With its two million residents, New Mexico has one of the smallest populations of a U.S. state.1 Still, the Land of Enchantment offers residents the full range of health insurance options: employer-provided plans; Affordable Care Act (ACA) individual and family plans purchased through the federal Health Insurance Marketplace; and plans bought directly from insurance companies. New Mexicans can also get healthcare coverage through government-assisted programs such as Medicare, Medicaid and the Children’s Health Insurance Program (CHIP), if they qualify.
More than one-third of New Mexico’s residents get their coverage through their work, and another third receive it through Medicaid. Medicare, the federal government’s health insurance for Americans over 65, covers one in seven people in the state, though the ACA (aka Obamacare) covers fewer than one in every 25 residents.2
New Mexico was one of the first states to expand Medicaid coverage under the ACA, starting in January 2014. Medicaid expansion helps adults 19 to 64 with incomes up to 133% of the federal poverty level (FPL) and, by November 2019, it covered an additional 268,500 New Mexicans.3 Obamacare and the state’s Medicaid expansion helped drop New Mexico’s uninsured rates from 19% in 2013 to 9% in 2018.4
Here you’ll find an overview of New Mexico’s health insurance landscape and get help navigating your options to find the plan that’s right for you.
When Is the Open Enrollment Period in New Mexico?
Each year, the Open Enrollment Period (OEP) in New Mexico runs from November 1 to December 15 for coverage that starts the following January 1. Remember to re-enroll during the OEP each year to avoid a break in coverage.
If you don’t enroll at that time, you won’t be able to apply until next year’s OEP. An exception: if you have what’s called a “qualifying life event,” which is something that changes the size of your family or leaves you uninsured, such as losing your job or adopting a child. That will trigger a short window called a Special Enrollment Period during which you can get insurance.5
Enrollment in New Mexico’s ACA Marketplace started at 32,000 in 2014, rose to a peak of nearly 55,000 in 2016, then dropped to 42,700 in 2020.6
How Do I Enroll in New Mexico’s Health Insurance Marketplace?
Under the ACA, New Mexicans can purchase coverage and possibly qualify for subsidies through the state’s Health Insurance Marketplace (also called an “exchange”), which is run through the federal government’s healthcare.gov website. Keep in mind that if you buy your coverage through a broker or agent, you will forfeit access to subsidies, which, if you qualify based on how much you earn, will help you pay your monthly premiums.
Every ACA plan must provide 10 “essential health benefits,” including things like hospital care, prescription drug coverage and preventive care.
How Much Does Marketplace Health Insurance Cost in New Mexico?
The New Mexico Marketplace organizes individual plans available on and off the Marketplace by levels of cost-sharing. These are called “metal” tiers of gold, silver and bronze. The more valuable the “metal,” the more coverage you get.
From 2018 to 2020, premiums in New Mexico for qualified bronze plans fell by about 5% and silver dropped by nearly 19%, while the cost of premiums for gold plans remained about the same. Here are the average monthly costs for a 40-year-old New Mexican for bronze, silver and gold plans sold through the state’s Marketplace:7
Average Premiums for New Mexico Marketplace Plans (for a 40-year-old person)
|Lowest-Cost Bronze Plan||$271||$250||$257|
|Lowest-Cost Silver Plan||$401||$347||$326|
|Lowest-Cost Gold Plan||$347||$354||$342|
The federal government uses a “benchmark” silver plan — the second-lowest-cost silver premium for a 40-year-old8 — to calculate subsidies. From 2018 to 2020, this benchmark has gone from $414 to $345, a decrease of nearly 17%.
Which Companies Offer Individual Health Insurance Plans in New Mexico?
In 2020, four health insurance companies sell individual policies to New Mexicans through healthcare.gov:9
- Blue Cross and Blue Shield of New Mexico
- Molina Healthcare
- New Mexico Health Connections
- True Health New Mexico
What Are My Coverage Options in New Mexico If I’m Low-Income?
ACA Marketplace Plans (Obamacare)
With an income of between one and four times the federal poverty level (FPL), you may qualify for help paying your premiums.10 In 2019, nearly eight out of 10 ACA enrollees in New Mexico received help in the form of subsidies called Advanced Premium Tax Credits (APTC).11 These monthly subsidies averaged $395.12
Here are some examples of cost savings with subsidies:
- A 28-year-old in Santa Fe who earns $24,000 a year could get a 2020 silver plan for $122 per month after subsidies.13 The same policy would cost $300 per month without the premium tax credits, which cover 59% of the cost.
- A family of three in Albuquerque with an income of $50,000 a year could pay $322 per month after subsidies for a 2020 silver plan.14 This policy would cost them $725 per month without the premium tax credits, which cover 56% of the cost.
If you earn between 100% and 250% of the FPL, purchase a silver plan on the Marketplace, and receive premium tax credits, you may also qualify for cost-sharing reductions (CSRs). These cut your out-of-pocket costs even more. In 2019, 34% of enrollees in New Mexico’s Marketplace plans received CSRs.15
By going through the Marketplace application process, you’ll find out if you qualify for Medicaid, the Children’s Health Insurance Program (CHIP) or other income-based discounts, too. You can also use the NM Health Coverage Connector.
The New Mexico Human Services Department oversees Centennial Care, which was introduced in January 2014 to replace the state’s outdated Medicaid system. Centennial Care’s services include care for physical and mental health, long-term care and community benefits, which are offered through managed care organizations (MCOs).16
These MCOs include Blue Cross Community Centennial (BCBSNM), Presbyterian Health Plan (PHP) and Western Sky Community Care (WSCC).17
New Mexico’s Centennial Care (Medicaid) program covers low-income children, pregnant women, families, adults without dependent children between ages 19 and 64, and the elderly, blind and permanently disabled.
As of April 2020, one in three New Mexicans was enrolled in Medicaid or CHIP.18 Enrollment has increased by 64% since the Affordable Care Act was implemented.19
To qualify, recipients must meet income eligibility requirements as a percentage of the federal poverty level (FPL). The percentages vary for different groups:20
- Parents: 138%
- Childless adults: 138%
- Pregnant women: 255%
- Children: 305%
- Seniors: 74%
- People with disabilities: 74%
To apply for Centennial Care online, go to the YesNM Online Portal. Here you can check your eligibility, enroll in your managed care plan or change your plan. When you use Express Eligibility to apply for Medicaid on the YesNM portal, you may get an answer in as little as 10 minutes.21
The Children’s Health Insurance Program (CHIP) was set up to cover children whose parents earn too much to qualify them for Medicaid but aren’t covered on another health plan. For children under six, the maximum family income to qualify for CHIP is between 240% and 300% of the FPL. For children ages six to 19, family income must fall between 190% and 240% of the FPL.22
New Mexico Medical Insurance Pool
If you don’t qualify for ACA coverage through beWellnm, the state’s health insurance Marketplace, or Medicaid, you will likely be able to get coverage through the New Mexico Medical Insurance Pool. Call (844) 729-7896 or visit www.nmmip.org.
What About Medicare Plans for New Mexico Seniors and People with Disabilities?
If you’re over age 65, under 65 with long-term disabilities, or have ALS or end-stage renal disease, Medicare is the federal health insurance program that helps cover your health costs.
Each year, the Open Enrollment Period for Medicare runs from October 15 through December 7. Nearly one in five New Mexicans receive Medicare benefits,23 and about 26% of those are also enrolled in Medicaid.24
Of New Mexico’s 417,000 Medicare beneficiaries, 67% choose to receive their benefits from Original Medicare (Medicare Parts A and B). The remaining beneficiaries in the state prefer private Medicare Advantage plans.25 Both types of coverage will provide you with Part A (hospital insurance) and Part B (medical insurance) so hospitalization, doctor’s visits and emergency room visits are taken care of.
Medicare Advantage (or Part C) offers additional benefits, such as Part D prescription drug coverage. (With Original Medicare, you would have to purchase a standalone Part D plan.) In 2020, eight companies in New Mexico offer Medicare Advantage plans.26
More than 285,000 New Mexicans bought a standalone Medicare Part D drug plan.27 In 2020, monthly plan premiums through nine insurers range from $13.20 to $123.10, for an average premium of $42.77.28 Among those with Part D prescription drug plans, nearly 28% received both low-income premium and cost-sharing subsidies in 2017.29
If you have Original Medicare, you can buy Medicare Supplement insurance (Medigap policy) from one of a dozen insurers in New Mexico. Medigap policies help pay the portion of your healthcare costs that Medicare doesn’t pay.
Medigap offers 10 standardized plans. Each plan’s benefits are the same no matter which insurance company you choose, but premiums vary by company. So it pays to compare pricing.
New Mexico’s Aging and Long-Term Services Department offers help through the State Health Insurance Assistance Program (SHIP). You can chat online with SHIP or call (800) 432-2080. If you can’t afford your insurance payments, ask SHIP if you qualify for one of the state’s Medicare Savings Programs: Qualified Medicare Beneficiary (QMB), Special Low-income Medicare Beneficiary (SLMB), Qualifying Individual (QI) and Qualified Disabled Working Individual (QDWI).3031
What Are My Coverage Options if I’m a Native American?
The Albuquerque Area Indian Health Service (IHS) provides health services to 27 different tribal groups across four Southwest states, including New Mexico. IHS is a federal program that delivers services through dozens of hospitals, health centers and field clinics.32 Native Americans can also seek care from Tribal 638 and Urban Health Programs (I/T/U).33
It’s worth knowing that if you decide to enroll in health coverage through the Marketplace, Centennial Care (Medicaid) or CHIP, you’d have better access to services that may not be provided by IHS. You won’t give up your IHS benefits if you sign up, and Medicaid and/or CHIP may end up saving you money.34
Can I Buy Short-Term Health Insurance in New Mexico?
For New Mexicans in transition, short-term health insurance can help fill temporary insurance gaps, such as leaving or losing your job or covering you until you turn 65, when Medicare kicks in.
In April 2019, the state passed a law that limits new short-term plans to a maximum duration of 90 days with no option to renew. That law went into effect in 2020.35
Short-term health insurance can be an affordable option in specific situations, but the plans often do not cover all of ACA’s “essential health benefits.” Check disclosures carefully to see what coverage is guaranteed by any policy you’re considering.
1. Kaiser Family Foundation. “Population Distribution by Age.” kff.org (accessed July 27, 2020).
2. Kaiser Family Foundation. “Health Insurance Coverage of the Total Population.” kff.org (accessed July 27, 2020).
3. Kaiser Family Foundation. “Status of State Medicaid Expansion Decisions: Interactive Map.” kff.org (accessed July 27, 2020).
5. U.S. Government Website for the Federal Health Insurance Marketplace. “Getting health coverage outside open enrollment.” healthcare.gov (accessed July 27, 2020).
6. Kaiser Family Foundation. “Marketplace Enrollment, 2014-2020.” kff.org (accessed July 27, 2020).
7. Kaiser Family Foundation. “Average Marketplace Premiums by Metal Tier, 2018-2020.” kff.org (accessed July 27, 2020).
9. New Mexico Human Services Department. “Choosing Health Insurance.” bewellnm.com (accessed July 27, 2020).
10. U.S. Government Website for the Federal Health Insurance Marketplace. “Federal Poverty Level (FPL).” healthcare.gov (accessed July 27, 2020).
11. Kaiser Family Foundation. “State Health Care Snapshots: New Mexico.” kff.org (accessed July 27, 2020).
12. Kaiser Family Foundation. “Estimated Total Premium Tax Credits Received by Marketplace Enrollees.” kff.org (accessed July 27, 2020).
13. Kaiser Family Foundation. “Health Insurance Marketplace Calculator.” kff.org (accessed July 27, 2020).
15. Centers for Medicare & Medicaid Services. ”Early 2019 Effectuated Enrollment Snapshot.” cms.gov (accessed July 27, 2020).
16. New Mexico Human Services Department. “Looking for Assistance.” hsd.state.nm.us (accessed July 27, 2020).
17. New Mexico Human Services Department. “Provider Frequently Asked Questions.” hsd.state.nm.us (accessed July 27, 2020).
18. U.S. Government Website for Medicaid. “April 2020 Medicaid & CHIP Enrollment Data Highlights.” medicaid.gov (accessed July 27, 2020).
19. Kaiser Family Foundation. “Total Monthly Medicaid and CHIP Enrollment.” kff.org (accessed July 27, 2020).
20. Kaiser Family Foundation. “Medicaid in New Mexico.” kff.org (accessed July 27, 2020).
21. New Mexico Human Services Department. “Welcome to YesNM.” yes.state.nm.us (accessed July 27, 2020).
22. New Mexico Human Services Department. “Medicaid Eligibility – Children Under 19.” hsd.state.nm.us (accessed July 27, 2020).
23. Kaiser Family Foundation. “Medicare Beneficiaries as a Percent of Total Population.” kff.org (accessed July 27, 2020).
26. Centers for Medicare & Medicaid Services. “Prescription Drug Coverage – General Information.” cms.gov (accessed July 27, 2020).
27. Cubanski, Juliette; Damico, Anthony and Neuman, Tricia. Medicare Part D in 2018: The Latest on Enrollment, Premiums and Cost Sharing, May 17, 2018. Kaiser Family Foundation. (accessed July 27, 2020).
30. New Mexico Aging & Long-Term Services Department. “Medicare Savings Programs.” newmexico.networkofcare.org (accessed July 27, 2020).
31. NCOA Center for Benefits Access. “Medicare Savings Programs (MSPs): Eligibility and Coverage (2020).” ncoa.org (accessed July 27, 2020).
32. U.S. Department of Health and Human Services. “Albuquerque Area.” ihs.gov (accessed July 27, 2020).
33. New Mexico Human Services Department. “Indian Health Service, Tribal 638 and Urban Indian Health Programs (I/T/Us).” hsd.state.nm.us (accessed July 27, 2020).
34. U.S. Government Website for the Federal Health Insurance Marketplace. “Health coverage for American Indians & Alaska Natives.” healthcare.gov (accessed July 27, 2020).
35. NM – HB285. (Apr. 2019). BillTrack50. Retrieved July 27, 2020, from https://www.billtrack50.com/BillDetail/1028834.