Overview of New Mexico’s Health Insurance Exchange
When the Affordable Care Act was passed in 2010, states gained the opportunity to build health insurance marketplaces called exchanges. The New Mexico Health Insurance Exchange (NMHIX) is New Mexico’s marketplace, and Be Well NM is the web portal for the program. This program will help people who are unable to buy their employer insurance plans, as well as those who are uninsured or buying their own insurance.
NMHIX is offering plans from the following providers: Blue Cross and Blue Shield of New Mexico, Lovelace, Molina, New Mexico Health Connections, and Presbyterian Health Plan. Several low- and mid-priced plans are offered.
Small businesses and individuals can start shopping/enrolling starting October 1, 2013. Employees of the small business employers setting up insurance through the Small Business Health Options Program (SHOP) site are able to begin enrolling on November 1, 2013
Open enrollment lasts until March 1, 2014. Your plan will be effective on January 1, 2014. There will be healthcare guides who can help you with any issues you have in the healthcare search and enrollment process. You can also consult an insurance agent or broker. The NMHIX call center is live 24 hours a day and seven days a week.
Per the Affordable Care Act, all plans have to offer the following essential services:
- Ambulatory patient services (doctor visits)
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices (Habilitative services are for people with disabilities who need speech, occupational, or physical therapy.)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
There are four basic plans available with varying levels of coverage: Bronze (60 percent of expenses paid by plan), Silver (70 percent), Gold (80 percent), and Platinum (90 percent). Lower plans have lower premiums, but higher out-of-pocket costs. A catastrophic plan is available for folks under the age of 30. This plan has a high deductible.
Adults livings at or below 133 percent of the federal poverty level (also known as the FPL, which is $11,490 a year in wages for one person and $23,550 a year in wages for a family of four), or pregnant women living at or below 250 percent of the FPL, can qualify for Medicaid in New Mexico, based on eligibility standards that will take effect January 1, 2014.
Additional federal financial protections will start in 2015 that include a maximum annual out-of-pocket cost of $6,350 for individuals and $12,700 for families. Capping out-of-pocket costs will help consumers pay medical bills that aren’t covered by insurance, reducing the chance of bankruptcy.
Tax credits are based on the Silver Plan, so you can easily determine what your additional out-of-pocket costs will be if you elect a higher or lower plan compared to Silver. The Affordable Care Act (ACA) was designed so the Silver Plan would be affordable to people who had to buy their own insurance, regardless of how expensive the healthcare rates may be where they live.
The two lowest-cost Silver Plans in New Mexico for a 40-year-old are $189 and $212 per month.
For the full information on all of the available plan rates in New Mexico, see the New Mexico Health Insurance Premium Summary 2014 document.
Individuals and families with incomes less than 400 percent of the federal poverty level (who are covered by an exchange plan) are eligible for healthcare tax credits. The payment of credits will begin in 2014.
People want to how much their subsidies are, but the real question is how much will you pay? Once you figure out what the maximum healthcare percentage is for your income, then you know that's the most you'll have to pay for a Silver Plan (you may pay less). For example, if your income is $32,500 a year (283 percent of the poverty level), the most you’ll have to pay for health insurance is nine percent of your income, which amounts to $2,926 a year, or $244 a month. The challenge is to look at the costs of the Bronze, Silver, Gold, and Platinum plans, and decide which plan offers the best value for you.
Information on Subsidies
For estimating any possible premium assistance, BeWellNM.com hosts the free Subsidy Calculator created by the Kaiser Family Foundation. Once live, NMHIX also will offers online Q&A to address specific questions, in addition to its call center for customers.