What You Need to Know
New Mexico residents can enroll in health coverage on BeWellnm, the state’s health exchange.
Enrollment for 2022 coverage starts on November 1, 2021 and ends on January 15, 2022.
If you’re looking for a non-Obamacare plan or don’t qualify for subsidies, New Mexico has several options, including Medicaid, the New Mexico Medical Insurance Pool and short-term health insurance.
New Mexico’s two million residents have access to a full range of health insurance options.1
- Employer-provided plans.
- Affordable Care Act (ACA) individual and family plans purchased through its state-based exchange, BeWellnm.
- Plans bought directly from insurance companies.
- Government-assisted programs such as Medicare, Medicaid and the Children’s Health Insurance Program (CHIP).
More than one-third of New Mexico’s residents get their coverage through their work.
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.
New Mexico was one of the first states to expand Medicaid coverage under the ACA, starting in January 2014.
Obamacare and the state’s Medicaid expansion helped drop New Mexico’s uninsured rates from 19% in 2013 to 10% in 2019.4
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?
If you don’t enroll at that time, you won’t be able to apply until next year’s Open Enrollment Period. 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.
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 43,000 in 2021.5
How Do I Enroll in New Mexico’s Health Insurance Marketplace?
Under the Affordable Care Act, New Mexicans can purchase coverage and possibly qualify for subsidies through beWellnm, the state’s Health Insurance Marketplace (also called an “exchange”).
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 2019 to 2021, premiums in New Mexico for qualified bronze plans fell by about 6% and silver dropped by nearly 5%. The cost of premiums for gold plans remained about the same.
Here are the average monthly costs 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)||2019||2020||2021|
|Lowest-Cost Bronze Plan||$250||$257||$236|
|Lowest-Cost Silver Plan||$347||$326||$328|
|Lowest-Cost Gold Plan||$354||$342||$324|
The federal government uses a “benchmark” silver plan — the second-lowest-cost silver premium for a 40-year-old8 — to calculate subsidies.
|Average Benchmark Premium||$365||$345||$339|
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Which Companies Offer Individual Health Insurance Plans in New Mexico?
- Blue Cross and Blue Shield of New Mexico
- Friday Health Plans
- Molina Healthcare of New Mexico
- Presbyterian Health Plans
- True Health New Mexico
- Western Sky New Mexico
ACA Marketplace Plans
In 2021, the federal government changed the rules so households pay no more than 8.5% on health insurance toward a benchmark plan. The maximum income cap was removed as well.
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 2021 silver plan for $30 per month after subsidies.13 The same policy would cost $296 per month without the premium tax credits, which cover 90% of the cost.
- A family of three in Albuquerque with an income of $50,000 a year could pay $134 per month after subsidies for a 2021 silver plan.14 This policy would cost them $759 per month without the premium tax credits, which cover 82% 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 2020, 33% 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.
Help with Premiums
In 2020, Obamacare enrollees received an average monthly subsidy of $374 to pay for health insurance.
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.
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 federal poverty level. 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 Part A and Part 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 and Part D
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 2022, 14 companies in New Mexico offer Medicare Advantage plans.26
Almost 313,000 New Mexicans enrolled Medicare Part D drug coverage.27
In 2022, monthly plan premiums through eight insurers range from $7.60 to $140.00 with deductibles from $0 to $480.28
Nearly 124,000 New Mexico residents qualified and received help paying for prescription drugs through Medicare’s low-income subsidy program, also called Extra Help.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.