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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 2020 health plans has ended, although New Mexico residents with qualifying events can still enroll or make changes to their coverage for 2020. The next open enrollment period, for plans effective in 2021, will begin November 1, 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 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 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from surprise balance billing, and to codify the ACA’s consumer protections into state law, in case the ACA is repealed or overturned (without federal funding for premium subsidies and Medicaid expansion, however, it’s unlikely that states could realistically maintain consumer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, Molina and True Health. Christus, which offered plans in previous years, was decertified by the exchange, but True Health is 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) are increasing by just under 1 percent in the state’s individual market, after decreasing by about 1 percent for 2019.

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 is one of only four, nationwide, that remain operational.

The CO-OP partnered with Evolent Health in 2018; the new entity created in the partnership, True Health, began offering group health insurance plans, while New Mexico Health Connections continued to offer individual market plans (prior to 2018, New Mexico Health Connections offered both). But as of 2020, True Health has also entered the individual market, becoming a direct competitor for New Mexico Health Connections.

New Mexico enrollment in qualified health plans

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 in 2018, as open enrollment was half as long as it had been in previous years, and states didn’t have an option to extend open enrollment.

Enrollment dropped again in New Mexico’s exchange in 2019, with only 45,001 people signing up for individual market private plans.

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 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. 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, but fell back to 35th in the 2019 ranking (based on 2017 data).

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 (49th place) and the Healthy Lives category (42nd place), it was in the top quintile (3rd place) for the Disparity metric. As of the 2019 analysis, New Mexico was still challenged by high rates of uninsured adults (ranked 34th 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. 2019 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).

Medicare in the state of New Mexico

New Mexico Medicare enrollment reached 423,496 by the fall of 2019. This is about 20 percent of the state’s population, which is a little higher than the percentage of the entire US population enrolled in Medicare (roughly 18.7 percent).

About 84 percent of New Mexico’s Medicare recipients are eligible based on age alone, and the other 16 percent are on Medicare as the result of a disability.

In 2017, Medicare spending amounted to $7,954 per beneficiary in New Mexico, which was 19 percent lower than the national average.

In 2018, 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-eight percent have stand-alone prescription drug coverage through a Medicare Part D plan. Nationally, about 43 percent of Medicare recipients select an Rx plan.

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 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 entitied (KNG Health Consulting, IHS Markit, and Lee Reynis, a researcher based in Albuquerque) have been awarded a $390,000 contract to conduct the study. A public meeting about the fiscal analysis took place in Albuquerque on December 4. 

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.