New Hampshire is operating its statewide health insurance exchange through a partnership with the federal government. After the launch of the exchange in 2014, the state over the years saw many carriers exiting the exchange (Community Health Options, Time/Assurant, Minuteman Health) with only Anthem, Ambetter from NH Healthy Families, and Harvard Pilgrim Health Care choosing to stay and offer plans for 2021. New Hampshire's individual health insurance marketplace continues to witness decline in its premiums thanks to the state's new reinsurance program. The state shifted Medicaid recipients off exchange plans and into managed Medicaid in January 2019. Anthem controls the exchange and commercial market share, while UnitedHealthcare dominates the Medicare Advantage market.