TABLE OF CONTENTS
New Mexico has several health insurance options. These options include Medicaid, government-funded health plans for children, and the Health Insurance Marketplace. This guide to New Mexico health insurance covers the following topics:
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. After providing your name, address, and other details, you’ll be able to search for plans offered by five insurers: True Health New Mexico, Ambetter by Western Sky Community Care, Blue Cross and Blue Shield of New Mexico, Molina Healthcare, and Friday Health Plans.
When you view a plan, you’ll be able to see the monthly premium and the annual deductible. In many cases, you can download a plan document that details how much you can expect to pay for certain services, such as primary care, durable medical equipment, mental health care, laboratory tests, and radiology services. HealthCare.gov also has a plan comparison tool.
To enroll in a plan via the Health Insurance Marketplace, you must provide the name and birth date of everyone in your household. You must also provide information about your income to help determine if you qualify for a tax credit to help pay your monthly premiums, so make sure you have pay stubs, W-2 forms, and other financial documents on hand when you’re ready to apply. The last step in the process is choosing a plan and completing the enrollment process.
Shopping for a family plan is a little more complicated than choosing an individual plan, as you’ll have to consider the health needs of multiple people. If you have a spouse or dependent with a chronic medical condition, for example, you might prioritize finding a plan with a low annual deductible over purchasing the plan with the lowest monthly premium. You may also have to look for a plan that has a comprehensive network of specialists to ensure your family member gets the right care at the right time.
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 the 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, for example. The more expensive plan may also give you access to more specialists or better coverage for your prescriptions. Blue Cross and Blue Shield of New Mexico, True Health New Mexico, and Friday Health Plans all offer individual insurance plans in New Mexico.
Budget is also an important consideration for families, especially when it comes to comparing plans based on their deductibles. Many plans have an individual deductible and a family deductible, meaning you need to shop carefully when purchasing insurance for multiple people. The individual deductible applies to each person covered by the plan, and 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.
Since everyone has different health care needs, family insurance can be complex. When you shop for yourself, you only need to think about your own health history. If you need coverage for a spouse or a child, 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. Therefore, you need to 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. Friday Health Plans, True Health New Mexico, and Blue Cross and Blue Shield of New Mexico all sell family plans to New Mexico consumers.
The cost of health insurance in New Mexico depends on which type of plan you choose. If you shop the Health Insurance Marketplace, you’ll be able to choose a Bronze, Silver, Gold, or Platinum plan. The plan name corresponds to the amount of the monthly premium, with Bronze plans costing the least and Platinum plans costing the most.
In 2021, the most affordable Bronze plan in New Mexico costs $236 per month, which is lower than four years ago in 2018. The premium for this type of plan is so low because Bronze plans only pay for about 60% of your covered costs, meaning you’d have to pay the other 40%. If you’re healthy, choosing a Bronze plan can help you get basic coverage at an affordable price. Silver plans cost a little more than Bronze plans, but they also pay a larger percentage of your covered costs, around 70%. In 2021, the most affordable Silver plan in New Mexico costs $328.
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 cost more than Bronze or Silver plans, but they also cover about 80% of your covered costs. As of 2021, the most affordable Gold plan in New Mexico costs $324, which is also cheaper than four years ago. Platinum plans offer the best coverage at the highest monthly cost. Many Platinum plans pay for 90% of your covered costs, leaving you to pay just 10% out of your own pocket. Gold and Platinum plans have lower deductibles than Bronze and Silver plans, meaning you don’t have to wait as long for your insurer to start covering your care.
|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 covers a variety of health care services, including laboratory tests, X-rays, hospital care, family planning, and home health. For regular Medicaid, New Mexico has a monthly income limit of $794 per month for a single applicant and $1,191 per month for a married couple. The limit increases to $2,382 per month for a single person and $4,764 per month for a married couple if you’re applying for institutional Medicaid or a Medicaid waiver program.
Your Medicaid eligibility also depends on the value of your countable resources, including cash, bonds, stocks, certificates of deposit, and money in a checking or savings account. In New Mexico, the resource limit for regular Medicaid is $2,000 for single individuals and $3,000 for married couples. The limit increases to $4,000 per married couple if both spouses are applying for institutional Medicaid or a Medicaid waiver. If only one spouse is applying for institutional Medicaid or a Medicaid waiver, the applicant is allowed to have $2,000 in countable resources, and the non-applicant spouse is allowed to have up to $130,380 in countable resources.
Medicaid is available to low-income residents who meet at least one of the following criteria:
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 the age of 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.
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:
Original Medicare is the basic form of Medicare managed by the federal government. It pays for hospital care, preventive services, durable medical equipment, and other medical services. Medicare Advantage Plans are sold by private insurance companies. Although they must offer at least the same coverage as Original Medicare, Medicare Advantage Plans often cover extra services, giving you more for your money.
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.
New Mexico has strict laws regarding the availability of short-term health insurance plans. If you buy one of these plans, the coverage is only good for three months. You can’t renew the plan and you can’t purchase a plan if you had short-term coverage within the previous 12 months. New Mexico also requires short-term plans to cover the following services:
Because the standards are so strict, none of New Mexico’s insurance companies offer short-term plans at this time.
The Affordable Care Act had an individual mandate requiring all Americans to obtain health insurance or pay a tax penalty, but that mandate was repealed in 2019, so health insurance is no longer required at the federal level. Some states have their own mandates, but New Mexico isn’t one of them. Therefore, New Mexico residents aren’t required to have health insurance.
You don’t have to use the Healthcare 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 Healthcare Marketplace.
New Mexico has several health care sharing plans available. These plans require members to pay a monthly share amount and an annual amount for their own expenses. As a result, members share their medical expenses rather than paying high monthly premiums to an insurance company. Health care sharing plans are less expensive than traditional health insurance, but they aren’t required to cover pre-existing conditions, so they’re usually best for people in good health.
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.
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, so it’s best to have health insurance even if you have short-term disability coverage.
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.
PIP is a type of auto insurance that covers accident-related medical expenses and may replace some of your lost income if you’re unable to work due to an auto accident. Whether you have health insurance doesn’t really matter for the purposes of determining if you need PIP. If you’re not sure if you need PIP coverage, contact your auto insurer for more information.
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.