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Medicare in New Mexico

New Mexico does not require Medigap insurers to offer coverage to beneficiaries under age 65, but the state does have a high-risk pool for these enrollees

Key takeaways

Medicare enrollment in New Mexico

There were 447,491 residents enrolled in Medicare in New Mexico as of October 2022, which amounts to about 21% of the state’s population (as an aside, roughly 45% of the state’s population is covered by Medicaid, so two-thirds of all New Mexico residents are covered under one of those two public programs).

For most Americans, Medicare enrollment goes along with turning 65. But younger Americans become eligible for Medicare if they have been receiving disability benefits for 24 months, or if they have ALS or end-stage renal disease. Nationwide, about 12% of all Medicare beneficiaries are under the age of 65; in New Mexico, it’s a little under 13%.

Original Medicare in New Mexico

Original Medicare, which includes Medicare Part A (hospital coverage) and Medicare Part B (physician/outpatient coverage), is the same in every state. So overall Medicare eligibility in New Mexico and Medicare enrollment in New Mexico both work the same way they do everywhere else. For people who aren’t yet receiving Social Security benefits and thus aren’t automatically enrolled when they turn 65, the Medicare application in New Mexico is done via the Social Security Administration, as is the case nationwide.

But the availability and pricing of private Medicare coverage, including Medicare Advantage plans, Medigap plans, and Medicare Part D plans, does vary from state to state.

Medicare Advantage in New Mexico

Private Medicare Advantage plans are an alternative to Original Medicare. Medicare Advantage plans include all of the healthcare benefits of Original Medicare (albeit with different out-of-pocket costs and typically a much more limited provider network), and most Advantage plans also include Part D coverage for prescription drugs as well as extras like dental and vision coverage.

Time to sign up for Medicare?There are pros and cons to either option, and the right solution is different for each person. Medicare Advantage plan availability varies by county: In Hidalgo County, there are only nine Medicare Advantage plans from which to choose for 2023 coverage, while several other counties have more than 50 plans available.

Nationwide, and in New Mexico, about a third of all Medicare beneficiaries were enrolled in Medicare Advantage plans as of 2018. By late 2022, there were 207,633 New Mexico Medicare beneficiaries with private coverage. That’s about 46% of the state’s Medicare population, and mirrors the uptick in Medicare Advantage enrollment nationwide. The other 54% of New Mexico’s Medicare beneficiaries had Original Medicare as of 2022.

Medicare’s annual election period (October 15 to December 7 each year) allows Medicare beneficiaries the chance to switch between Medicare Advantage and Original Medicare (and add, drop, or switch to a different Medicare Part D prescription plan). There is also a Medicare Advantage enrollment window that allows people who are already enrolled in Medicare Advantage plans to switch to a different Advantage plan or to Original Medicare. This is the Medicare Advantage open enrollment period, which runs from January 1 to March 31.

Medigap in New Mexico

Original Medicare does not limit out-of-pocket costs, so most enrollees maintain some form of supplemental coverage. Nationwide, more than half of Original Medicare beneficiaries get their supplemental coverage through an employer-sponsored plan or Medicaid. But for those who don’t, Medigap plans (also known as Medicare supplement plans, or MedSupp) will pay some or all of the out-of-pocket costs they would otherwise have to pay if they had only Original Medicare.

According to an AHIP analysis, there were 70,590 New Mexico Medicare beneficiaries with Medigap coverage as of 2020. The New Mexico Office of the Superintendent of Insurance used to maintain a page that listed the state’s Medigap insurers, but they removed it in 2019 as it was outdated. They confirmed that they do not currently maintain a listing of Medigap insurers in the state, although filing data is available on SERFF. But Medicare’s Medigap plan finder tool shows all of the insurers that offer Medigap plans; there are 34 separate insurers offering Medigap plans in New Mexico as of 2023.

Although Medigap plans are sold by private insurers, the plans are standardized under federal rules, with ten different plan designs (differentiated by letters, A through N). The benefits offered by a particular plan (Plan A, Plan M, etc.) are the same regardless of which insurer sells the plan.

Unlike other private Medicare coverage (Medicare Advantage and Medicare Part D plans), there is no annual open enrollment window for Medigap plans. Instead, federal rules provide a one-time six-month window when Medigap coverage is guaranteed issue. This window starts when a person is at least 65 and enrolled in Medicare Part B (you must be enrolled in both Part A and Part B to buy a Medigap plan).

People who aren’t yet 65 can enroll in Medicare if they’re disabled and have been receiving disability benefits for at least two years; about 13% of New Mexico Medicare beneficiaries are under age 65. Federal rules do not guarantee access to Medigap plans for people who are under 65. Although the majority of the states have taken action to ensure access to Medigap coverage for disabled enrollees, New Mexico is not among them. The New Mexico Office of the Superintendent of Insurance confirmed that Medigap insurers in the state are not required to offer coverage to applicants under the age of 65. But insurers can do so voluntarily, and at least three do so as of 2022 — Blue Cross Blue Shield of New Mexico, State Farm Mutual Automobile Insurance Company, and United American Insurance Company.

New Mexico is also one of several states where pre-ACA high-risk pools remain operational, with coverage available to supplement Medicare if the enrollee is unable to obtain Medigap coverage. Information about New Mexico Medical Insurance Pool’s Medicare carve-out plan is available here. Standard premiums for this plan range from $196 to $785 in 2023, depending on the enrollee’s age. But the state has a subsidy program for people with income under 400% of the poverty level, resulting in lower net premiums for people with low or modest incomes.

New Mexico is one of several states where private Medigap insurers are not required to offer plans to people under age 65, but state high-risk pool coverage provides a back-up option. The others are Alaska, Iowa, Nebraska, North Dakota, South Carolina, Washington, and Wyoming.

Disabled Medicare beneficiaries have access to the normal Medigap open enrollment period when they turn 65. At that point, they can enroll in a Medigap plan with the normal premiums that apply to people who are enrolling in Medicare due to age, rather than disability.

Disabled Medicare beneficiaries have the option to enroll in a Medicare Advantage plan instead of Original Medicare ( this includes people with kidney failure, who were not eligible to enroll in most Advantage plans prior to 2021). Medicare Advantage premiums are not higher for those under 65. But Medicare Advantage plans have more limited provider networks than Original Medicare, and total out-of-pocket costs can be as high as $8,300 per year for in-network care, plus the out-of-pocket cost of prescription drugs.

Although the Affordable Care Act eliminated pre-existing condition exclusions in most of the private health insurance market, those rules don’t apply to Medigap plans. Medigap insurers can impose a pre-existing condition waiting period of up to six months if you didn’t have at least six months of continuous coverage prior to your enrollment (although not all of them choose to do so). And if you apply for a Medigap plan after your initial enrollment window closes (assuming you aren’t eligible for one of the limited guaranteed-issue rights), the Medigap insurer can consider your medical history in determining whether to accept your application and at what premium.

Medicare Part D in New Mexico

Original Medicare does not provide coverage for outpatient prescription drugs. More than half of Original Medicare beneficiaries nationwide have supplemental coverage via an employer-sponsored plan (from a current or former employer or spouse’s employer) or Medicaid, and these plans often include prescription coverage.

But Medicare beneficiaries who do not have drug coverage through Medicaid or an employer-sponsored plan need Medicare Part D in order to have coverage for prescriptions. Part D can be purchased as a stand-alone plan, or integrated with a Medicare Advantage plan. Part D was created under the Medicare Modernization Act of 2003, which was signed into law by President George W. Bush.

Medicare Part D enrollment is available when a beneficiary first becomes eligible for Medicare. And the annual Medicare election period each fall (October 15 to December 7) allows beneficiaries the opportunity to change to a different Medicare Part D plan or enroll for the first time if they didn’t do so when they were first eligible, albeit with a late enrollment penalty if they didn’t have creditable coverage prior to enrolling.

In terms of plan availability, there are 24 stand-alone Medicare Part D plans for sale in New Mexico in 2022, with premiums that range from about $9 to $105/month.

A total of 336,168 New Mexico Medicare beneficiaries had Part D coverage for prescription drugs as of late 2022. That included 139,133 with stand-alone Medicare Part D plans, and 197,035 with Part D coverage integrated with Medicare Advantage. As the popularity of Medicare Advantage plans has grown, the number of people with stand-alone Part D coverage in New Mexico has been steadily declining, while the number of people enrolled in Part D coverage as part of an Advantage plan has been growing.

How does Medicaid provide financial assistance to Medicare beneficiaries in New Mexico?

Many Medicare beneficiaries receive financial assistance through Medicaid with the cost of Medicare premiums and services Medicare doesn’t cover – such as long-term care.

Our guide to financial assistance for Medicare enrollees in New Mexico includes overviews of these programs, including long-term care coverage, Medicare Savings Programs, and eligibility guidelines for assistance.

Medicare in New Mexico: Resources and information for beneficiaries and their caregivers

You can contact the New Mexico State Health Insurance Assistance Program with questions related to Medicare eligibility in New Mexico and Medicare enrollment in New Mexico.

The New Mexico Office of the Superintendent of Insurance (Russell Toal) can provide assistance and customer service with a variety of insurance-related issues, and they license and oversee the health insurers, brokers, and agents that offer coverage in the state.

The page details how New Mexico Medicaid can provide assistance to Medicare beneficiaries in the state who have limited financial means.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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