New Mexico health insurance marketplace guide 2023

New Mexico has a state-run exchange, beWellnm (also referred to as NMHIX, or the New Mexico Health Insurance Exchange). For coverage effective in 2021 and previous years, the state used the federal enrollment platform at HealthCare.gov for individual enrollments. But starting in November 2021 (for enrollment in 2022 coverage), New Mexico began running its own exchange platform and is no longer using HealthCare.gov.

New Mexico had initially planned to make this transition by the fall of 2020, but the board voted in 2019 to push the transition date out to the fall of 2021. For small businesses, New Mexico has long had its own SHOP exchange enrollment platform.

New Mexico previously had a unique exchange; the state ran the small-business portion, and while the individual exchange was also technically state-run, HealthCare.gov was used to enroll people in individual insurance (ie, a federally supported state-based exchange, or SBE-FP). But as of November 2021, the state fully runs both the small business and individual/family enrollment platforms.

(New Mexico is considering discontinuing its small business enrollment platform, which would bring it into line with the exchanges in most other states.)

Nevada transitioned back to having its own exchange platform as of the fall of 2019. Pennsylvania and New Jersey did so in the fall of 2020. Kentucky and Maine also transitioned to their own fully state-run exchanges in the fall of 2021, along with New Mexico. Virginia plans to transition to a fully state-run exchange in the fall of 2023.

For 2023 coverage, there are four insurers that offer exchange plans in New Mexico:

• Blue Cross Blue Shield of New Mexico (Health Care Service Corporation)
• Molina
• Presbyterian Health Plan 
• Western Sky Community Care (Ambetter/Centene)

True Health, owned by Bright HealthCare, announced in April 2022 that they would exit the markets in six states at the end of 2022, including New Mexico. Bright subsequently announced that they would fully exit the individual market in every state where they offered coverage, so Bright’s plans are not available anywhere for 2023. The New Mexico Office of the Superintendent of Insurance has published some helpful information for True Health members. 

Friday Health Plans also exited the market in New Mexico (and Texas) after 2022, so their plans are not available for 2023. All True Health and Friday plans in New Mexico terminated on December 31, 2022. 

People who have individual/family True Health or Friday coverage through beWellnm were automatically transitioned to a similar plan from another insurer as of January 2023, unless they actively selected their own new plan during open enrollment. Actively selecting a new plan is the recommended approach.

People who purchased individual/family coverage directly from True Health or Friday (ie, off-exchange) were uninsured as of January 2023 if they didn’t select a new plan. They had the option to select a new plan off-exchange from a different insurer, or through beWellnm (subsidies are only available for plans selected through beWellnm). People whose coverage ended on December 31, 2022 also have the first 60 days of 2023 during which they can select a new plan, albeit with a gap in coverage before the new plan takes effect.

Insurer participation in New Mexico’s exchange has been much more consistent over the years than insurer participation in other states. There are six insurers offering plans for 2022, but that’s expected to drop to five in 2023, with True Health’s exit from the market.

There were four insurers offering plans statewide in New Mexico every year except 2015 and 2021, when there were five. But there has been some musical chairs in terms of which insurers offered plans each year.

The Santa Fe New Mexican reported that there were only two health insurance companies offering individual coverage in New Mexico pre-ACA, so competition has increased in the state under the ACA. John Franchini, New Mexico’s former Superintendent of Insurance, explained in 2016 that in terms of access to coverage and plan choice, New Mexico “in a much better place than we were four years ago. It’s getting better and better.” And insurer participation has grown even more since then.

In 2014, plans were available in the New Mexico exchange from Blue Cross Blue Shield of New Mexico (Health Care Service Corporation), Molina Healthcare of New Mexico, New Mexico Health Connections (one of the few ACA-created CO-OPs still operational as of 2020, but NM Health Connections closed at the end of 2020), and Presbyterian Health Plan.

In 2015, Christus Health Plan joined the exchange, and the four existing insurers continued to offer plans. The five insurers offered a total of more than 40 plans through the New Mexico exchange in 2015.

But for 2016, the New Mexico exchange dropped back down to four insurers after Blue Cross Blue Shield of New Mexico opted to leave the exchange at the end of 2015. In the summer of 2015, Blue Cross and Blue Shield of New Mexico filed a proposal to increase premiums for 2016 by an average of 51.6%. The announcement generated headlines nationwide, standing out even among some of the relatively steep rate increases proposed in other states. BCBS had about a third of the market share in the New Mexico exchange in 2015, so their proposed rate increase would have had a significant impact on the market.

But the New Mexico Office of the Superintendent of Insurance (OSI) denied the proposed rate hike, stating that the data submitted with the rate proposal didn’t justify a rate increase of more than 24%. BCBS rejected the rate change offered by the state, but came back in the following days and submitted new rates that they claimed had an average rate increase of 11.3%. But the OSI has said that they didn’t consider the secondary proposal to be a “real offer or realistic offer” and it was not accepted.

BCBSNM confirmed in late August that they would not be offering individual plans in the New Mexico exchange in 2016. They continued to offer one individual off-exchange plan — a bronze level HMO — with rates unchanged from 2015. This avoided a full market exit, meaning that BCBS preserved their option to return to the individual market with additional plans in 2017, which they decided to do (long-standing HIPAA rules prevent an insurer from returning to a market for five years after a full market exit).

So for 2016, plans were available in the New Mexico exchange from Christus, Molina, Presbyterian, and NM Health Connections. Individual market PPOs disappeared from the New Mexico exchange in 2016 (HMOs and EPOs help insurers control costs, so they’ve been steadily replacing PPOs in many markets).

Insurer participation changed again in 2017, but the total number of exchange insurers remained at four. Presbyterian Health Plan announced in July 2016 that they would transition to only offering off-exchange coverage in 2017. They noted that their on-exchange enrollees were incurring 30% more claims than their off-exchange enrollees, and Presbyterian determined that their on-exchange business was not sustainable. Through 2021, Presbyterian only offered off-exchange plans, although they returned to the exchange in 2022.

Blue Cross Blue Shield of New Mexico returned to the exchange for 2017. BCBSNM requested an average rate increase of 83.1% for their HMO product, but later revised it to 93.25 and regulators approved the requested rate hike. BCBSNM did not raise the rates on their remaining off-exchange HMO product for 2016, so the 93.2% rate increase was in relation to the 2015 rates.

For 2018 and 2019, there were no changes. Covered continues to be available from BCBSNM, Christus, Molina, and NM Health Connections. Presbyterian initially filed rates and plans to once again participate in the exchange starting in 2019, but ended up withdrawing that filing, noting that “due to concerns with current market environment, PHP has decided to continue offering plans only off the exchange.” So Presbyterian’s plans continued to be available only outside the exchange in 2019, and they didn’t return to the exchange until 2022.

And although Molina threatened to exit New Mexico altogether at the end of 2018 when their Medicaid managed care contract was not renewed, that did not come to pass. An updated Molina rate filing, submitted in mid-August 2018, indicated that Molina was still planning to participate in the exchange in 2019, despite the fact that they still had a pending challenge to the Medicaid bidding process at that point. Molina’s plans continue to be available in the New Mexico exchange in 2022, just as they have since 2014.

There were four insurers in New Mexico’s exchange in 2020. but there were some changes: Christus, which had offered plans in the New Mexico exchange since 2015, failed to meet New Mexico’s QHP certification requirements, so its plans had to terminate at the end of 2019. Christus covered about 1,100 people in New Mexico’s individual market in 2019, all of whom needed to select new plans for 2020.

But True Health obtained individual market certification in New Mexico and offered coverage in the exchange as of 2020 — so New Mexico continued to have four exchange insurers. It’s noteworthy that True Health was created in order to take over New Mexico Health Connection’s employer-sponsored plans as of 2018 and allow NMHC to focus on the individual market. But as of 2020, both True Health and NMHC were offering individual market plans in the New Mexico exchange, in direct competition with each other.

Evolent paid $10.25 million to acquire NMHC’s commercial insurance membership, and True Health New Mexico established an administrative services agreement that allowed them to support NMHC’s ongoing operations in the individual market, while letting NMHC continue to be an independent non-profit. The administrative services relationship ended, however, at the end of 2019. For 2020, NMHC partnered with Friday Health Plans Management Services for plan administration. And in early 2021, True Health was acquired by Bright Health (more on that below; Bright Health is exiting six states at the end of 2022, including New Mexico).

New Mexico Health Connections closed its doors at the end of 2020 (leaving just three CO-OPs remaining nationwide, with plans available in five states).

But Friday Health Plans and Western Sky Community Care (Centene/Ambetter) joined New Mexico’s exchange for 2021, bringing the total number of participating insurers to five. All marketplace insurers in New Mexico are required to offer plans statewide, so residents throughout New Mexico can choose from among all five insurers in 2021 (it’s quite rare for all plan available in a state’s marketplace to be available statewide, but New Mexico requires this, making the marketplace more robust, even in rural areas, than many other states’ marketplaces).

For 2022, Presbyterian Health Plan rejoined the exchange, bringing the total number of participating insurers to six.

For 2023, however, True Health/Bright Health and Friday Health Plans are both exiting the market in New Mexico, leaving New Mexico’s exchange with four insurers offering plans for 2023.

The open enrollment period for individual/family coverage runs from November 1 through January 15 in New Mexico. 

Outside of the annual open enrollment window, you’ll need a special enrollment period to enroll or make a change to your coverage. Most special enrollment periods are tied to a qualifying life event, although some special enrollment periods (such as the enrollment opportunity for Native Americans and for New Mexico residents with income up to 200% of the poverty level) do not require a specific life event.

If you have questions about enrollment opportunities, you can read more in our comprehensive guides to open enrollment and special enrollment periods.

Coverage is more affordable than ever in New Mexico as of 2023, thanks to the debut of additional state-funded premium subsidies and cost-sharing subsidies that are available as of 2023. 

And starting in 2022, New Mexico began requiring insurers to price Silver plans in a manner that reflects their higher value based on integrated cost-sharing reductions that apply to most people who purchase Silver-level coverage. This helped to increase the value of premium subsidies available through New Mexico’s exchange, resulting in lower after-subsidy premiums for most enrollees. 

Specifically, the state instructed insurers that they should assume that consumers will be rational and thus not purchase on-exchange Silver plans if their household income is above 200% of the poverty level (here’s more about the reasoning for that). Below that income level, all Silver plans have actuarial values of 87% of 94%, which is well above the actuarial value of Gold plans. So the state instructed insurers to price Silver plans accordingly.

When Silver plan prices increase, premium subsidies increase too. Especially when you consider the more generous subsidy structure created by the American Rescue Plan, and the elimination of the income cap for subsidy eligibility (through 2025), it’s clear that coverage is now much more affordable for most New Mexico consumers.

According to ratereview.healthcare.gov, the following average rate changes were approved for 2023 in New Mexico (before any federal or state subsidies are applied):

• Molina: 12.53% increase
• Blue Cross Blue Shield of New Mexico (Health Care Service Corporation): 5.44% increase 
• Western Sky Community Care (Ambetter/Centene): 7.53% increase
• Presbyterian Health Plan: 12.63% increase

The weighted average rate change initially amounted to an increase of about 11.3%, but that was before Friday Health Plans announced that they would exit the market, and their average increase (more than 16%) was the highest of any of the insurers. The average rate increase for the four remaining insurers is lower, but of course, people with 2022 coverage from True Health or Friday had to pick a different insurer’s plan for 2023.

And average rate changes are calculated before any subsidies are applied. Most enrollees qualify for subsidies, and the subsidies are substantial, due to the American Rescue Plan’s enhancement of federal subsidies and the new state-funded subsidies that New Mexico is offering.

For perspective, here’s a look back at how premiums have changed in previous years in New Mexico’s marketplace:

2015: Average rate decrease of 1.65%. The lowest-cost bronze plan in the NM exchange had averaged $217 a month in 2014, quite a bit lower than the national average of $249.

2016: Average rate increase of 4% (but BCBSNM enrollees had to switch plans). For 2016, BCBSNM did not offer plans in the exchange. Average rate changes for the other insurers ranged from a decrease of 2% for Molina to an increase of 4% to 17% for NM Health Connections. Overall, the average benchmark (second-lowest-cost Silver) plan in the New Mexico exchange was 7% more expensive in 2016 than in 2015 (an earlier HHS report pegged the increase at 25.8 percent, but that was because New Mexico Health Connections plans weren’t appearing in the quote system due to the technical glitch, and their rates weren’t taken into consideration when HHS initially analyzed the change in second-lowest-cost premium).

2017: Average rate increase of 28.4%. In 2017, with Presbyterian’s exit and BCBSNM’s return, four carriers offered 57 plans in the New Mexico exchange. Their approved average rate increases for 2017 were substantial, ranging from nearly 16% for Christus to more than 93% for BCBSNM. The average benchmark plan in New Mexico was 29% more expensive in 2017 than it was in 2016 (compared to an average of 22% across all 38 states that used HealthCare.gov in 2016). But to keep that data in context, we have to note that New Mexico’s average benchmark premium was the lowest of all those 38 states in 2016, and even with the 29% average increase, New Mexico’s benchmark premiums were still among the lowest-priced in 2017. They averaged $224/month for a 27-year-old, versus an average of $296/month across all the states that use HealthCare.gov.

2018: Average rate increase of about 30%. BCBSNM raised their average rates by about 26%, NM Health Connections by about 28%, Christus by about 49%, and Molina by more than 56%. New Mexico insurers were allowed to file two sets of rates, to accommodate the uncertainty that the Trump Administration created in the individual market — particularly the issue of whether federal funding would continue for the ACA’s cost-sharing reductions (CSR). By September 2017, the insurers in New Mexico had all assumed that CSR funding would end, and had officially added the cost of CSR to silver plan premiums for 2018. The Trump administration ultimately did terminate CSR funding that October. The cost of CSR was added to premiums for silver exchange plans and the mirrored off-exchange versions of those silver plans, but silver off-exchange-only plans were also available without the cost of CSR added to their premiums.

The fact that the cost of CSR was added to silver plans resulted in larger premium subsidies for all subsidy-eligible enrollees in 2018, since subsidies are based on the cost of silver plans. Although the cost of CSR was added only to silver plan premiums, NMOSI also confirmed that Blue Cross Blue Shield of New Mexico also added the cost of Native American cost-sharing reductions to all plans for 2018 (Native Americans can purchase $0 cost-sharing plans at all metal levels if their income doesn’t exceed 300% of the poverty level). NMOSI noted that the cost of Native American CSR only added about 0.5% to 2% to the overall premiums for 2018, and the other three insurers didn’t account for it in their rate filings. Essentially, BCBSNM was concerned that the potential elimination of CSR funding would include elimination of Native American CSR funding, so they added that cost to their 2018 premiums as well. CMS confirmed in November that all CSR funding had ended, including funding for the enhanced benefits for Native Americans. Although it’s a much smaller total cost to insurers than regular CSR, insurers that didn’t add the cost of Native American CSR to their 2018 premiums had to absorb the cost of enhanced benefits for Native Americans, while BCBSNM baked that cost into their premiums.

2019: Average rate decrease of about 1%. On the heels of sharp rate increases in New Mexico’s individual market for 2018, many consumers saw small rate decreases for 2019. Insurers that offer on-exchange coverage were instructed by the New Mexico Office of the Superintendent of Insurance (NMOSI) to add the cost of cost-sharing reductions (CSR) only to on-exchange silver plans and the identical versions of those plans offered off-exchange (different silver plans offered only off-exchange do not have the cost of CSR added to their premiums).

In early 2018, Molina had threatened a possible exit of the individual market in New Mexico due to the impending loss of their Medicaid managed care contract. But Molina did file on- and off-exchange plans — with a proposed reduction in rates — and a revised filing, submitted in mid-August, indicated that they would continue to participate in the exchange, and with an even more significant rate reduction than they had originally proposed.

Off-exchange, Presbyterian Health Plan implemented an average rate increase of 18.5%. Presbyterian had 20,288 off-exchange members in 2018.

2020: Average rate increase of 0.9%. Although average rates increased only slightly for 2020 in New Mexico’s individual market, it’s important to note that average benchmark premiums in New Mexico decreased by 6% for 2020. Premium subsidies — which 80% of New Mexico exchange enrollees receive — are based on the cost of the benchmark plan. So when benchmark rates decrease more sharply than overall average rates — which actually increased slightly in this case — the result can be an increase in net premiums for enrollees who receive subsidies. This essentially makes coverage less affordable than it was the year before, which could be a factor in New Mexico’s lower enrollment for 2020.

There’s an interesting note in the filing details for True Health: The insurer initially estimated that their risk adjustment receivables would amount to $19.24 per member per month, or about 4% of premiums. But they later revised that to 5.5%, which would have allowed them to reduce their proposed premiums. However, they submitted this modification to state regulators outside of the rate filing amendment period, so they were required to keep the estimated risk adjustment receivables at 4% of premiums.

This is what True Health explained in the filing notes:

“True Health is new to the individual market without any experience. The review was focused on actuarial assumptions and we requested support for these assumptions. The Company initially assumed a risk adjustment factor of 4.0%. The Company revised this assumption to 5.5% and this change was outside of the allowable amendment period. We requested additional support for the risk adjustment assumption. Ultimately, there was a conference call between Lewis & Ellis, True Health and the NM OSI. The Company provided adequate support for the 4.0% risk adjustment assumption. However, modifying this assumption outside of the amendment period was disallowed sine this would be an unfair advantage. The Company was required to revise the assumption back to the 4% of premium receivable.”

But this is what the New Mexico Office of the Superintendent of Insurance explained:

“True Health is new to the individual market without any experience. The review was focused on assumptions like risk adjustment that required adequate support. The support provided continued to be inadequate in responses to inquiry and in fact, went further away from what would typically be expected as a new market entrant with low rates. Changes were made outside of the allowable amendment period. Ultimately, there was a conference call between Lewis & Ellis, True Health and the NM OSI to discuss. We were able to come to a reasonable conclusion that the Company had a reasonable rationale for the direction of the risk adjustment assumption (as a receivable). However, the conclusion was made that the Company did not provide enough support that they should be allowed an unfair advantage of revising the assumption after the amendment period, so the Company was required to revise the assumption back to the 4% of premium receivable.”

2022: Average rate increase of about 8.6%. The following average rate changes were approved for 2022 in New Mexico. But again, it’s important to understand that Silver plan rates increased more than other metal levels, which pushed subsidies higher and made coverage more affordable for more people. As the Office of the Superintendent of Insurance has clarified, most enrollees likely saw their net premiums decrease in 2022, despite these full-price average rate changes:

• Molina: Average increase of 25.7%
• Blue Cross Blue Shield of New Mexico (Health Care Service Corporation): Average decrease of 4.5% 
• True Health: Average increase of 11.77% 
• Friday Health Plans: Average increase of 2.47%.
• Western Sky Community Care (Ambetter/Centene): Average decrease of 4.17%
• Presbyterian Health Plan: 0% rate change (Presbyterian Health Plan rejoined the exchange, after exiting at the end of 2016. Presbyterian had only offered off-exchange plans for the previous five years, but resumed exchange participation for 2022. Presbyterian had 16,595 off-exchange enrollees in 2021.)

According to CMS, 40,689 people enrolled in private plans through beWellnm during the open enrollment period for 2023 coverage. That was lower than CMS had reported the year before, when they indicated that 45,664 people enrolled. But it appears that there could be an error in one of those enrollment totals; enrollment in 2023 plans might be higher than the prior year’s enrollment, which would make sense given New Mexico’s new state-funded subsidies in 2023.

Here’s an overview of how enrollment has changed in New Mexico’s exchange over the years:

• 2014: 34,966 people enrolled
• 2015: 52,358 people enrolled
• 2016: 54,865 people enrolled
• 2017: 54,653 people enrolled
• 2018: 49,792 people enrolled
• 2019: 45,001 people enrolled
• 2020: 42,714 people enrolled
• 2021: 42,984 people enrolled
• 2022: 45,664 people enrolled (this was the first year the state switched to its own enrollment platform; might be erroneous data)
• 2023: 40,689 people enrolled

Across most of the states that use HealthCare.gov, enrollment tended to peak in 2016 and decline over the following four years, with a modest increase in enrollment coming in 2021 (and record-high enrollment in 2022 and again in 2023). But most of the other state-based exchanges that used the federal HealthCare.gov enrollment platform (SBE-FPs) for 2021, including Kentucky, Oregon, Virginia, and Maine, saw an enrollment drop that year. Arkansas and New Mexico were the only SBE-FPs that saw enrollment increase from 2020 to 2021.

Nationwide, enrollment hit a new record high for 2022 and again for 2023, driven in large part by the American Rescue Plan’s subsidy enhancements.