New Mexico Health Insurance: Find Affordable Plans

New Mexico has several affordable 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.

• Marketplace plans: In New Mexico, you can buy a private insurance plan if you’re self-employed, your employer doesn’t offer group coverage, your employer’s plan doesn’t meet your needs, or if the plan doesn’t cover your spouse or dependents.
• Open enrollment: New Mexico open enrollment runs from November 1 to January 15. If you miss Open Enrollment, you can’t buy a marketplace plan until the next year unless you qualify for a Special Enrollment Period.
• Special enrollment: You may qualify for a special enrollment period if you have experienced a qualified life event (QLE) that caused you to lose coverage, if you need to make changes to your current plan (due to a life change such as getting married, having a child, or getting divorced), or if you have had a change in eligibility for Medicare or Medicaid. You have 60 days from the time of the event to sign up for a new plan or make changes to your current plan.
• Health Insurance Marketplace: New Mexico uses the federal Health Insurance Marketplace. If you’re interested in getting an Advanced Premium Tax Credit to help cover your costs, it’s best to use the exchange to purchase a plan.
• Premium tax credit: If you don’t qualify for an Advanced Premium Tax Credit (or don’t want to take the credit), you can buy one directly from a New Mexico insurance company.
• Coverage types: In 2019, 9.8% of New Mexicans were uninsured. Another 36.6% had coverage through their employers, 32.7% were covered by Medicaid, and 15% were covered by Medicare. The rest had military health insurance or non-group plans.

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:

• Are you single or married?
• How many tax dependents will you claim on your current return?
• How much income will your household make this year?
• Do you want to see if you can get help paying for coverage?

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:

• Ambetter by Western Sky Community Care
• Blue Cross and Blue Shield of New Mexico
• Molina Healthcare
• Presbyterian Health Plan

There are some important considerations when shopping for individual coverage, whether for yourself or multiple people. These considerations include:

• Medical needs
• Preferred plan type
• Premium affordability
• Individual vs. family deductibles

Insurance for individuals in New Mexico

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.

There are different types of plans you can choose from:

• A Health Maintenance Organization plan (HMO) offers the best choice if you don’t make many visits to a doctor or a specialist or require prescriptions. It has lower monthly premiums and higher deductibles. HMO plans are the least expensive plans. However, there are restrictions with an HMO plan. You’ll need to get a referral if you want to see a specialist, you’ll need to name a primary care physician, and you’re limited to using the HMO plan’s in-network medical providers.
• A Preferred Provider Organization (PPO) plan is a better idea if you regularly visit doctors or specialists. You’ll have more flexibility with a PPO plan, although you’ll pay more for it. You aren’t limited to in-network providers, you don’t need to name a primary care physician, and you’ll never need to obtain a referral to see a specialist.
• A Point of Service Plan (POS) is a hybrid of an HMO and a PPO. You can use out-of-network providers, but any time you want to see a specialist, you’ll need to get a referral.

Insurance for families in New Mexico

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 https://www.healthcare.gov/choose-a-plan/plans-categories/.

• Bronze plans have the lowest monthly premiums, but also have higher deductibles and only pay 60% of covered medical costs. If you don’t have a chronic health condition and only want coverage for emergencies, a Bronze plan gives you basic coverage at an affordable price. In 2023, the most affordable Bronze plan in New Mexico costs $357 per month.
• Silver
• plans have higher premiums than Bronze plans but also have lower deductibles and coinsurance requirements. The plans pay around 70% of your covered costs. In 2023, the most affordable Silver plan in New Mexico costs $429.
• Gold and Platinum plans have the highest monthly premiums but also have lower deductibles and insurance requirements. If you have a chronic health condition, you may want to spend a little more per month to get a plan that gives you extra coverage. Gold plans generally cost more than Bronze or Silver plans, but also cover about 80% of your covered costs (90% for a Platinum plan). As of 2023, the most affordable Gold plan in New Mexico costs $353.

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 in New Mexico

Medicaid is available to low-income residents who meet at least one of the following criteria:

• At least 65 years old
• Pregnant
• Responsible for a minor child
• Have a disability
• Have a household member with a disability

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.

New MexiKids in New Mexico

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 $31,937 per year for a household of one to $109,581 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.

• Original Medicare
• is the basic form of Medicare managed by the federal government. It consists of Part A (inpatient care), and Part B (preventive care and outpatient medical services). It pays for hospital care, preventive services, durable medical equipment, and other medical services, but does not cover prescriptions. Supplemental plans are available to help with prescription costs – these plans are known as Medicare Part D. The Medicare Part A deductible for inpatient hospital stays is $1,600 in 2023. Medicare Part B enrollees pay a standard monthly premium of $226 for 2023.
• Medicare Advantage Plans are sold by private insurance companies. Although plans must offer at least the same coverage as Original Medicare, Medicare Advantage Plans often cover extra services such as prescription medications, dental, and vision. As of 2023, there are 72 Medicare Advantage Plans available in the state, however, you can only select a plan that’s available in your county.

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.

Eligibility

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 of payments from the Social Security Disability Insurance program or Railroad Retirement Board. You may be able to qualify sooner if you have end-stage renal disease or amyotrophic lateral sclerosis (Lou Gehrig’s disease).

Enrollment

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:

• Initial enrollment: Your initial enrollment period starts three months before your 65th birthday and ends three months after your 65th birthday. If you’ve never had Medicare, you can enroll during this period. If you started receiving Medicare when you were younger, you can also make changes to your plan.
• General enrollment: Choose this enrollment period if you missed your initial enrollment period. The Medicare general enrollment period is January 1 to March 31. You can choose Original Medicare, Medicare Advantage, Medigap, or Part D.
• Medicare Advantage open enrollment: You can make changes to your Medicare Part C, also known as Medicare Advantage, from January 1 to March 31.
• Open enrollment: You can join, switch plans, or drop your coverage from October 15 to December 7 each year.
• Special enrollment periods: You may qualify for a special enrollment period if you lose your coverage or have changes to your eligibility outside the regular enrollment periods.

Medicare Resources

New Mexico’s State Health Insurance Assistance Program (SHIP) can provide you with free assistance understanding your Medicare options, can help you find a Medicare Advantage plan that suits your needs, or give you information about available financial assistance programs. You can visit the SHIP website or call 800-432-2080 for assistance.

Due to New Mexico’s strict laws regarding short-term health insurance plans, no insurance companies offer short-term plans in the state.

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