New Mexico Health Insurance: 2021 Coverage Guide

Fran
Fran Majidi
August 28, 2020

New Mexico Affordable Healthcare Insurance

Unless you have a qualifying event, it’s important to buy health insurance during the Open Enrollment Period. As a resident of New Mexico, you have some options when it comes to your health care. So it’s important to understand coverage tiers and the different types of plans available to you before you shop for a health plan. We’re here to help.

When Is Open Enrollment in New Mexico?

November 1, 2020 - December 15, 2020. Coverage begins January 2021.

How to Get Health Insurance in New Mexico

It’s worthwhile to spend some time trying to estimate your medical expenses for the year based on the previous year. You’ll need this sort of information to decide which type of coverage is right for you, and which level tier will save you the most money. Sometimes, paying more in premiums means less out-of-pocket costs, especially if you frequently visit care providers. When you have compiled all the information you need, compare health insurance companies and health insurance quotes with SmartFinancial. After you submit the form you’ll know which plans fit your needs, and we’ll even connect you with an agent so you can buy a plan or ask questions.

After you figure out which level of health care suits your needs and budget, you should compare health insurance companies and health insurance quotes. After you submit the form from SmartFinancial, you’ll receive competing health insurance rates, and we’ll connect you with an agent in your area so you can buy the coverage or ask questions.

What Types of Health Insurance Are Available in New Mexico?

You’ll find several HMOs, EPOs, PPOs and POS plans as well as catastrophic plans, which offer the least benefits. In New Mexico, the tier system allows you to choose from all the coverage levels: bronze, silver, gold and platinum. Platinum covers about 90% of all costs, gold 80%, silver 70% and bronze 60%. Sometimes, it makes sense to pay more monthly so that you spend less when you visit doctors. But if you’re healthy and rarely see a physician and take no prescription medications, a lower premium plan may be more economical for you.

Does Health Insurance Cover Pre-existing Conditions?

Yes, the ACA made it illegal to deny anyone health insurance coverage based on pre-existing conditions.

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Do I Qualify for a Special Enrollment Period?

Common reasons people qualify for a special enrollment period:

  • If you lost a job, changed jobs to where insurance was not offered or even started your own business, you qualify to buy health insurance outside the open enrollment period.
  • If you turned 26 and can no longer be your parents’ health insurance plan, you can buy an individual health plan.
  • If you moved outside the coverage area and your insurance is not valid where you live, you can buy a new health plan.
  • If you extended your healthcare with Cobra and reached the deadline, you can enroll in a new health plan.
  • If you divorced a spouse and had been sharing a health plan, you may enroll in a new health plan.
  • If you recently got married, you may buy a new health insurance plan together or individually.
  • If you gave birth or adopted a child, you may buy a new health plan for that child.
  • If you shared a health insurance policy with a spouse or partner and they passed away, you can enroll in a new health plan.
  • If you shared a health plan with a spouse or partner and they lost coverage, you may be able to buy a new health plan together or as individuals.

Is Health Insurance Required in New Mexico?

No, only California, Massachusetts, New Jersey, Vermont, Rhode Island, and DC still require health insurance. Otherwise, there is a tax penalty. Even in states that don’t require it, buying health insurance is the best way to avoid medical bankruptcy.

How Much Is Health Insurance in New Mexico?

The average cost of health insurance in New Jersey for a 40 year old is about $364 a month. The older you are, the more expensive health insurance is. Tobacco use also increases health insurance rates.

How to Save on Health Insurance in New Mexico

The best way to save on health insurance in New Mexico is to compare rates based on the tier system. Beforehand, you’ll want to estimate your medical costs

Medicare in New Mexico

Medicare is health insurance coverage for Americans ages 65 years and older. The government also allows younger people with disabilities to enroll in the program. Individuals with End-Stage Renal Disease (a permanent kidney failure treated with dialysis or a transplant) can also sign up as can some individuals with severe mental health issues. Others who qualify for Medicare disability coverage are individuals with Amyotrophic Lateral Sclerosis (also called Lou Gehrig’s Disease). Most beneficiaries will receive Original Medicare (Parts A and B). Some people buy Medicare Advantage, which includes Part A and B as well as offering vision, dental and prescription drug coverage.

How Many People Are on Medicare in New Mexico?

20% of New Mexicans are on Medicare.

How Much Is Medicare in New Mexico?

If you do not qualify for Medicare, you can pay $458 a month for Part A in 2020, otherwise Part A is free. A standard monthly premium for Medicare Part B was $144.60 for 2020, or even higher depending on income. It’s important to note that if you do not sign up for Part B when you first become eligible, you pay a penalty fine for the remainder of your time on Medicare.

How to Get Medicare Coverage in New Mexico

If you receive social security payments, you may automatically enroll in Medicare, but you may have to sign up if you do not receive payments. The easiest way to enroll in Medicare is by working with a trusted insurance agent to get the coverages you want. Just enter your zip code and answer a few simple questions.

Original Medicare vs Medicare Advantage: What’s the Difference?

Medicare is a government subsidized health plan that is available to qualified Americans age 65 and older. Medicare Advantage is sold through private health insurance companies, but these policies are also regulated by the government. Medicare Advantage plans offer the same benefits as Medicare Parts A and B. Medicare Advantage plans also offer more coverage for dental, vision, hearing and prescription drugs. Medicare Advantage plans have a maximum out-of-pocket limit. For 2020, it was $6,700 but many plans set their maximums at a much lower cost. That is why it’s important to compare companies. People who opt for original Medicare can buy Medicare Supplements to help with out-of-pocket costs. You cannot buy both Medicare Advantage and Medicare Supplements. If you enroll in a Medicare Advantage Plan during open enrollment, you will automatically be disenrolled from original Medicare.

HHow Do I Qualify for Medicare?

To qualify for Medicare you must be a citizen of the U.S. or have been a legal resident for at least five years. If you are age 65 or older and you/your spouse have worked for at least 10 years (40 quarters) or you have a disability, Amyotrophic Lateral Sclerosis (ALS) or end-stage renal disease (ESRD), you most likely qualify for Medicare.

How Can I Save on Medicare in New Mexico?

You can save on Medicare by signing up for Part B as soon as you’re eligible. People who enroll late must pay a penalty every year. If you’re interested in buying Medicare Advantage, you can shop and compare Medicare plans for the best value.

New Mexico State Health System Ranking

  • New Mexico: Overall State Ranking: 35 of 51
  • New Mexico: Overall Performance: Worse than Average
  • New Mexico: Access & Affordability: 40
  • New Mexico: Prevention & Treatment: 49
  • New Mexico: Avoidable Hospital Use & Cost: 16
  • New Mexico: Healthy Lives: 42
  • New Mexico: Health Care Disparities: 3
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New Mexico Health Insurance Coverage

The people of New Mexico have different kinds of health insurance while some New Mexico residents are not insured at all. See the breakdown below:

  • Private coverage: 35%
  • Medicaid: 34%
  • Medicare: 20%
  • Uninsured: 11%

New Mexico Health Insurance Companies

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