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New Mexico health insurance

Four insurers are offering 2019 individual-market coverage in New Mexico. Premiums decreased slightly for 2019.

Health insurance in New Mexico

New Mexico’s health marketplace

New Mexico has a state-run health insurance exchange that utilizes the federal enrollment platform at HealthCare.gov (known as an SBE-FP, for “state-based exchange-federal platform”). Starting in fall 2020, however, the state plans to operate its own enrollment platform, and will have a fully state-run exchange at that point.

For small businesses, New Mexico has its own SHOP exchange enrollment platform.

In 2018, a task force is studying ways to stabilize the state’s individual insurance market, and lawmakers have requested information about the costs and pros/cons of allowing New Mexico residents who aren’t eligible for Medicaid to purchase Medicaid, as an alternative to being uninsured or purchasing private health insurance.

Open enrollment for 2019 coverage started November 1 and continues through December 15, 2018.

The same four insurers that offered 2018 health plans through New Mexico’s exchange – Blue Cross Blue Shield of New Mexico, New Mexico Health Connections, Molina and Christus – are offering plans for 2019. Overall, average 2019 premiums (before subsidies are applied) are decreasing by about 1 percent in the individual market.

New Mexico Health Connections is the state’s Consumer Operated and Oriented Plan (CO-OP), which was established with a federal grant of nearly $77.4 million under the ACA. While most Obamacare CO-OPs announced their closure in recent years, New Mexico Health Connections remains in operation in 2018.

The CO-OP has partnered with Evolent Health in 2018; the new entity created in the partnership is offering group health insurance plans, while New Mexico Health Connections is offering individual market plans (prior to 2018, New Mexico Health Connections offered both).

New Mexico enrollment in qualified health plans

In November 2013, the Kaiser Family Foundation estimated that the potential market for the exchange in New Mexico was 193,000 residents and that 118,000 of them would qualify for premium subsidies to lower the cost of their coverage. By mid-April 2014, when the first open enrollment period ended,32,062 people had finalized their enrollment in qualified health plans (QHPs) New Mexico’s exchange, and HHS reported that 78 percent of them received subsidies to lower their premiums.

During the 2016 enrollment period, a total of 54,865 people enrolled in private plans through New Mexico’s exchange. That was a 5 percent increase over 2015.

Enrollment dropped slightly in 2017, when 54,653 people purchased coverage through the exchange. But it dropped more significantly – by almost 9 percent – in 2018, when fewer than 50,000 people enrolled. Lower enrollments were the norm in states that use HealthCare.gov in 2018, as open enrollment was half as long as it had been in previous years, and HealthCare.gov states didn’t have an option to extend open enrollment.

Read more about the New Mexico health insurance marketplace.

Medicaid/CHIP in New Mexico

New Mexico agreed to accept federal funding to expand Medicaid eligibility under the Affordable Care Act and, as of early 2014, it was estimated that nearly 48 percent of the uninsured population in New Mexico would be eligible for expanded Medicaid or CHIP. As of mid-April 2014, 30,147 people had enrolled in Medicaid through the New Mexico exchange. By the end of 2017, New Mexico Medicaid enrollment had grown by 63 percent.

As of July 2018, an estimated 728,449 New Mexico residents were enrolled in Medicaid/CHIP – up 59 percent from fall of 2013.

Read more about Medicaid expansion in New Mexico.

Short-term health insurance in New Mexico

New Mexico currently defaults to the new federal rules for short-term plans. That means plans can have initial terms up to 364 days and total duration – including renewals – of up to 36 months.

But New Mexico consumer advocates are expecting legislation in 2019 to regulate short-term plans and the state’s Superintendent of Insurance was expected to issue regulations limiting plan duration in the fall of 2018.

Read more about short-term health insurance in New Mexico.

How has Obamacare helped New Mexico?

In the past, New Mexico has struggled with public health and a high uninsured population. But under the Affordable Care Act, the state has implemented Medicaid expansion and a federally supported state-based marketplace and seems to be moving in a better direction.

According to U.S. Census data, the uninsured rate in New Mexico was 18.6 percent in 2013, but was reduced by more than half – to 9.2 percent – by 2016.

New Mexico health ratings

When it comes to health, New Mexico faces several challenges that place it firmly toward the bottom half of most rankings. Among them, higher rates of uninsured and fewer primary care physicians and dentists than other states.

New Mexico ranked 37th in the 2015 edition of America’s Health Rankings, performing at #45 for lack of health insurance and #48 for infectious disease rates. In the 2017 edition of the Rankings, New Mexico was in 36th place.

In terms of healthcare affordability and access, a 2014 Commonwealth Fund study put New Mexico last in the nation. Think New Mexico launched a healthcare initiative in 2014 aimed at solving that problem and specifically tackling the issue of affordability and access. They recommended steps to help to bring more price transparency to healthcare, and also more fairness by prohibiting providers from charging different prices for the same procedure depending on who is paying the bill.

The Commonwealth Fund’s Scorecard on State Health System Performance 2015 rated New Mexico 33rd among the 50 states and District of Columbia – up three spots from 36th in 2014. On the 2017 Scorecard, New Mexico ranked 29th.

New Mexico’s scorecard includes details on how the rankings are determined. While the state placed in the fourth quintile for the Prevention & Treatment category, it was in the top quintile (7th place) for Avoidable Hospital Use & Costs. As of the 2017 analysis, New Mexico was still challenged by high rates of uninsured adults (16 percent, ranked 37th in the country) and children (5 percent, ranked 26th in the country), as well as a large percentage of adults who go without dental visits and healthcare.

Trust for America’s Health has compiled additional details on overall public health in New Mexico; check out the 2016 listing of Key Health Data About New Mexico. A county-by-county comparison is also available.

Does New Mexico have a high-risk pool?

Before the ACA, individual health insurance was underwritten in nearly every state, which meant that pre-existing conditions could prevent a person from obtaining a policy, or could result in significantly higher premiums or policy exclusions. The New Mexico Medical Insurance Pool (NMMIP) was created to give people an alternative if they were unable to obtain individual health insurance because of their medical history.

Now that the ACA has been implemented, all health insurance plans are guaranteed issue, making high-risk pools largely obsolete. But NMMIP is one of a few state-run risk pools that is still operational and has no plans to terminate coverage. 2018 rates for NMMIP are available here.

Although there were once more than 10,500 people enrolled in NMMIP coverage, enrollment had dropped to 2,500 by the end of 2017, due to people transitioning to Centennial Care (Medicaid) or individual market plans.

Medicare in the state of New Mexico

New Mexico Medicare enrollment reached 372,685 in 2015, the 50th anniversary of Medicare. This is about 17 percent of the state’s population and consistent with average national enrollment.

Historically, about 82 percent of New Mexico’s Medicare recipients have qualified based on age alone, and the other 18 percent are on Medicare as the result of a disability.

Medicare spends about $7,060 annually per enrollee, which is relatively low compared with other states. New Mexico ranks 37th in terms of overall spending on Medicare with $2.5 billion per year.

In 2017, about 33 percent of New Mexico Medicare beneficiaries select a Medicare Advantage plan instead of Original Medicare, which is on par with Medicare beneficiaries nationwide. Thirty-nine percent have stand-alone prescription drug coverage through a Medicare Part D plan. Nationally, about 44 percent of Medicare recipients select an Rx plan.

New Mexico health insurance resources

State-based health reform legislation

Scroll to the bottom of the page for a summary of recent health reform-related bills in New Mexico


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 healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.