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.
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 2023 coverage will begin on November 1, 2022.
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) do not require a specific life event.
The New Mexico exchange has six insurers offering plans statewide:
- Blue Cross Blue Shield of New Mexico (Health Care Service Corporation)
- Friday Health Plans
- Presbyterian Health Plan (rejoined the marketplace for 2022)
- True Health (owned by Bright Health)
- Western Sky Community Care (Ambetter/Centene)
True Health/Bright Health will exit the market at the end of 2022, so consumers with True Health coverage will need to select a plan from another insurer during the open enrollment period that begins November 1, 2022. A new plan will be automatically selected for those with on-exchange coverage who don’t select their own new plan (but it’s recommended that people select their own replacement coverage, in order to get the plan that best fits their needs).
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).
The following average rate changes were approved for 2022 in New Mexico. It’s important to note here that New Mexico required insurers to price 2022 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):
- Molina: Average increase of 25.7%
- Blue Cross Blue Shield of New Mexico (Health Care Service Corporation): Average decrease of 4.5%
- True Health: Average increase of 11.77%
- Friday Health Plans: Average increase of 2.47%
- Western Sky Community Care (Ambetter/Centene): Average decrease of 4.17%
- Presbyterian Health Plan: 0% rate change (Presbyterian Health Plan rejoined the exchange for 2022, after exiting at the end of 2016)
The weighted average rate change for 2022 amounted to an increase of about 8.6%. But that’s before any subsidies are applied. Most enrollees qualify for subsidies (especially now that the American Rescue Plan is in place), and the subsidies are larger for 2022, due to the way the state required insurers to price Silver-level plans. The Office of the Superintendent of Insurance noted that most enrollees would see their net premiums decrease in 2022.
45,664 people enrolled in coverage through beWellnm during the open enrollment period for 2022 coverage.
That was a 6% increase over the year before, but still quite a bit lower than 2016’s enrollment, when nearly 55,000 New Mexico residents enrolled in coverage through the marketplace/exchange during open enrollment.
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 November 2021, Medicaid enrollment in New Mexico was 88% higher than it had been in 2013, reflecting an increase in enrollment driven by the coronavirus pandemic.
A significant number of New Mexico’s Medicaid enrollees are eligible due to the state’s expansion of Medicaid under the ACA. As of late 2021, 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 11 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 late 2021, 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 are in effect throughout 2022).
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.
- 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 is a nod to the possibility that the ACA could be overturned by the Supreme Court in the California v. Texas (Texas v. Azar/US) lawsuit, but 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.
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.
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 14% 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.