A TRUSTED INDEPENDENT HEALTH INSURANCE GUIDE SINCE 1994.
New Mexico uses a state-run exchange named BeWellNM for enrollment in certified individual/family dental plans.
Not all insurers that offer medical plans through the New Mexico exchange include pediatric or adult dental coverage with their health plans, but stand-alone plans are available for purchase.
For adults who purchase their own stand-alone or family dental coverage through BeWellNM, premiums range from $35 to $86 per month.
IHC Specialty Benefits reports that the average monthly premium for a stand-alone family dental plan sold in New Mexico in 2022 was $59.57.
If a family is purchasing coverage through the health insurance exchange, the premiums associated with pediatric dental coverage may or may not be offset by premium tax credits (premium subsidies). Here’s more about how that works, depending on whether the health plan has integrated pediatric dental benefits.
The stand-alone pediatric dental plans available in New Mexico will comply with the ACA’s pediatric dental coverage rules. This means out-of-pocket costs for pediatric dental care will not exceed $375 per child in 2023 (or $750 for all the children on a family’s plan), and there is no cap on medically-necessary pediatric dental benefits.
As is the case for all essential health benefits, the specific coverage requirements for pediatric dental care are guided by the state’s essential health benefits benchmark plan.
The New Mexico benchmark plan includes coverage for both basic and major dental services for children.
In 2023, two insurers offer stand-alone individual/family dental coverage through the health insurance marketplace in New Mexico. These are dental plans that are not included with a medical plan and must be purchased separately:
This coverage can be purchased through HealthCare.gov during open enrollment (November 1 to January 15) or during a special enrollment period triggered by a qualifying life event. Exchange-certified stand-alone dental plans are compliant with the ACA’s rules for pediatric dental coverage.
There are also a variety of dental insurers that sell stand-alone dental plans directly to consumers in New Mexico. These plans are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the New Mexico Office of Superintendent of Insurance (OSI). If you would like to purchase a non-ACA qualified dental plan, ask a dentist for recommendations or search online.
There are also various dental discount plans available in every state. Dental discount plans are not insurance, but can offer discounted rates at participating dentists. Learn about the differences between dental insurance and dental discount plans.
To find plans in your area, search online for dental discount plans and the state you are looking to buy a plan in.
Adults enrolled in Medicaid in New Mexico are eligible for extensive dental services through several health plans offered by the state Medicaid program. Children are also eligible for dental benefits through Centennial Care.
New Mexico has a Medicaid expansion CHIP, which provides dental coverage to uninsured children and pregnant women with with income above the eligibility limits for Medicaid.
New Mexico residents use bewellNM – a state-run platform – to enroll in health plans. New Mexico has five insurers offering health plans in the exchange for 2023 (True Health/Bright HealthCare exited the market after 2022). Overall average rates increased for 2023, but the state implemented rating rules in 2021 that push federal subsidies higher, and also debuted additional state-funded premium subsidies and cost-sharing assistance for 2023.
healthinsurance.org has been a guide for individuals and families since 1994. Compare plans, get a free quote, and check your subsidy eligibility today.
New Mexico is once again considering a Medicaid buy-in program during the 2023 legislative session.
For all information on Medicare in New Mexico, healthinsurance.org has you covered. Get all the resources you need to make an informed decision.
