- In New Hampshire, Medicare beneficiaries who struggle to afford their premiums may be eligible for help through a Medicare Savings Program (MSP).
- Applicants can qualify for Medicaid for the aged, blind and disabled in New Hampshire with incomes up to $797 a month if single and $1,176 a month if married.
- In New Hampshire, applicants whose incomes are higher than the eligibility limit for Medicaid for the aged, blind and disabled can enroll in the Medicaid spend-down.
- The income limits for Medicaid nursing home care in New Hampshire are $2,349 a month if single and $4,698 a month if married (and both spouses are applying).
- In New Hampshire, the income limits for HCBS in New Hampshire are $2,349 a month if single and $4,698 a month if married.
- Spousal impoverishment rules allow spouses who don’t have Medicaid to keep an allowance that is between $2,155 and $3,216 per month.
- New Hampshire requires applicants for Medicaid nursing home care and HCBS to have no more than $595,000 in home equity.
- Applicants for nursing home care or HCBS cannot transfer or give away assets for less than their value without incurring a penalty in New Hampshire).
- New Hampshire pursues estate recovery of the cost of all Medicaid benefits received beginning at the age of 55.
As a Medicare beneficiary, where you live – meaning your state of residence – can have a significant impact on the care that you receive and how you pay for that care during your “golden years.” This page explains how New Hampshire’s regulations and policies are likely to affect your bottom line.
Does New Hampshire help with my Medicare premiums?
Many Medicare beneficiaries who struggle to afford the cost of Medicare coverage are eligible for help through a Medicare Savings Program (MSP). In New Hampshire, these programs pay for Medicare Part B premiums, Medicare Part A and B cost-sharing, and – in some cases – Part A premiums.
- Qualified Medicare Beneficiary (QMB): The income limit is $1,063 a month if single and $1,437 a month if married. QMB pays for Part A and B cost sharing, Part B premiums, and – if a beneficiary owes them – it also pays their Part A premiums.
- Specified Low Income Medicare Beneficiary (SLMB): The income limit is from QMB levels up to $1,276 a month if single and $1,724 a month if married. SLMB pays for Part B premiums.
- Specified Low Income Medicare Beneficiary 135 (SLMB135): The income limit is from SLMB levels up to $1,436 a month if single and $1,940 a month if married. This program pays for Part B premiums. (The Qualified Individuals MSP is called SLMB135 in New Hampshire, because this program is offered to enrollees with incomes up to 135 percent of the federal poverty level.)
- Qualified Disabled Working Individuals (QDWI): The income limit is usually $2,126 a month if living alone and $2,873 a month if living with one other person. QDWI pays the Part A premiums (but not Part B premiums) owed by certain disabled beneficiaries who have returned to work. (Note that few enroll in this program due to other Medicaid benefits available to disabled workers.)
New Hampshire doesn’t count – or it ‘disregards’ – the first $13 of an applicant’s unearned income (e.g. Social Security or pensions) when determining their eligibility for an MSP, Medicaid for the aged, blind and disabled or Long Term Services and Supports (LTSS) programs.
MSP asset limits: The asset limits for QMB, SLMB and SLMB135 are $7,860 if single and $11,800 if married. QDWI’s asset limit is $4,000 if living alone and $6,000 if living with one other person.
Who's eligible for Medicaid for the aged, blind and disabled in New Hampshire?
Medicare covers a great number services – including hospitalization, physician services, and prescription drugs – but Original Medicare doesn’t cover important services like vision and dental benefits.
Some beneficiaries – those whose incomes make them eligible for Medicaid – can receive coverage for those additional services if they’re enrolled in regular Medicaid benefits for the aged, blind and disabled.
In New Hampshire, Medicaid for the aged, blind and disabled has different names depending on who is applying:
- Age 65 or older – Old Age Assistance (OAA)
- Disabled (age 18 to 64) – Aid to the Permanently and Totally Disabled (APTD)
- Blind (any age) – Aid to Needy Blind (ANB)
Income eligibility: The income limit is $797 a month if single, $1,176 a month if married, and $1,555 a month for a three person household.
Asset limits: The asset limit is $1,500 for households of any size. Applicants who have slightly higher assets – up to $2,500 for a one person household and $4,000 for a two person household – can enroll in the Medicaid spend-down (which is described below).
New Hampshire’s Medicaid spend-down for regular Medicaid for the aged, blind and disabled benefits and LTSS
In New Hampshire, individuals whose incomes are too high to qualify for Medicaid for the aged, blind and disabled can enroll in the Medicaid spend-down, which allows applicants to subtract incurred medical expense from their income that is counted toward the spend-down’s income limit. The Medicaid spend-down is called the In and Out Program in New Hampshire.
In New Hampshire, the Medicaid spend-down is approved in either one or six month increments – and additional coverage periods require new medical expenses to be submitted.
Income eligibility: The income limit is $591 a month if single and $675 a month if married. (This is equal to 58 percent of the federal poverty level.)
Asset limits: The asset limit is $2,500 for a one person household and $4,000 for a two person household.
How does New Hampshire regulate long-term services and supports (LTSS)?
Medicare beneficiaries increasingly rely on long-term services and supports (LTSS) – or long-term care – which is mostly not covered by Medicare. In fact, 20 percent of Medicare beneficiaries who lived at home received some assistance with LTSS in 2015. Medicaid fills this gap in Medicare coverage for long-term care, but its complex eligibility rules can make qualifying for benefits difficult. What’s more – eligibility rules vary significantly from state to state.
Medicaid nursing home coverage
Income limits: The income limit is $2,349 a month if single and $4,698 a month if married (and both spouses are applying).
If only one spouse needs nursing home care, the income limit for single applicants applies – and usually only the applying spouse’s income is counted.
This income limit doesn’t mean nursing home enrollees are allowed to keep all of their income up to this limit. Instead, nursing home enrollees must pay nearly all their income toward their care, other than a small personal needs allowance (of $70 a month) and money to pay for health insurance premiums (such as Medicare Part B and Medigap).
Assets limits: The asset limit is $2,500 if single and $5,000 if married (and both spouses need Medicaid). If only one spouse has Medicaid, the other spouse can keep up to $128,640.
Home and Community Based Waiver (HCBS) services
Every state’s Medicaid program covers community-based long-term care services. Programs that pay for this care are called Home and Community-Based Services (HCBS) waivers. Enrollees continue living in the community, rather than entering a nursing home.
Income limits: The income limit is $2,349 a month if single and $4,698 a month if married (and both spouses are applying).
Spousal impoverishment protections in New Hampshire
Eligibility rules for Medicaid LTSS programs differ from other Medicaid benefits when only one spouse is applying. When this occurs, only the applying spouse’s income is counted. (Normally with Medicaid benefits, the income of both spouses is counted – regardless of who is applying.)
Spousal impoverishment rules allow spouses who don’t have Medicaid to keep a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their Medicaid spouse’s income (along with resource and housing allowances). This rule applies when one spouse needs Medicaid-covered LTSS, and the other spouse doesn’t receive any Medicaid benefits.
In New Hampshire in 2020, these spousal impoverishment rules allow community spouses to keep:
- An MMMNA that is between $2,155 and $3,216 per month.
- A Community Spouse Resource Allowance (CSRA) of between $25,728 and $128,640.
- A housing allowance of up to $646.50 a month.
Medicaid home equity limit in New Hampshire
Federal law requires states to limit eligibility for Medicaid nursing home and HCBS to applicants with a home equity interest below a specific dollar amount. In 2020, states set this home equity level based on a federal minimum of $595,000 and maximum of $893,000.
New Hampshire uses the most restrictive limit on home equity – meaning that applicants for Medicaid LTSS can’t have more than $595,000 in home equity.
Penalties for transferring assets in New Hampshire
Because long-term care is expensive, individuals can have an incentive to give away or transfer assets to make themselves eligible for Medicaid. To curb these asset transfers, federal law requires states to have a penalty period for Medicaid nursing home applicants who give away or transfer assets for less than their value. States can choose to also have a penalty period for HCBS. Medicaid will not pay for LTSS during this period.
New Hampshire has chosen to have an asset transfer penalty for nursing home care and HCBS. This penalty is based on a 60-month lookback period during which time asset transfers and gifts are prohibited.
The penalty period’s length is calculated by dividing the amount of money transferred or given away by the monthly cost of nursing home care (about $10,750 in New Hampshire in 2020).
Estate recovery in New Hampshire
A state’s Medicaid agency is required to recover the cost of long-term care benefits received beginning at the age of 55 after an enrollee dies. States can choose to also pursue estate recovery for the cost of other Medicaid services (and for enrollees who did not receive LTSS).
New Hampshire has chosen to recover the cost of all Medicaid benefits received beginning at the age of 55. This means it will pursue estate recovery against enrollees who received Medicaid coverage for routine medical care or a hospitalization. Estate recovery applies to Medicaid expansion enrollees in New Hampshire.
When coverage was administered by an insurer, the state will attempt to recover what it paid the insurer. That means the estate recovery amount could be more (or less) than the actual cost of Medicaid services received.
New Hampshire will not pursue estate recovery if a Medicaid enrollee is survived by a spouse or a child who is under 21 or disabled. The state may also grant a hardship exemption from estate recovery under certain circumstances.
The estate recovery programs in every state attempt to recover from assets that are subject to a will (which is known as the ‘probate estate’). But in New Hampshire, estate recovery also applies to assets passing outside of probate. This means the state will attempt to recover from assets held in joint tenancy, life estates, living trusts and accounts with ‘transfer-on-death’ provisions.
Congress exempted Medicare premiums and cost sharing from Medicaid estate recovery starting with benefits paid after December 31, 2009, but Medicaid will try to recover what it paid for MSP benefits through that date.
Where can Medicare beneficiaries get help in New Hampshire?
New Hampshire State Health and Insurance Assistance Program (SHIP)
Free volunteer Medicare counseling is available by contacting the New Hampshire State Health and Insurance Assistance Program (SHIP) at 1-866-634-9412.
The SHIP can help beneficiaries enroll in Medicare, compare and change Medicare Advantage and Part D plans, and answer questions about state Medigap protections. SHIP counselors may also be able to offer referrals to local agencies for services like home care and long-term care. This brochure has more information about the services the SHIP offers.
Elder Law Attorneys
Elder law attorneys can help individuals plan for Medicaid long-term care benefits. The National Academy of Elder Law Attorneys (NAELA) has a search feature beneficiaries can use to find an elder attorney locally.
This brochure contains other resources for seniors and individuals with disabilities in New Hampshire.
New Hampshire Area Agencies on Aging (AAAs)
Medicare beneficiaries in New Hampshire can also receive assistance from an Area Agency on Aging (AAA). These organizations provide help accessing benefits and services that help with aging or living with a disability. This is a list of AAAs throughout the state.
Where can I apply for Medicaid in New Hampshire?
Medicaid is administered by the Department of Health and Human Services (DHHS) in New Hampshire. The DHHS website contains information about applying for Medicaid. Medicaid has a customer service phone number: (800) 852-3345, ext. 4344.
Josh Schultz has a strong background in Medicare and the Affordable Care Act. He coordinated a Medicare technical assistance contract at the Medicare Rights Center in New York City, and represented clients in extensive Medicare claims and appeals. In addition to advocacy work, Josh helped implement federal and state health insurance exchanges at the technology firm hCentive. He has also held consulting roles, including at Sachs Policy Group, where he worked on Medicare and related Medicaid client projects.