’s name, address or insurance information changes at any time

If Medicaid patient responsibilities are met, many critical health services will be provided to the patient at no cost, or the patient will owe very little in medical fees

What Services are Covered by Medicaid in New Hampshire?

What is covered by Medicaid, exactly? Medicaid coverage assists millions of Americans who cannot afford to pay for medical care. Medicaid coverage varies by state, per federal Medicaid requirements. Medicaid assists adults, children, elderly adults, people with disabilities and pregnant women.

NH Medicaid coverage provides ambulance services in the event of a medical emergency, including as many as 24 wheelchair van services per fiscal year. Certain types of Medicaid insurance include transportation coverage, which would also reimburse a beneficiary for certain public transportation costs that transport the patient to and from Medicaid-covered appointments.

Additionally, NH Medicaid coverage includes a certain amount of services per fiscal year (from July 1 through June 30). Beneficiaries may contact Medicaid Medical Services to request approval to go over service limits. If additional Medicaid services are not approved by the state, the beneficiary will need to cover the costs of these services out-of-pocket.

Other New Hampshire Medicaid coverage includes the following: 15 diagnostic X-rays per year (excluding radiation therapy), 12 outpatient hospital visits (emergencies and urgent care visits excluded), two dental cleanings per year for beneficiaries under 21, 80 units of 15-minute therapy appointments (including speech therapy, occupational therapy and physical therapy), four podiatrist visits per year, psychotherapy sessions (18 visits per year for adults over 21 and 24 visits for patients under 21) and one eye exam per year. NH Medicaid coverage also takes care of many prescription drugs, but there is no specific yearly limit.

What Does Medicaid Not Cover in New Hampshire?

Many Medicaid services are handled by state-sponsored health coverage in New Hampshire, but not every type of service is covered. What is not covered by Medicaid? NH Medicaid excludes the following services: biofeedback and acupuncture, investigational and experimental procedures, gender reassignment operations, sterilization reversals or operations for erectile dysfunction, conditioning or exercise programs, cosmetic surgery, fertility treatments, chiropractic services and hypnosis.

Additionally, NH Medicaid coverage excludes medically unnecessary services such as inpatient care, halfway houses, therapy or service animals, most homemaker services, nutritional counseling or dietary services, auditory or visual training and services for work-related injuries.

Certain types of Medicaid insurance plans in New Hampshire require prior authorization before receiving certain services, such as the following: private-duty nursing, organ transplant services (excluding kidneys) and certain X-rays and inpatient hospitalization if residing outside of New Hampshire.

Medicaid coverage also requires prior authorization for durable medical equipment (such as hospital beds), incontinence supplies and certain nursing facility services, communication devices, certain dental services for patients under 21 and specific prescription drugs. By downloading our in-depth guide, you will learn more about the coverage options for Medicaid.

Types of Medicaid Insurance in New Hampshire

In New Hampshire, types of Medicaid insurance are provided through Medicaid Care Management programs. The Medicaid types of insurance available in New Hampshire include plans from New Hampshire Healthy Families and the Well Sense Health Plan.

Beneficiaries will need to select a plan of their choosing or they will be assigned to one of the available health plans. Certain types of NH Medicaid insurance plans offer care management services, which are ideal for patients with complex medical needs.

How Much is Medicaid in New Hampshire?

How much is Medicaid in NH? Medicaid coverage fees vary from free to very low-cost, depending on the household size and income of each applicant.

With many types of Medicaid insurance, patients must submit a co-payment to the pharmacy for any prescription drugs. NH Medicaid coverage will pay for the remainder of the prescription costs. Medicaid coverage co-payments are typically between $1 for generic name prescriptions and $2 for brand name prescriptions.

Medicaid coverage costs will not include a co-payment for beneficiaries under 18, nursing home recipients, members of the Home- and Community-Based Care waiver program. In addition, pregnancy-related services, family-planning products and Clozaril and Clozapine prescriptions are not included in Medicaid services.

Medicaid coverage costs not paid for under Medicaid plans are the patient’s responsibility. Bill-related questions may be directed to Medicaid Client Services. However, Medicaid services will not be withheld due to the patient’s failure to pay for services. Explore Medicaid coverage and costs by downloading our detailed guide.

Medicaid Cost Estimates in New Hampshire

The cost of Medicaid coverage varies by a recipient’s income. Medicaid cost estimates and Medicaid eligibility depend on the income of all household members, including wages, self-employment income, rental income, Social Security benefits and veterans benefits. However, a number of specific expenses are subtracted from the household’s total income amount.

Medicaid cost estimates also depend on the applicant’s other financial resources, including bank accounts, cash, bonds, stocks, certain vehicles, permanently unoccupied real estate and certain trusts. However, to estimate Medicaid costs accurately, candidates should exclude current homes, furniture and some cars and vehicles.