New Mexico health insurance exchange
New Mexico health insurance exchange
By Louise Norris
July 24, 2014
According to a report released by HHS in mid-June, the average after-subsidy premium in the New Mexico exchange is $120/month, significantly higher than the $82/month average across the 36 federally-facilitated marketplaces (FFM). And only 78% of New Mexico exchange enrollees received subsidies, compared with 87% across all of the FFMs. The average after-subsidy premium in New Mexico is the fifth highest among the 36 FFMs, but NM Superintendent of Insurance John Franchini attributes that to one of the four carriers in the exchange charging premiums that were 20 to 25 percent higher than the other three carriers. He didn’t say which carrier it was, but noted that it was a carrier with which people were already familiar, and about a third of the enrollees picked that carrier’s plans, despite the higher premiums. Since the tax credit subsidies are based on the cost of the second-lowest-price Silver plan, an outlier plan on the high end will mean higher average after-subsidy premiums if a significant number of people choose to apply their subsidy towards the high cost plan instead of selecting a less expensive policy. Franchini notes that even though $120/month is higher than the average in most of the other FFM states, it’s still far less expensive than people would have been paying prior to the implementation of Obamacare and the premium tax credits.
Obamacare enrollment in New Mexico has continued during the summer, thanks to qualifying events that trigger special open enrollment periods. HHS will release the total enrollment increase in November, which is also when the 2015 open enrollment period is scheduled to begin (November 15).
By April 15, 34,966 people had completed their private plan selections through the New Mexico Exchange. Open enrollment ended on March 31, but the total also included people who had enrolled through mid-April during a special open enrollment triggered by a qualifying event, or through an extension granted to people who had begun their applications by the end of March. An additional 30,147 exchange applicants had been found to be eligible for the state’s expanded Medicaid program. But the total number of New Mexico residents who had enrolled in the expanded Medicaid program was actually about 107,000 by mid-April, as most newly-eligible individuals had enrolled directly rather than going through the exchange.
New Mexico’s exchange had the seventh highest cost per enrollee in the nation, coming in at about $6181 per enrollee when total start-up and operating expenses were divided among the 32,062 people who had selected a private plan by the end of March. However, nearly three thousand more New Mexicans completed their Obamacare enrollment in the first half of April, which brings the total cost per enrollee down to about $5668. This is still far higher than the national average of $922 though. The exchange must be financially self-sufficient by 2016 and is still working out the details of how to get there.
For 2014, four private carriers are offering a total of 23 plans in New Mexico’s exchange: Health Care Service Corporation (Blue Cross and Blue Shield of New Mexico), Molina Healthcare of New Mexico, New Mexico Health Connections and Presbyterian Health Plan. The lowest cost bronze plan in the NM exchange averages $217 a month in 2014, quite a bit lower than the national average of $249. On July 1, it was announced that CHRISTUS Health Plan had applied to join the New Mexico exchange for the 2015 open enrollment period, which would bring the total number of carriers to five and introduce more competition to the marketplace.
New Mexico settled on a unique approach to its health insurance marketplace. For individuals seeking health insurance, the state operated Be Well New Mexico in partnership with the federal government for 2014. Small businesses use the state-run SHOP exchange. The state had previously announced that it would run all aspects of the exchange on its own, the exchange board determined in May 2013 that it did not have enough time to get computer systems up and running. (While Utah is also using a hybrid approach, the specifics are different. Utah is leaving the individual exchange exclusively to the federal government and operating the small business exchange on its own.). New Mexico is planning to have its own individual exchange operational by October 1, 2014, in time for the 2015 open enrollment that begins on November 15.
By March 18, the state-run SHOP exchange had enrolled 524 people, including 345 employees and 179 of their dependents. Nearly 1500 small businesses had started their applications in the SHOP exchange by the end of 2013, and several thousand employee names had been entered into the system, so total enrollment is likely to grow substantially over the next few months as employers settle on a plan. SHOP enrollment runs year-round, so businesses can continue to apply even though the individual open enrollment window has ended.
Because the individual side of the New Mexico exchange is operating in partnership with HHS, Healthcare.gov is used to enroll in 2014. General open enrollment has ended, but people with qualifying events can enroll during their own special open enrollment window. Enrollees can also call 1-855-99-NMHIX for personal assistance with individual coverage, and the exchange created a website where consumers can see average prices for individual plans in order to get an idea of what’s available from the five participating insurers without having to access the full services at Healthcare.gov.
New Mexico’s path to establishing an exchange was atypical. New Mexico Gov. Susana Martinez, a Republican who opposes the federal health reform law, has been the driving force in establishing an exchange and advocating for the state-run model. Martinez designated that the Health Insurance Alliance develop the state exchange. The Health Insurance Alliance is a nonprofit association of health plans created by the state Legislature in 1994 to offer health insurance coverage to small employers. In mid-March, the Senate and House both approved a state-run exchange.
The state expects 200,000 people to purchase insurance through the exchange. According to Kaiser’s statehealthfacts.org, 417,000 New Mexicans — 21 percent of the population — are uninsured.
New Mexico health insurance exchange links
Guide to the New Mexico Health Insurance Exchange
Includes details about carriers, important dates, eligibility and enrollment information
New Mexico Health Insurance Exchange
Administrative and start-up information
State Exchange Profile: New Mexico
The Henry J. Kaiser Family Foundation overview of New Mexico’s progress toward creating a state health insurance exchange.