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New Mexico has several health insurance options. You can enroll in your employer’s plan or sign up for Medicare or Medicaid (if you qualify). There are government-funded health plans for children, direct plans from insurance companies, or you could use the Health Insurance Marketplace for Affordable Care Act options.
This guide explains your New Mexico health insurance options in detail.
Like many states, New Mexico uses the federal Health Insurance Marketplace. If you’d like to purchase a plan from the exchange, visit HealthCare.gov to create an account.
Once you have an account, you can apply for health insurance. The Health Insurance Marketplace checks your eligibility for Medicaid and uses the information you provide to determine if you qualify for an Advanced Premium Tax Credit. Make sure you have the full name, birth date, and Social Security number of every person in your family who needs coverage before you start the application process.
The application will ask you several questions related to your income and family, including the following:
After entering the required information, you’ll be able to view a list of available plans, including monthly premiums, annual deductibles, and coinsurance requirements. HealthCare.gov also allows you to make side-by-side comparisons of up to three plans at a time. Once you pick a plan, you’ll be able to complete the enrollment process.
The following insurance companies offer health insurance plans to New Mexico residents in the Marketplace::
There are some important considerations when shopping for individual coverage, whether for yourself or multiple people. These considerations include:
When shopping for an individual plan, your budget and your overall health are the two most important factors to consider. For most plans, the monthly premium isn’t your only out-of-pocket cost. You also have to think about the deductible, the copay for each service, and the coinsurance requirements.
If you’re in good health and don’t plan to use your insurance often, you may save the most money by enrolling in the plan with the lowest premium. You’ll be covered in the event of a sudden illness or injury, but you won’t have to worry about paying a high premium each month.
If you have a chronic health condition, however, you need to weigh the low premium against other out-of-pocket costs. A plan that costs $350 per month and has a $500 deductible may be a better fit for your financial needs than a plan that costs $250 per month and has a $5,000 deductible if you require regular medical care. A more expensive plan may also give you access to more specialists or better coverage for your prescriptions.
If you need coverage for multiple people, you need to think about how each person might use the plan. A spouse may need maternity care or fertility services, while a child might need to be covered for a tonsillectomy or other common childhood procedure. Review the plan details carefully to make sure the services you need are covered. If someone in your family receives specialty care, you should also check to make sure the specialist participates in the plan’s network.
Another consideration for family plans is that many plans have an individual deductible and a family deductible. An individual deductible applies to each person covered by the plan, while the family deductible applies to the entire family. If one of your family members is hospitalized or undergoes an expensive surgery, it’s possible to meet the family deductible before every person on the plan has met their individual deductible.
The cost of health insurance in New Mexico depends on which type of plan you choose. If you shop via the Health Insurance Marketplace, you’ll be able to choose a bronze, silver, gold, or platinum plan..
|Average Premiums in New Mexico||2018||2019||2020||2021|
|Most affordable Bronze plan||$271||$250||$257||$236|
|Most affordable Silver plan||$401||$347||$326||$328|
|Most affordable Gold plan||$347||$357||$342||$324|
New Mexico has several types of health insurance available for low-income individuals and families, including Medicaid, New MexiKids, and New MexiTeens. Your eligibility depends on how many people live in your household, your total monthly income, and the value of your countable assets.
Medicaid is available to low-income residents who meet at least one of the following criteria:
Medicaid covers a variety of health care services, including laboratory tests, X-rays, hospital care, family planning, and home health. Your eligibility for Medicaid is dependent upon income limits, including resources such as cash, bonds, stocks, certificates of deposit, and money in a checking or savings account.
Regular Medicaid income/resource limits:
Institutional Medicaid or Medicaid waiver program income/resource limits:
New MexiKids is part of the Children’s Health Insurance Program (CHIP). Coverage is available to children under the age of 18 or primary caregivers who have at least one child under 18. To qualify, a child must be uninsured and ineligible for Medicaid coverage. New MexiKids has higher income limits than Medicaid, from $30,268 per year for a household of one to $104,951 for a household of eight. New MexiKids covers routine checkups, prescriptions, emergency care, and other medical services.
New Mexico has several Medicare options available to older adults and people with disabilities.
If you choose Original Medicare, you can also purchase supplemental plans to extend your coverage. Medicare Part D covers prescription medications, while Medicare Supplement Insurance (Medigap) covers deductibles, copays, and other out-of-pocket Medicare costs. If you have questions about Medicare, contact your local Area Agency on Aging or the New Mexico Aging & Long-Term Services Department.
To qualify for Medicare, you must be at least 65 years old or have a qualifying disability. In most cases, a qualifying disability is a condition that makes you eligible for at least 24 months’ worth of payments from the Social Security Disability Insurance program. You may be able to qualify sooner if you have end-stage renal disease or amyotrophic lateral sclerosis (Lou Gehrig’s disease).
If you start receiving your Social Security or Railroad Retirement Board benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:
Due to New Mexico’s strict laws regarding short-term health insurance plans, no insurance companies offer short-term plans in the state.
Does New Mexico require health insurance?
No, New Mexico residents aren’t required to have health insurance. At the federal level, the Affordable Care Act’s individual mandate requiring all Americans to obtain health insurance or pay a tax penalty was repealed in 2019.
Do I have to use the Health Insurance Marketplace in New Mexico?
You don’t have to use the Health Insurance Marketplace if you want to purchase a private health plan from one of New Mexico’s insurance companies. If you’re interested in getting a tax credit to help pay for your health insurance, however, you must apply for coverage via the marketplace.
What types of alternative health insurance plans are available in New Mexico?
New Mexico has several health care sharing plans available. Members share medical expenses rather than paying monthly premiums to an insurance company. Health care sharing plans are less expensive than traditional health insurance, but aren’t required to cover pre-existing conditions, so these plans are usually best if you’re in good health.
Do I need health insurance if I have an HSA/FSA?
It’s a good idea to have health insurance even if you have an HSA or FSA. The HSA contribution limit for 2021 is only $3,600 for individuals and $7,200 for families, while FSA contributions are capped at $2,750. That sounds like a lot of money, but the average cost of a three-day hospital stay is about $30,000, which far exceeds the annual HSA and FSA contribution limits.
Do I need short-term disability coverage in New Mexico if I have health insurance?
Short-term disability insurance replaces some of your income if you’re unable to work due to a temporary disability. Some plans only pay 60% to 70% of your base pay, which wouldn’t be enough to cover a hospital stay or an expensive trip to the emergency room. It’s best to have health insurance even if you have short-term disability coverage.
Do I need long-term disability coverage in New Mexico if I have health insurance?
Long-term disability replaces 50% to 70% of your income if you’re unable to work due to a non-work-related injury. LTD coverage can be used on its own or in combination with short-term disability. Because LTD insurance replaces only part of your income, you should have health insurance even if you have an LTD policy. Otherwise, you might not be able to afford any medical expenses incurred while you’re not working.
What does New MexiKids cover?
New MexiKids covers preventive care, hospital care, vision and hearing exams, prescription drugs, and dental care. Some beneficiaries receive care at no cost, while others have to pay a copay for each service. Out-of-pocket costs vary based on your household income.