Urgent Care Centers Or Facilities
CoveredWhat this is:
Your Cost
- In-Network$45
- Out-of-Network$45
A copay is a flat dollar amount you pay per visit. Coinsurance is a percentage of the cost you pay after meeting your deductible.
Back to 2025 New Hampshire plans
New Hampshire · 2025
WellSense Clarity NH Gold 1500 + $0 Rx List + 24/7 Nurse Advice
WellSense Health Plan
Premium & Pricing
Your price depends on you.
Marketplace premiums are personalized based on your age, household size, income, tobacco use, and zip code. Most households qualify for a premium tax credit that lowers the monthly cost — often by a lot.
Share a few details and we'll show you the real monthly price for this plan, including any subsidy you're eligible for.
Get my personalized priceDeductibles
The most you'll have to pay for covered services in a plan year. Once you reach this amount, the plan pays 100% of covered services for the rest of the year. Premiums and out-of-network charges don't count toward this limit.
Combined Medical and Drug EHB Deductible
In-Network · Individual
$1,500
Maximum Out-of-Pocket
The most you'll have to pay for covered services in a plan year. Once you reach this amount, the plan pays 100% of covered services for the rest of the year. Premiums and out-of-network charges don't count toward this limit.
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total)
In-Network · Individual
$7,800
Plan Classification
- Metal Level
- Gold
- Plan Type
- HMO
- Market
- Individual
- HSA Eligible
- No
- Simple Choice
- No
Bronze, Silver, Gold, and Platinum plans balance monthly premiums against out-of-pocket costs. Higher metal levels cost more per month but pay more of your care.
HMO, PPO, EPO, POS, and Indemnity plans differ in how they handle networks and referrals. PPOs and POS plans give you more freedom; HMOs and EPOs trade flexibility for lower costs.
Individual plans are bought directly by consumers. SHOP plans are offered through small employers.
If Yes, you can pair this plan with a Health Savings Account to set aside pre-tax money for medical expenses.
Simple Choice (Standardized) plans follow a common cost-sharing template defined by CMS, making it easier to compare plans side by side.
Sample Bill Estimates
Sample bill estimates are not available for this plan.
Covered Benefits
A sampling of the benefits this plan covers, what they mean, and what you'll pay. The full list of covered services is in the plan's Summary of Benefits.
Mental/Behavioral Health Outpatient Services
CoveredWhat this is:
Your Cost
- In-Network$30
- Out-of-NetworkNot Covered
A copay is a flat dollar amount you pay per visit. Coinsurance is a percentage of the cost you pay after meeting your deductible.
Specialist Visit
CoveredWhat this is:
Your Cost
- In-Network$60
- Out-of-NetworkNot Covered
A copay is a flat dollar amount you pay per visit. Coinsurance is a percentage of the cost you pay after meeting your deductible.
Emergency Room Services
CoveredWhat this is:
Your Cost
- In-Network25% Coinsurance after deductible
- Out-of-Network25% Coinsurance after deductible
A copay is a flat dollar amount you pay per visit. Coinsurance is a percentage of the cost you pay after meeting your deductible.
Generic Drugs
CoveredWhat this is:
Your Cost
- In-Network$15
- Out-of-NetworkNot Covered
A copay is a flat dollar amount you pay per visit. Coinsurance is a percentage of the cost you pay after meeting your deductible.
Mental/Behavioral Health Inpatient Services
CoveredWhat this is:
Your Cost
- In-Network25% Coinsurance after deductible
- Out-of-NetworkNot Covered
A copay is a flat dollar amount you pay per visit. Coinsurance is a percentage of the cost you pay after meeting your deductible.
Primary Care Visit to Treat an Injury or Illness
CoveredWhat this is:
Your Cost
- In-Network$30
- Out-of-NetworkNot Covered
A copay is a flat dollar amount you pay per visit. Coinsurance is a percentage of the cost you pay after meeting your deductible.
Quality Rating
- Overall (2025)
- New-Ineligible for Scoring
- Clinical Quality Management
- Not Rated
- Enrollee Experience
- Not Rated
- Plan Efficiency
- Not Rated
CMS combines member experience, clinical quality, and plan efficiency into a single 5-star overall rating. Higher is better.
Measures how well the plan helps members get recommended care — things like preventive screenings, chronic disease management, and behavioral health follow-ups.
Reflects surveyed members' experience with their plan and providers — access to care, customer service, and overall satisfaction.
Measures how efficiently the plan delivers care — use of appropriate services, avoiding unnecessary hospitalizations, and network stability.
Network & Access
- National Network
- No
- Specialist Referral Required
- No
A Yes means you have in-network coverage when traveling outside your state. Most Marketplace plans are regional only.
When Yes, you must see a primary care provider first for a referral before the plan covers specialist visits.
Disease Management Programs
Free programs to help members manage specific chronic conditions. They typically include nurse coaching, medication support, and educational resources.
No disease management programs are listed for this plan.
Prescription Drug Benefits
- 90-Day Mail Order
- No
When Yes, you can get a 90-day supply of maintenance medications delivered by mail — usually cheaper than filling three 30-day prescriptions at a retail pharmacy.
Eligibility & Coverage Rules
- Maximum Child Age
- 26
- Covers Non-Hyde Abortion Services
- No
- Currently Available
- Yes
The oldest a dependent child can be and still stay on this plan. The ACA generally allows coverage up to age 26.
Indicates whether the plan covers abortion services beyond the narrow exceptions (rape, incest, life of the mother) allowed under the Hyde Amendment.
Whether this plan is currently open to new enrollment. Some plans are shown for informational purposes only.
Issuer Information
- Issuer
- WellSense Health Plan
- Licensed State
- NH
The insurance company that underwrites and administers this plan. You'll deal with them for ID cards, claims, and customer service.
The state in which the issuer is licensed to sell this product.