New Mexico health insurance

Four insurers are offering 2020 individual-market coverage in New Mexico. ACA protections and surprise balance billing protections codified into state law

Health insurance in New Mexico

New Mexico’s health marketplace

State legislative efforts to preserve or strengthen provisions of the Affordable Care Act

Could New Mexico be doing more to preserve the Affordable Care Act’s provisions? Compare its efforts to other state-level actions.

Open enrollment for 2021 health plans will run from November 1, 2020 to December 15, 2020. New Mexico residents with qualifying events can still enroll or make changes to their coverage for 2020.

New Mexico has a state-run health insurance exchange that utilizes the federal enrollment platform at (known as an SBE-FP, for “state-based exchange-federal platform”). Starting in fall 2021, 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 began studying ways to stabilize the state’s individual insurance market, and lawmakers 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. Medicaid buy-in legislation was considered during the 2019 session, and although it did not pass, it could be reconsidered in a future session.

New Mexico did enact legislation in 2019 to protect consumers from surprise balance billing, and to codify the ACA’s consumer protections into state law, in case the ACA is repealed or overturned (without federal funding for premium subsidies and Medicaid expansion, however, it’s unlikely that states could realistically maintain consumer protections, as premium subsidies are necessary for most enrollees in order to make guaranteed-issue health insurance affordable).

Four insurers are offering plans through New Mexico’s exchange for 2020: Blue Cross Blue Shield of New Mexico, New Mexico Health Connections (one of only four ACA-created CO-OPs still operational in the US as of 2020), Molina and True Health. Christus, which offered plans in previous years, was decertified by the exchange, but True Health was new to the exchange for 2020, keeping the total number of participating individual market insurers the same as it was in 2019.

Overall, average 2020 premiums (before subsidies are applied) increased by just under 1 percent in the state’s individual market, after decreasing by about 1 percent for 2019.

Read more about New Mexico’s health insurance exchange, including details about enrollment, insurer participation, and premium changes over the years.

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 expected, Medicaid enrollment initially grew rapidly, and then stabilized. By the end of 2017, it was about 63 percent higher than it had been in 2013. As of early 2020, an estimated 740,053 New Mexico residents were enrolled in Medicaid/CHIP – up 62 percent from fall of 2013, and roughly equal to what it had been by the end of 2017.

Read more about Medicaid expansion in New Mexico.

Short-term health insurance in New Mexico

New Mexico used to default to the federal regulations for short-term health insurance plans. But after the Trump administration changed the rules, allowing short-term plans to have longer durations, New Mexico changed its rules. As of 2019, the state only allows short-term plans to have terms of up to three months, bans renewals, and doesn’t allow the plans to be sold to anyone who has had short-term coverage in the past 12 months. After the state’s new regulations took effect, short-term insurers stopped offering plans in New Mexico, and the state is now one of 11 where there are no short-term plans for sale.

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. But it had increased to 9.5 percent by 2018, following the nationwide trend of a growing uninsured rate under the Trump administration.

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.

New Mexico ranked 37th in the 2019 edition of America’s Health Rankings, and 35th in the Commonwealth Fund’s 2019 Scorecard on State Health System Performance.

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. 2020 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. NMMIP remains an important source of coverage for disabled New Mexico residents who are under 65 and enrolled in Medicare (with Medicare eligibility triggered by their disability), as the state does not require private Medicare Supplement (Medigap) insurers to offer coverage to enrollees under the age of 65 (about 16 percent of Medicare beneficiaries in New Mexico are under the age of 65).

NMMIP is also serving as a critical safety net during the COVID-19 pandemic, as the state is allowing people without access to other health insurance to enroll in NMMIP coverage during the pandemic.

Medicare in the state of New Mexico

As of April 2020, there were 428,619 New Mexico residents enrolled in Medicare, including those with Original Medicare as well as those with Medicare Advantage plans.

Read more about Medicare in New Mexico, including the state’s rules for Medigap plans.

New Mexico health insurance resources

State-based health reform legislation

Some significant pieces of legislation were enacted in 2019 in New Mexico, including HB436, which codifies ACA consumer protections into state law, and SB337, which protects consumers from surprise balance billing (ie balance billing from out-of-network providers in emergency situations or when the patient goes to an in-network facility but is treated by an out-of-network provider—either unknowingly or when there is not an in-network provider available).

New Mexico gained national attention during the 2019 legislative session due to H.B.416 and S.B.405, which would have allowed people to buy into the state’s Medicaid program even if they were otherwise ineligible. Neither bill passed, but they could be revisited in the future.

Legislation to create a Health Security Plan (HB295 and SB279) did not advance to a vote in either chamber. But lawmakers did pass HM92, directing the legislative finance committee to conduct a fiscal analysis of a health security plan. The results of the analysis are to be reported to the legislature by July 2021. Three consulting entities (KNG Health Consulting, IHS Markit, and Lee Reynis, a researcher based in Albuquerque) have been awarded a $390,000 contract to conduct the study. 

New Mexico also made headlines in 2020 with legislation that would have essentially extended the federal health insurance tax (which is being eliminated at the end of 2020) and used the money to make coverage more affordable for New Mexico residents. The legislation passed the House in the 2020 session, but died in the Senate.

Scroll to the bottom of the page for a summary of other 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 Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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