Medicare New Mexico offers healthcare coverage to people 65 and older in the state, and in 2018, 409,851 people were enrolled in Medicare plans in New Mexico. There are several types of plans and insurance providers, so research your options thoroughly before you sign up for Medicare New Mexico.
There are four main types of Medicare plans in New Mexico, and understanding each one will help you make an informed decision about your healthcare needs. Each type offers different coverage options, from basic to comprehensive.
Also known as Part A and Part B, original Medicare New Mexico provides basic healthcare coverage to people 65 and older across the United States. If you qualify for social security benefits, you’ve likely already been enrolled in Part A and may qualify for premium-free coverage.
Original Medicare coverage includes:
- hospital services
- hospice care
- part-time home health services
- short-term assisted living care
- outpatient services
- annual flu vaccine
- blood tests
- doctor appointments
Part D Medicare plans in New Mexico provide prescription drug coverage. There are a number of plans to choose from, each with a select list of prescriptions that are covered.
You can add Part D coverage to your original Medicare to offset the cost of medications.
Medicare Advantage plans in New Mexico, also known as Part C, give you a range of coverage options at all premium levels. These all-in-one plans include all the services covered by original Medicare, as well as drug coverage. Some Medicare Advantage plans in New Mexico also include additional coverage for health and wellness programs, preventative health, dental care, or vision needs.
Medicare Advantage and Medicare Part D prescription drug plans are subject to change every year. Updated plan information for 2021 should become available on October 1, in advance of Medicare’s Annual Election Period beginning October 15. Healthline.com will provide updated 2021 plan information once it is announced by the Centers for Medicare & Medicaid Services (CMS).
Advantage plan carriers in New Mexico include:
- Amerigroup Community Care of New Mexico
- CHA HMO
- Christus Health Plan
- First Health
- Health Care Service Corporation
- Molina Healthcare Of New Mexico
- Presbyterian Health Plan
- Sierra Health and Life
- Symphonix Health Insurance
- Total Community Care
- Western Sky Community Care
Each of these carriers offers several Medicare Advantage plans and provide everything from basic coverage to comprehensive health and drug coverage.
Not all carriers provide insurance in all counties, so check the location requirements of each provider, and use you zip code when searching to make sure you’re only looking at plans that are available in your county.
Most people over the age of 65 are eligible for Medicare New Mexico. To be eligible you must:
- be 65 or older
- be a citizen or permanent resident of the United States for the past 5 or more years
If you’re under the age of 65, you may also qualify for Medicare New Mexico if you:
- have a permanent disability
- have been eligible for Social Security disability benefits for 24 months
- have a chronic illness such as Lou Gehrig’s Disease (ALS), end-stage kidney disease (ESRD), cardiovascular disease, or cancer
You’re also eligible to receive premium-free Part A coverage if you meet one of the following requirements:
- you or your spouse are eligible for benefits from Social Security
- you or your spouse are eligible for benefits from the Railroad Retirement Board
- you worked at a job where you paid Medicare taxes
Your first opportunity to enroll in Medicare New Mexico coverage is during your initial enrollment period. This 7-month period starts 3 months before the month you turn 65, includes your birth month, and stretches 3 months after your turn 65. You can enroll in Medicare parts A and B during this time.
Your next opportunity to enroll in Medicare is during the open enrollment period from January 1 to March 31 of each year, or during the annual enrollment period from October 15 to December 7 of each year.
During these two periods you can:
- add Part D coverage to your original Medicare
- switch from original Medicare to an Advantage plan
- switch from an Advantage plan back to original Medicare
- switch between Medicare Advantage plans in New Mexico
You may also be able to enroll during a special enrollment period if you’ve recently lost your employer health benefits or have moved outside the range of your current plan. You can also qualify for special enrollment if you’ve recently moved into a nursing home, or if you qualify for a special needs plan due to a disability or chronic illness.
With so many Medicare plans in New Mexico, it will take some time to find the right plan for your health needs and budget. Here are some tips to help you evaluate your plan options.
- Find out if your preferred doctor or pharmacy is covered. Each Medicare Part D and Advantage Plan carrier works with a set number of network-approved doctors and pharmacies. Call your doctor’s office to find out what carriers they work with, and make sure you’re only considering plans that will cover your doctor’s appointments.
- Make a complete list of your current medications and prescriptions. Each plan has a list of drugs covered, so compare that list against your own and only opt for a plan that will provide you with appropriate drug coverage.
- Compare ratings. To find out what others have thought about each plan, compare the Star Ratings of each plan to see which performs better. CMS uses a 1- to 5-star rating system, where a 4 or 5 indicates that people who were enrolled in the plan the previous year had good experiences with it.
If you need advice on how to choose a plan, or to clarify your eligibility or enrollment dates, contact any of the following state organizations for help.
- New Mexico Department of Aging & Long-Term Services, 1-800-432-2080. The Department of Aging provides unbiased counseling on Medicare, State Health Insurance Assistance Program (SHIP) services, Ombudsman information, and access to services such as meals or groceries.
- Paying for Senior Care, 206-462-5728. Find out about Prescription Drug Assistance in New Mexico, as well as financial assistance for care and assisted living.
- Medicare, 1-800-633-4227. Contact Medicare directly to ask about Medicare plans in New Mexico, ask about Star Ratings, or enquire about special enrollment periods.
Are you ready to enroll in Medicare New Mexico? Make sure you’re eligible for Medicare and then start enrolling by:
- Determining when you can enroll in Medicare, either during your initial enrollment period or during open enrollment.
- Review your coverage options, and choose the plan that provides the healthcare and drug coverage you need at a reasonable premium.
- Call Medicare or the insurance provider to begin the enrollment process.
The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.