What You Need to Know
Medicare Supplement plans in New Mexico are extra coverage from private insurance providers.
Medigap policies help pay for costs not covered by Medicare, like deductibles and copayments.
You’ll need to purchase a separate Medicare Part D plan for prescription drug coverage.
You might know you can sign up for Medicare, the federal health insurance program for seniors, after turning 65. You’ll first sign up for Original Medicare, or Medicare Part A and B. Original Medicare covers a lot of medical costs, but there are still out-of-pocket costs to consider.
You can help pay for these expenses with a Medicare Supplement plan, or Medigap policy. Medicare Supplement Insurance plans in New Mexico are offered by private insurance companies. They provide additional coverage to help cover out-of-pocket costs related to Original Medicare.
When Can You Enroll in Medigap?
Before you sign up for a Medicare Supplement plan in New Mexico, you’ll first need to enroll in Original Medicare.
- Medigap Open Enrollment Period (OEP): Your first chance to enroll is during the six months after you turn 65 and join Medicare Part B. This is the best time to enroll in a Medicare Supplement plan in New Mexico. Insurance companies aren’t allowed to deny your application based on preexisting health conditions such as diabetes or cancer. They also can’t charge you more because of your health.1 This means you’ll have access to the most plans at the best prices.
- Outside Open Enrollment Period: You can still buy a Medigap policy outside of your OEP. However, insurance companies can turn you down or charge you more based on your health.
- Guaranteed Issue: Certain circumstances give you the right to buy a Medigap policy in New Mexico outside of your OEP, known as guaranteed issue rights. Insurance companies can’t charge you more, reject your application or impose a waiting period because of your health.2
- Special Enrollment Period: You can enroll in any Medicare Supplement plan outside of your OEP if you have a guaranteed issue right. Times where you have guaranteed issue include:
- You have coverage from a group plan, such as an employer, and that coverage is ending
- You’re moving out of a Medicare Advantage plan’s service area
- You joined a Medicare Advantage plan and decide to switch to Original Medicare within a year of enrolling
- Your current insurance company committed fraud and was terminated
When to Sign Up
The best time to sign up for a Medicare Supplement plan is during your Medigap Open Enrollment Period.
What Are the Most Popular Medicare Supplement Plans?
Over 67,000 Medicare beneficiaries are enrolled in Medicare Supplement Insurance plans in New Mexico. The most popular plans are F, G and N. Medigap Plan F has over 40,000 enrollees. Medigap Plan G is next, with over 12,000 members.3
- Plan F: This plan covers most of the costs of Medicare Part A hospital insurance, including up to three pints of blood. It pays for hospital and hospice care and skilled nursing facility coinsurance. The plan also covers your Medicare Part A and B deductibles. You can’t sign up for Plan F if you became eligible for Medicare after January 1, 2020.
- Plan G: Plan G is a good alternative if you’re not eligible for Plan F. It covers similar things, including hospital and skilled nursing facility coinsurance. However, the plan doesn’t cover your Medicare Part B deductible.
- Plan N: This plan covers your Medicare Part A coinsurance and deductible. It also pays for Medicare Part B copayments. It doesn’t cover your Part B deductible or Medicare Part B excess charges.
How Do You Choose a Medicare Supplement Plan?
If you think a Medigap policy provides the coverage you need, start comparing plans before your OEP. Plans are standardized, making it easy to compare costs between private insurance providers.
You should also consider other healthcare needs like prescription drugs. Medicare Supplement plans in New Mexico don’t cover medications. You can get prescription drug coverage from a separate Medicare Part D plan.
How Much Do Medigap Policies Cost?
Insurance providers use three ratings to price plans.
- Community-rated: Everyone on the plan pays the same premium.
- Issue-age-rated: Premiums are based on your age when you sign up and don’t go up as you age.
- Attained-age-rated: Your premium increases as you get older.
In Albuquerque, you could pay between $97 and $587 per month for a regular Plan G, or between $26 and $163 with a high-deductible option. This is in addition to the Medicare Part B premium of $148.50 a month for most Medicare enrollees in 2021.4
What If You Want to Change Your Medigap Policy?
Switching Medigap policies in New Mexico is as simple as applying for a new plan. However, you could be denied or charged higher rates if you don’t have a guaranteed issue right or are outside of your OEP. If you join a new plan, you’ll need to contact your old provider and request to cancel your existing plan.
Outside your OEP, signing up for a Medigap policy can be more difficult and more expensive, except in certain situations.
What Are Alternatives to Medicare Supplement?
You can replace Original Medicare in New Mexico with a Medicare Advantage (MA), or Medicare Part C, plan. MA plans are private insurance that must offer the same coverage as Original Medicare. Most plans use a provider network, such as an HMO or PPO, and include coverage for prescription drugs.
What Are Medicare Resources in New Mexico?
- New Mexico Aging & Disability Resource Center: The ADRC runs the New Mexico State Health Insurance Assistance Program (SHIP), which offers free, unbiased counseling to help you enroll in Medicare and find the right coverage.
- NM Office of Superintendent of Insurance: This state department provides resources to protect insurance consumers, including Medicare beneficiaries.
- New Mexico Medicaid, or Centennial Care: Low-income seniors and those with certain disabilities may qualify for free or low-cost medical coverage through Medicaid.
Does a Medigap policy provide the right coverage for you? If so, you’ll want to compare Medicare Supplement Insurance plans in New Mexico before you turn 65. This way, you’ll be ready to buy a Medigap policy as soon as you enroll in Original Medicare.