What You Need to Know
New Mexico Medicare Advantage (MA) plans are a bundled, all-in-one alternative to Original Medicare that can help lower your healthcare costs.
Most MA plans include Medicare Part D prescription drug coverage.
The average monthly cost for an MA plan in New Mexico is $13.26, which is below the national average of $21.
What Are Medicare Advantage Plans in New Mexico?
Medicare has significant out-of-pocket costs. Medicare Parts A and B have deductibles, copays and coinsurance. New Mexico Medicare Advantage (MA) plans are a bundled, all-in-one alternative to Original Medicare offered by private insurance companies that help lower your healthcare costs.
Also known as Medicare Part C, these plans typically include Medicare Part D prescription benefits. Most plans also include other benefits, like vision, dental and hearing care.1
What Types of Medicare Advantage Plans Are Available?
New Mexico residents have access to several types of MA plans, including:
- Health maintenance organization (HMO): With this type of plan, you must seek treatment from providers within the plan’s network (except for emergencies). If you visit an out-of-network provider, you’ll be responsible for the costs. You typically need a referral to see a specialist.
- Preferred provider organizations (PPO): With this plan type, you can visit in- or out-of-network providers. You will pay more if you go to out-of-network providers, however. You typically don’t need a referral to see a specialist.
- Special needs plans (SNP): These plans are for Medicare members with specific healthcare needs. There are three types of SNPs:
- Chronic condition SNP (C-SNP): This plan is for people with health conditions like diabetes, HIV/AIDS, cancer, and end-stage renal disease (ESRD).
- Dual eligible SNP (D-SNP): This option is for people who are eligible for both Medicare and Medicaid.
- Institutional SNP (I-SNP): This plan is for people who either are in an institution, like a nursing home, or are receiving nursing-home level care at home.
- Private fee-for-service (PFFS) plans: These plans may or may not have a network. You can go to any healthcare provider that agrees with the plan’s terms and conditions.
- Medical savings account (MSA): This option combines a high deductible MA plan with a medical savings account (MSA). The insurance company puts money into your MSA that you can use to pay Medicare-approved healthcare costs. If you run out of money in your MSA before meeting your deductible, you’re responsible for paying your healthcare costs until you reach your deductible.2
Understand the Different Plan Types
Different types of Medicare Advantage plans have different regulations for seeing out-of-network providers and specialists. Be sure you know what the rules are for any plan you are considering.
What Are Prescription Drug Options with Medicare Advantage Plans?
Most MA plans include Medicare Part D prescription drug coverage. If you enroll in an HMO or PPO without drug coverage, you cannot purchase a separate Part D plan. If you enroll in some PFFS plans or an MSA, you can purchase a separate Part D plan from a private insurer.
Keep in mind that if you don’t sign up for one of the Part D prescription drug plans when you’re first eligible, you may have to pay a late enrollment penalty.3
How Do You Choose a Medicare Advantage Plan?
New Mexico residents have several factors to consider when choosing an MA plan.
- Premium: Many plans have a $0 monthly premium, but some plans charge more. Keep in mind that you’ll also need to pay your monthly Medicare Part B premium.
- Coinsurance: This is a percentage you pay for a service. For example, you might pay 20% for durable medical equipment.
- Copayments: This is a fixed amount you pay for a service. For example, you might pay $50 for an urgent care visit.
- Deductibles: This is the amount you pay for Medicare-approved services before your plan starts paying.4
- Out-of-pocket maximum: This is the most you’ll pay out-of-pocket in a given year.5
- Plan benefits: Most plans offer additional benefits, which may include:
- Vision care: This typically includes eye exams and glasses.
- Dental care: This usually includes cleanings and routine visits and may cover more advanced services like crowns and dentures.
- Telehealth: This allows you to visit with healthcare providers from home either online or by phone.6
- Other perks: This may include transportation to medical appointments or a membership in a local gym.7
Besides monthly premiums, New Mexico Medicare Advantage plans may also have copays, coinsurance, deductibles, and out-of-pocket maximums.
When and How to Enroll in a Medicare Advantage Plan
You can only enroll in Medicare Advantage plans at specific times. Here are your opportunities.
- Initial Enrollment Period: This period starts three months before the month you’re eligible for Medicare and lasts for three months after. For most people, this is when you turn 65. If you’re receiving disability benefits, Medicare starts after you’ve been receiving Social Security payments for 24 months.
- Open Enrollment Period: Also known as the Annual Election Period, this lasts from October 15 – December 7 each year. During this time, you can enroll in an MA plan, switch plans, or drop your coverage.
- Medicare Advantage Open Enrollment Period: This lasts from January 1 – March 31 each year. During this period, you can drop your MA plan or switch plans.
- General Enrollment Period: This period is also from January 1 – March 31. If you enroll in Medicare Part B during this time, you can enroll in an MA plan. However, your plan coverage may not start until July 1.8
- Special circumstances: You’re also entitled to enroll in a plan under certain circumstances, including:
- Plan changes: For example, if Medicare terminates its contract with your plan, you can enroll in new coverage.
- Moving: If you move out of your plan’s service area, you can enroll in a new plan.
- Health changes: If you’re diagnosed with a chronic condition that would be better served by a C-SNP, you can enroll in a new plan.
- Coverage changes: For example, if you qualify for Medicaid, you can enroll in a D-SNP.9
To enroll in a plan, contact the insurance company you’re interested in, a licensed professional or use the Medicare Plan Finder.
What’s Medicare Advantage Enrollment in New Mexico?
New Mexico has a penetration rate of about 36%, which means 36% of everyone eligible for Medicare has enrolled in an MA plan.
How Much Do Medicare Advantage Plans Cost in New Mexico?
The average cost for an MA plan in New Mexico is $13.26. This is below the national average of $21.10
For example, a Medicare beneficiary living in Albuquerque has access to 32 MA plans. Eighteen of these plans have a $0 premium. Ten plans range from $10 to $40 per month, and the most expensive plan is $188 per month.
How Do You Change Your Medicare Advantage Plan?
You can change your MA plan during the Medicare Advantage Open Enrollment Period, which lasts from January 1 – March 31 each year. To change plans, contact the plan you want to enroll in, a licensed professional or use the Medicare Plan Finder.11
What Are Alternatives to Medicare Advantage Plans?
Original Medicare is one alternative to an MA plan. You can have Original Medicare on its own, which leaves significant out-of-pocket costs. You could also buy Medicare Supplement insurance to help cover those costs.
Medicare Supplement insurance plans (also known as Medigap plans) are also sold by Medicare-approved private insurance companies, and they don’t include prescription benefits. If you want prescription coverage, you’ll also need to purchase a Medicare Part D plan.12 This means you could have as many as three types of coverage (Original Medicare, Medicare Supplement, and Part D) rather than just one MA plan.
Another alternative is the Program of All-Inclusive Care for the Elderly (PACE). This program provides long-term care services to people with Medicaid and/or Medicare to help them stay in their home rather than move to a nursing home. Learn more from the Human Services Department.
What Are Medicare Resources in New Mexico?
New Mexico residents have access to several Medicare resources:
- State Health Insurance Assistance Program (SHIP): This program is run by the Aging and Disability Resource Center. It provides free, unbiased information about Medicare and related health insurance programs. Call them at 1-800-432-2080.
- Office of the Superintendent of Insurance: This is New Mexico’s consumer protection agency for insurance. If you have an issue with an MA plan, you can file a complaint online.
- Medicaid: This program provides low- and no-cost healthcare to people with limited income and assets. Apply online.
To find the best MA plan for you, look at whether the ones you are interested in have a network and whether your preferred providers are a part of that network. If the plan has prescription drug coverage, confirm that your prescriptions are covered. Consider the out-of-pocket expenses and choose a plan that’s affordable and that provides the coverage you need.