New Mexico Health Insurance

Overview

If you live in New Mexico and either buy your own health insurance or are currently uninsured, this guide is for you. It will help you:

  • Determine whether you may qualify for a credit to help you pay for health insurance under the Affordable Care Act (also known as Obamacare)
  • Compare private health plans using U.S. News & World Report's health insurance ratings for New Mexico

Do I Qualify for a Tax Break on Health Insurance?

Use the calculator below to determine whether you qualify to receive a tax credit (called a subsidy) that you can use to pay for health insurance. The calculator will also help steer you toward health insurance options that may be best for your needs.

What Plan Type is Right For Me?
How Many Need Coverage
Total Annual Income
 
 

You may qualify for Medicaid, a free, state-sponsored health insurance program. Call 855-996-6449 or go to the New Mexico Health Insurance Exchange website to find out if you can enroll in Medicaid.

You qualify for a subsidy (tax credit) that will save you money if you buy a plan on New Mexico's new insurance marketplace, called New Mexico Health Insurance Exchange. Plans should be offered there starting October 1, 2013. While your subsidy will cover part of the monthly premium for any of the marketplace's plans, a plan that's in the "silver tier" probably offers the best deal. That's because you also qualify for a second subsidy that increases the value of benefits you'd get from any silver plan.

You qualify for a subsidy (tax credit) that will save you money if you buy a health plan on New Mexico's new insurance marketplace, called New Mexico Health Insurance Exchange. Plans should be offered there starting October 1, 2013. Your subsidy will cover part of the monthly premium for any of the marketplace's plans, known as Qualified Health Plans.

You don't qualify for a subsidy. You can either buy a plan on the New Mexico Health Insurance Exchange website or click the button below to compare U.S. News-rated plans in your state's private insurance market. Plans on New Mexico Health Insurance Exchange will generally offer more health coverage than plans in the private market, but they also tend to cost more in monthly premiums. The New Mexico Health Insurance Exchange website should offer plans beginning October 1, 2013.

Any children in your household may be eligible for Medicaid. Call 855-996-6449 or go to the New Mexico Health Insurance Exchange website to find out if your children are Medicaid-eligible.

See Plans

If You Qualify: Plans That Cost Less

Under the Affordable Care Act, you might qualify for a subsidy to help pay for your health insurance. If you qualify, the subsidy can be used to reduce the cost of your monthly premium or can be taken as an annual tax credit. To take advantage of a subsidy, you must choose a health plan that has been approved by the federal government and the government of New Mexico. These plans, known as Exchange Plans, meet a set of standards that aim to eliminate benefit loopholes to make sure that people with pre-existing conditions are not being denied coverage. 

Note: you had until March 31 to enroll for coverage for the rest of 2014 (enrolling on March 31 would cover you starting May 1). If you missed this date, with few exceptions, you will pay a penalty.

Premiums on New Mexico Health Insurance Exchange

The average premium rates listed below are the lowest that might be charged to a 21-year-old nonsmoker. You can use the amounts listed to gauge the relative cost of each tier. Higher tiers tend to cost more, but offer better health coverage. Premium rates will vary depending on your age, where you live and whether the plan covers multiple members of your family or just one person. Tobacco users will pay higher premiums than nonsmokers in New Mexico.

Gold
Average Premium: $210 per month
Silver
Average Premium: $181 per month
Bronze
Average Premium: $147 per month

If You Don't Qualify: Private Plans

If you don’t qualify for a subsidy, you can still choose among the Health Exchange Plans, or consider one of the many private health insurance plans available in New Mexico’s private marketplace. We have rated these private plans on a 1-star to 5-star basis, with 5-star plans providing the most comprehensive coverage.  What’s the biggest difference between a private market health plan and a government-approved one? The trade-off is usually cost. Insurance companies can charge less for private plans with less-extensive network coverage or fewer benefits, which makes more-affordable options available to you.

Do I Have To Buy Health Insurance?

You may have heard that everyone in New Mexico must have health insurance in 2014 or pay a penalty – Obamacare's so-called “individual mandate.” With a few exceptions, this is true. For 2014, not carrying insurance will cost $95 per adult plus $47.50 per child (up to $285 per family) or 1 percent of your family’s income, whichever is more. 

U.S. News generally recommends getting health insurance of some kind, even if it is only catastrophic coverage. That's because unexpected medical expenses can easily bankrupt anyone who is uninsured.

Where To Buy Health Insurance

New Mexico's Official Marketplace

New Mexico Health Insurance Exchange is New Mexico’s official portal for buying an Obamacare Health Exchange Plan under the Affordable Care Act. To sign up online for coverage on New Mexico Health Insurance Exchange, be prepared to fill out a form that could take 30 minutes or longer. To complete the process quickly, have this info handy:

  • Social security numbers for everyone in your household
  • Your employer’s name and address
  • Your most-recent pay stub or recent records of your wages
  • Information about other types of income you receive, such as alimony, unemployment benefits or a pension

 

Insurance Companies and Brokers

Some people prefer to buy health insurance directly from an insurance company or through a broker. Thanks to strict regulation, you'll pay the same price for a plan regardless of where you buy it – whether on the New Mexico Health Insurance Exchange website, through a broker or directly from an insurer – and regardless of whether you sign-up via phone, online, or by filling out paper forms.

U.S. News & World Report has teamed up with eHealth.com, an online broker licensed to sell health insurance, to help you buy the health plan you want. The eHealth customer service team can answer questions, determine whether you're eligible for a subsidy and help you apply for insurance.

Qualified Plans on New Mexico Health Insurance Exchange

Beginning October 1, 2013, each state was required by law to have a new online marketplace where residents can buy health insurance. In these marketplaces, most states will offer five tiers of Obamacare Health Exchange Plans: platinum, gold, silver, bronze and catastrophic. Platinum plans will offer the highest level of coverage but tend to cost more in monthly premiums. Bronze plans will cover only a bare minimum of health care expenses but tend to have low premiums. If you are relatively healthy and want to pay less up front, consider a lower-tier plan such as bronze or silver.

You should also look at a New Mexico Health Insurance Exchange plan if you are lower-income, because the government will give financial help on a sliding scale to pay for premiums, and better benefits if you select a silver-tier plan. If you have not already done so, we can tell you if a New Mexico Health Insurance Exchange plan makes sense given your income on the State Overview tab, under the heading, "Do I Qualify For a Tax Break?"

Read ACA and Health Insurance: Which "Metal" Tier is Right for You? for more advice on choosing between metal tiers.

Participating Companies

Health Care Service Corporation (Blue Cross and Blue Shield of New Mexico). BCBSNM is a division of the Health Care Service Corporation, an affiliate of the Blue Cross and Blue Shield Association, the oldest U.S. health insurance system. The Blue Cross and Blue Shield Association offers coverage in all 50 states, the District of Columbia and Puerto Rico and has 37 Blue Cross and Blue Shield companies that serve over 100 million members (one third of all Americans), according to the company. Nationally, Blue Cross and Blue Shield companies have contracts with over 96 percent of hospitals and 91 percent of providers. BCBSNM offers exchange plans in Bronze through Gold tiers on the exchange, according to the New Mexico Office of Superintendent of Insurance.

Lovelace Health System. Tracing its history back to the 1880s, LHS now comprises six hospitals (Lovelace Medical Center, Lovelace Westside Hospital, Lovelace Women’s Hospital, Lovelace Rehabilitation Hospital, Heart Hospital of New Mexico at Lovelace Medical Center and the Lovelace Regional Hospital-Roswell), the Lovelace Pharmacy and eleven retail pharmacies in Albuquerque, Rio Rancho and Santa Fe, and approximately 4,000 doctors and employees, according to the company. Lovelace Health System offers exchange plans in Bronze through Platinum tiers, according to the state's insurance superintendent.

Molina Healthcare of New Mexico. Established in 1980 in California, Molina Healthcare is a multi-state health care organization with a focus on providing government-sponsored health services to over 5 million Americans in 15 states, according to the company. Molina offers exchange plans in Bronze through Gold tiers, according to the state's insurance superintendent.

New Mexico Health Connections. NMHC is a new nonprofit, member-governed co-op. NMHC offers exchange plans in all tiers, according to the state's insurance superintendent. Its exchange network includes 38 hospitals. A searchable provider directory is available. 

Presbyterian Health Plan. Established in 1908, Presbyterian Health is New Mexico’s only private, nonprofit healthcare system, according to the company. Its network includes eight hospitals. Presbyterian Health offers exchange plans in all tiers, according to the state's insurance superintendent.   

The monthly premiums listed below are the lowest that might be charged to a 21-year-old nonsmoker. Premium rates will vary depending on your age, where you live and whether the plan covers multiple members of your family or just one person. Tobacco users will pay higher premiums than nonsmokers in New Mexico. Depending on your income, you may qualify for a subsidy (tax credit) that covers part of your premium.

Gold

New Mexico Health Connections | HMO
Premium $179

Health Care Service Corporation | Blue Community HMO
Premium $181

Molina Healthcare of New Mexico | HMO
Premium $186

Lovelace Health System | HMO
Premium $207

New Mexico Health Connections | PPO
Premium $210

Presbyterian Health Plan | HMO
Premium $227

Health Care Service Corporation | Blue PPO
Premium $242

Health Care Service Corporation | Blue PPO MSP
Premium $246

Silver

Health Care Service Corporation | Blue Community HMO
Premium $147

Molina Healthcare of New Mexico | HMO
Premium $166

New Mexico Health Connections | HMO
Premium $170

Lovelace Health System | HMO
Premium $181

New Mexico Health Connections | PPO
Premium $188

Presbyterian Health Plan | HMO
Premium $194

Health Care Service Corporation | Blue PPO
Premium $201

Health Care Service Corporation | Blue PPO MSP
Premium $202

Bronze

Health Care Service Corporation | Blue Community HMO
Premium $121

New Mexico Health Connections | HMO
Premium $126

Molina Healthcare of New Mexico | HMO
Premium $146

Lovelace Health System | HMO
Premium $153

Presbyterian Health Plan | HMO
Premium $155

Health Care Service Corporation | Blue PPO
Premium $163

Health Care Service Corporation | Blue PPO MSP
Premium $167

Need More Help?

If you need help choosing a health insurance plan or filling out your application, New Mexico has trained nongovernment groups to guide you through the process. Sometimes called “Navigators,” these groups can answer technical questions on insurance, Medicaid, and tax credits (subsidies on monthly premiums) . Navigators also specialize in assisting non-English speaking populations. For more information, contact the New Mexico Health Insurance Exchange call center at 855-996-6449.

The New Mexico Office of Superintendent of Insurance exists to help residents resolve issues with their insurance company, locate a doctor or other provider within their network, appeal a denial of service, and resolve billing problems with insurers and providers. Residents can call 855-427-5674 or file an insurance complaint online.

Health Insurance Guide

U.S. News offers information on how to buy health insurance and publishes plan ratings for every state. If you’re over 65, see the guide to Medicare plans. Otherwise, start by looking up the Health Insurance Guide for your state.

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2014-05-01