New Hampshire’s individual health insurance market has remained stable in 2026, defying national trends following the expiration of enhanced federal premium tax credits, according to data released February 25th. While other states grappled with potential enrollment declines and market disruption, New Hampshire’s participation levels have not only held steady but have exceeded those of 2024.
The state’s success is largely attributed to a long-term strategy centered on affordability and a state-based reinsurance program initially implemented in 2020. This program was designed to address the highest-cost claims, thereby stabilizing the risk pool and lowering premiums without relying on ongoing federal subsidies or mandates.
The groundwork for the reinsurance program was laid in 2017 and 2018, when then-Insurance Commissioner Roger Sevigny spearheaded the initiative. The program gained federal approval and was a collaborative effort across multiple administrations, including current Insurance Commissioner D.J. Bettencourt, who served as policy director for Governor Chris Sununu during its development.
Reinsurance functions as a financial safety net for insurance companies. By covering a portion of exceptionally high medical claims, the program reduces financial risk for insurers, enabling them to offer more competitive premiums. The New Hampshire Health Plan is responsible for administering the program, which commenced operation on January 1, 2021.
The reinsurance program’s origins trace back to 2019, when the New Hampshire Legislature amended state statutes to allow the Insurance Commissioner, with the support of actuarial experts, to propose a risk-sharing or reinsurance program to support the affordability of the individual insurance market. Following a report from his actuarial experts, the Insurance Commissioner issued an order in February 2020 requiring the New Hampshire Health Plan to assess and develop a reinsurance program utilizing federal funding through a Section 1332 State Innovation Waiver – also known as a State Relief and Empowerment Waiver – under the Affordable Care Act.
A public forum regarding the Section 1332 Waiver and the Reinsurance Program was held on June 11, 2025, as required by federal regulations. The New Hampshire Health Plan will hold its next annual public forum on the state’s health insurance reinsurance program at a date to be determined.
