Frequently asked questions about health insurance
coverage options in New Mexico
New Mexico has a state-run health insurance marketplace that utilizes the federal enrollment platform at HealthCare.gov (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.
Read our overview of the New Mexico health insurance marketplace.
Open enrollment in New Mexico for 2021 health plans ran from ended December 15, 2020, but the federal government is currently offering a one-time COVID-related enrollment window, which continues through August 15, 2021.
This enrollment window is a good opportunity for uninsured or underinsured residents to obtain marketplace coverage, and it allows people to take advantage of the enhanced premium subsidies created by the American Rescue Plan.
The annual open enrollment window for 2022 coverage will start November 1, although New Mexico’s new fully state-run marketplace might opt for an extended enrollment deadline (in states that use HealthCare.gov, enrollment ends December 15 unless the Biden administration opts to extend it; states that run their own enrollment platforms can choose to extend the enrollment window, and most tend to do to). Open enrollment is an opportunity for individuals and families to sign up for new health coverage, or renew or change an existing plan for the coming year.
New Mexico residents with qualifying events can enroll outside of the open enrollment period.
Although small group health plans are available through New Mexico’s state-run SHOP exchange (beWellnm for small businesses), employers are not limited to purchasing coverage during a particular time of the year. The SHOP exchange relaxed its rules regarding employer contributions in 2019, allowing more small businesses to obtain coverage for their employees, even if they needed the employees to cover the majority of the cost.
For people employed by a business – small or large – that offers health benefits, the employer sets the schedule for the annual open enrollment period, giving employees time to make changes to their coverage for the coming plan year if they wish to do so.
New Mexico had four individual market insurers in 2020, but New Mexico Health Connections – one of just four remaining ACA-created CO-OPs in the nation – closed at the end of 2020 and did not offer plans for 2021.
But two new insurers – Friday Health Plans and Western Sky Community Community Care (Ambetter/Centene) – joined New Mexico’s marketplace for 2021. So the total number of participating insurers has grown to five.
The insurers offering coverage in New Mexico’s exchange for 2021 implemented the following average rate changes:
- Molina: Average rate decrease of 0.42%
- Blue Cross Blue Shield of New Mexico (Health Care Service Corporation): Average rate increase of 7.61%
- True Health: Average rate decrease of 1.42%
- Friday Health Plans: New to the market so no applicable rate change.
- Western Sky Community Care (Ambetter/Centene): New to the market so no applicable rate change.
Nearly 43,000 New Mexico residents enrolled in 2021 coverage through the state’s marketplace. This was the first year-over-year increase in five years, but it’s still down more than 21% from peak enrollment in 2016.
More than 2,200 New Mexico residents enrolled in plans through the marketplace during the first several weeks of the COVID/American Rescue Plan enrollment window in 2021; that window continues through August 15, giving thousands of other residents time to sign up for coverage and take advantage of the American Rescue Plan’s larger and more widely available subsidies.
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 May 2020, an estimated 807,831 New Mexico residents were enrolled in Medicaid plans – up 77% from fall of 2013, and 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 2019, 258,061 New Mexico residents were enrolled in Medicaid under the expanded eligibility guidelines. That number has likely grown higher in 2020 as a result of the job and income losses caused by the pandemic.
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 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% 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 2019, there were more than 258,000 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 2021, there were nearly 43,000 New Mexico residents with private health plans selected through the exchange, all of whom had coverage for the ACA’s essential health benefits. Nearly three-quarters were receiving premium subsidies that make their monthly premium costs more affordable — and that was before the American Rescue Plan made premium subsidies larger and more widely available for 2021.
New Mexico opted to create a state-run exchange from the start, but has always 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). But as of the fall of 2021, New Mexico plans to transition away from HealthCare.gov and run its own enrollment platform 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.
By the fall of 2014, a total of nine Republican governors had agreed to expand Medicaid. And by early 2018, the majority of the Medicaid expansion states had Republican governors.
As of February 2021, there were 434,640 New Mexico residents enrolled in Medicare plans, including those with Original Medicare as well as those with Medicare Advantage plans. Most Medicare beneficiaries are eligible because of their age, but 16% of New Mexico’s Medicare population is under 65 and eligible because of a disability.
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 (as of the fall of 2021, individuals and families will also use this platform to enroll in health coverage; until then, they use HealthCare.gov).
- 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. 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.