Frequently asked questions about health insurance coverage options in New Mexico
New Mexico runs its own health insurance exchange, beWellnm. The state used HealthCare.gov until the fall of 2021 (as a state-based exchange using the federal enrollment platform, or SBE-FP). But starting in November 2021, the state began to have a fully state-run exchange, using beWellnm for enrollment.
For small businesses, New Mexico already had its own SHOP exchange enrollment platform on beWellnm, where employers can select a small group plan for their employees. But as of 2023, New Mexico is considering discontinuing its SHOP platform (most other states have already done this).
beWellnm is also one of just three state-run exchanges that collect premiums from enrollees and send them on to the insurers (in the rest of the country, including all of the states that use HealthCare.gov, enrollees pay premiums directly to the insurers). But New Mexico is also considering dropping this feature and transitioning to the approach used in most other states.
Read our overview of the New Mexico health insurance marketplace.
Open enrollment for individual/family coverage runs from November 1 to January 15 in New Mexico, so the open enrollment period for 2024 coverage will begin on November 1, 2023.
Outside of open enrollment, a special enrollment period is necessary to enroll or make changes to your coverage.
Special enrollment periods are generally linked 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.
Learn more about enrollment opportunities in our comprehensive guide to open enrollment and to special enrollment periods.
In New Mexico, consumers may be able to buy affordable individual and family health insurance by enrolling through the ACA marketplace (HealthCare.gov). Nearly 90% of consumers who enrolled in 2022 coverage through their state exchange received premium subsidies.
New Mexico residents may also find affordable coverage through Medicaid if they’re eligible. See Medicaid eligibility guidelines in New Mexico.
The New Mexico exchange has four insurers offering plans statewide:
- Blue Cross Blue Shield of New Mexico (Health Care Service Corporation)
- Molina
- Presbyterian Health Plan (rejoined the marketplace for 2022)
- Western Sky Community Care (Ambetter/Centene)
True Health/Bright Health and Friday Health Plans offered coverage through beWellnm in 2022, but exited the market at the end of 2022.
Consumers in New Mexico have more insurer options than consumers in most of the rest of the country. This is because New Mexico requires participating insurers to offer at least one plan statewide at each metal level that the insurer wants to offer (Silver and Gold plans are required by the ACA; insurers can choose to offer plans at the other metal levels).
Before we get into specific rate change information, it’s important to note that starting in 2022, New Mexico requires insurers to price Silver plans based on the fact that most silver plans come with cost-sharing reductions that give them a higher actuarial value (ie, more robust coverage). So Silver plan rates are higher than they used to be in New Mexico, resulting in larger premium subsidies (since subsidy amounts are based on the cost of the second-lowest-cost Silver plan in each area). The Office of the Superintendent of Insurance noted that most enrollees would see their net premiums decrease in 2022.
And starting in 2023, New Mexico is providing additional state-funded subsidies to exchange applicants with income up to 300% of the poverty level. The combination of the state’s approach to silver-plan rates and the state-funded subsidies means that most residents have access to coverage that’s more affordable than it would otherwise be.
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
Before Friday Health Plans announced that they would exit the market, the weighted average rate change amounted to an increase of about 11.3%. But Friday’s average increase (more than 16%) was the highest of any of the insurers, so the weighted average rate increase ended up being lower than 11%.
During the open enrollment period for 2023 coverage, 40,689 people enrolled through beWellnm, according to CMS. That was lower than CMS had reported the year before, when they indicated that 45,664 people enrolled. But there could be an error in one of those enrollment totals, and 2023 enrollment might be higher than 2022 enrollment (which would be expected, given the new state-funded subsidies that debuted in 2023).
New Mexico agreed to accept federal funding to expand Medicaid coverage eligibility under the Affordable Care Act and, as of early 2014, it was estimated that nearly 48% of the uninsured population in New Mexico would be eligible for expanded Medicaid coverage.
As expected, Medicaid enrollment initially grew rapidly, and then stabilized. By the end of 2017, it was about 63% higher than it had been in 2013. But as of October 2022, Medicaid enrollment in New Mexico was 93% higher than it had been in 2013, reflecting an increase in enrollment driven by the coronavirus pandemic and the three-year pause on Medicaid disenrollments (March 2020 through march 2023).
A significant number of New Mexico’s Medicaid enrollees are eligible due to the state’s expansion of Medicaid under the ACA. As of mid-2022, nearly 300,000 New Mexico residents were enrolled in Medicaid under the expanded eligibility guidelines.
Read more about Medicaid expansion 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 health insurance plans to have longer coverage periods, New Mexico changed its rules.
Currently, the state only allows short-term health insurance 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, insurers stopped offering short-term health insurance plans in New Mexico, and the state is now one of 13 (including DC) where there are no short-term plans for sale.
Read more about short-term health insurance in New Mexico.
New Mexico Health Connections (one of only four ACA-created CO-OPs that were still operational in the United States as of 2020) closed its doors at the end of 2020, leaving just three CO-OPs operational nationwide.
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 fully state-run exchange, and seems to be moving in a better direction.
According to U.S. Census data, the uninsured rate in New Mexico was 18.6% in 2013, but was reduced by more than half – to 9.2% – by 2016. But it had increased to 9.5% by 2018, and to 10% by 2019, in keeping with the nationwide trend of a growing uninsured rate under the Trump administration.
As of 2022, there were nearly 300,000 New Mexico residents enrolled in expanded Medicaid, all of whom were eligible for this coverage as a result of the ACA.
And as of early 2022, there were more than 45,000 New Mexico residents with private health plans selected through the exchange, all of whom had coverage for the ACA’s essential health benefits. The majority of these enrollees were receiving premium subsidies that make their monthly premium costs more affordable (thanks in part to the American Rescue Plan’s subsidy enhancements, which have been extended through 2025).
New Mexico opted to create a state-run exchange from the start, but from 2014 through 2021, the state relied on the federal government’s HealthCare.gov enrollment platform and call center (this is called a state-run exchange on the federal platform, or SBE-FP).
As of the fall of 2021, however, New Mexico transitioned away from HealthCare.gov and now run its own enrollment platform (beWellnm) and call center.
On January 9, 2013, Governor Susana Martinez announced that New Mexico would participate in Medicaid expansion, describing expansion as “what is best for New Mexicans.” At the time, Martinez was only the second Republican governor to accept Medicaid expansion.
As of October 2022, there were 447,491 New Mexico residents enrolled in Medicare plans, including those with Original Medicare as well as those with Medicare Advantage plans.
Read more about Medicare enrollment in New Mexico, including the state’s rules for Medigap plans.
- Health Action New Mexico
- beWellnm — The state’s exchange for small businesses, individuals, and families
- New Mexico Aging and Disability Resource Center
- New Mexico Office of the Superintendent of Insurance — Licenses and regulates health insurance companies in New Mexico, as well as brokers and agents; can provide assistance and information to consumers who have questions or complaints about regulated entities.
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).
Codifying the ACA’s consumer protections was a nod to the possibility that the ACA could have been overturned by the Supreme Court in the California v. Texas (Texas v. Azar/US) lawsuit, although the Court ultimately upheld the ACA in 2021. And the federal government implemented surprise balance billing protections nationwide in 2022, under the No Surprises Act.
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 the issue is being revisited in 2023, with H.B.400.
In 2021, New Mexico enacted S.B.317, which creates the Health Care Affordability Fund in New Mexico, and also eliminates cost-sharing when people with state-regulated health plans (ie, plans that aren’t self-insured) seek behavioral health care. The state is calling plans with the additional state-funded cost-sharing reductions (and federal cost-sharing reductions, in some cases) Turquoise plans, to make them easy for consumers to find.
In 2020, New Mexico enacted H.B.100, under which the state has created standardized health plans at the Silver, Gold, and Turquoise level, which will be available for purchase starting in the fall of 2023.
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. 2022 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 (nearly 13% of Medicare beneficiaries in New Mexico are under the age of 65).
NMMIP has also served 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.