NH Ryan White CARE Insurance Program
The NH CARE Insurance Program provides health insurance coverage and co-pays for people living with HIV (PLWH) and who meet the program guidelines. This is funded by Part B of the Ryan White HIV/AIDS Program by the Health Resources and Services Administration. The program
Insurance Enrollment
Insurance Enrollment
ALL clients, regardless of whether they change their plan or not, should contact American Exchange (AE) during open enrollment.
Important Open Enrollment Deadlines - for coverage to begin on January 1st
- Affordable Care Act (ACA) Marketplace: November 1st - December 15th
- Medicare: October 15th - December 7th
Health Insurance Benefits
Delivery of health insurance benefits paid by NH CARE is coordinated with American Exchange (AE Insurance LLC).
American Exchange is a third-party benefits manager contracted with the NH CARE Program to support the health insurance program as well as medical and dental claims processing, and support clients to ensure success.
American Exchange can act as an authorized broker to assist clients to maintain insurance coverage.
They offer a dedicated NH CARE Call Center and an online webpage for secure file uploads making it easier for NH CARE to receive and process plan payments.
Clients and providers may contact American Exchange for all insurance premium and billing related questions:
- Email Customer Success General Inbox: nhcares@americanexchange.com
- Dedicated Customer Success Line (Toll Free): 888-507-5102
- Fax: 423-567-1075
NH CARE Insurance Benefits
What services are covered?
The NH CARE Program pays for continued health insurance and cost-sharing support toward outpatient medical services for HIV healthcare for clients enrolled in the NH CARE Program. This includes related office visits, labs and diagnostic testing.
Clients must be actively enrolled in the NH CARE Program and NH AIDS Drug Assistance Program (ADAP).
How does it work?
The use of NH CARE program dollars to pay medical and dental fees on behalf of clients, supports continued access to covered services while saving money for the NH CARE Program.
Clients may enroll with the program to cover insurance monthly premiums, to maintain a health plan, to cover medical co-payments, or cover the full cost of a visit when under-insured or without insurance.
We assist clients to enroll in all available public and private insurance plans, including the ACA Marketplace, Medicare, and Medicaid. When these programs are not an option, plan premiums, office visit deductibles and co-payments may be covered.
The NH CARE Program is a payer of last resort. Clients enrolled in the NH CARE Program are required to apply for NH Medicaid yearly.
Although the NH CARE Program is the payer of last resort, claim payment is not based solely on diagnosis codes. The NH CARE Program has an internal process for reviewing prior authorization decisions. In NH, we look at the client’s whole health system and are generous with what the program can afford for each client, as it relates to medical and dental care. Exceptions are considered for outpatient ambulatory services when our funding can support it.
What if I have other insurance, Medicare and Medicaid?
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The client’s primary insurance is always billed first.
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The NH CARE Program is billed as secondary and covers co-pays and deductibles.
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When applicable, the NH CARE Program pays co-insurance before paying the full amount of a bill.
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Therefore, if a client has primary health insurance through another plan, that coverage must be billed first.
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The NH CARE Program will cover the portion not covered by the insurance plan (secondary payer).
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NH CARE does not pay Medicaid co-payments, but evaluates paying a Medicaid claim when a Medicaid Prior Authorization is denied.
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Veterans may qualify for NH CARE Program services, including prescription drugs, even if they have health insurance coverage through Veterans (VA) or other benefits.
What if I have no insurance and am not eligible for Medicaid?
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Client who have no other form of insurance are referred to as "Full Pay" and the NH CARE Program is their only source of medical financial assistance.
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Outpatient medical services are reimbursed at current NH Medicaid rates, and are only covered through a NH CARE contracted provider.
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For more information about contracted providers, and a full list of current providers, visit the Contracted Provider webpage.
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What is the insurance premium coverage?
The NH CARE Program pays for insurance plan premiums through the ACA Marketplace, COBRA, some private plans, Medicare Part D prescription plans, and Medicare supplemental plans.
Insurance plans that do not cover prescriptions are not covered.
What dental services are covered?
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The NH CARE Program has a list of contracted dental providers who agree to see our enrolled NH CARE clients, and accept NH CARE payment according to our fee schedule.
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The NH CARE Program requests an in advance phone call, from the dental provider, for any procedure over $800.00.
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Please contact the NH CARE Program to view the current dental fee schedule, or call Patty Chandler at 603-271-0560.
What services are NOT covered?
The NH CARE Program does not pay for:
- inpatient hospital or surgical bills,
- emergency room visits,
- urgent care visits,
- cosmetic dentistry,
- plastic surgery, or
- eyeglasses.
The NH CARE Program does not cover NH Medicaid or dental co-pays.
What are the preferred ACA marketplace insurance plans?
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Each year, the NH CARE Program examines plans and determines which plans provide the greatest coverage, while controlling cost.
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Ambetter Silver remains our preferred plan due to the broad NH provider network and preferred drug list with the widest choice of covered ART medications.
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The NH CARE Program does offer alternate plans based on client needs.
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For more information, contact the NH CARE Program at 603-271-4502.