The Land of Enchantment has plenty of health care options for residents. According to a study by US News, New Mexico has the 31st best health care in the nation. That study looks at access, quality, and public health.
Health insurance options in New Mexico
There are several avenues for NM residents to get health care:
Employer-provided
- From your employer
- Through your spouse's employer
Individual or family plans
- Through HealthCare.gov
- Directly from a health insurance company
Government-assisted
- Medicare
- Medicaid
Where do most New Mexico residents get their health insurance coverage?
| Sources | Percent | ||
|---|---|---|---|
| Employer-Provided | 37% | ||
| Individual or family | 4% | ||
| Medicaid | 33% | ||
| Medicare | 15% | ||
| Military | 2% | ||
| Uninsured | 9% | ||
| Source: Kaiser Family Foundation, Health Insurance Coverage of the Total Population | |||
Nine percent of NM residents are uninsured, on par with the national average. Which is good news for residents. High rates of uninsured people lead to higher rates for policyholders.
New Mexico health insurance companies
There are several provider options for NM residents. These health insurance companies offer both individual and family plans in your state:
- BlueCross BlueShield of New Mexico
- Friday Health Plans
- Molina
- True Health
- Western Sky Community Care (Ambetter/Centene)
New Mexico health insurance costs and rate factors
NM residents spend an average of $7,214 per year on health care, less than the national average. So, what determines your rates in the Land of Enchantment? Prices vary person to person, but are based mostly on these factors:
Health insurance plan type
Marketplace plans come in metal tiers: bronze, silver, and gold. More health care coverage costs more in monthly premiums.
How much should you expect to pay in NM? These are the average monthly prices for each plan type for a middle-aged resident in 2020:
| Bronze | Silver | Gold | |
|---|---|---|---|
| $257 | $326 | $342 | |
| Source: Kaiser Family Foundation, Change in Average Marketplace Premiums by Metal Tier | |||
Gold plans cost 33 percent more than bronze plans. However, in New Mexico silver plans cost more than gold plans. Why? New Mexico prices scrambled after the federal government ended certain subsidies for insurers. Companies increased the price of their plans, especially silver plans, to make up for these changes. That means you can buy more coverage for lower monthly premiums. However, this could change.
Residents may also qualify for a catastrophic plan, the lowest level of coverage available. These plans come with low monthly premiums but a yearly deductible of $8,150. You may save money with a gold or bronze plan if you need to use your insurance.
Body mass index
According to the CDC, a high body mass makes you more likely to suffer from several health conditions. Insurance companies analyze your BMI to determine your risk-level. Thus, people with a high BMI pay more for health insurance.
In 2019, NM had a 32 percent obesity rate, the 28th highest rate in the country. Out of the many state residents who used QuoteWizard to compare health insurance plans, 35 percent have an obese BMI.
Tobacco use
Tobacco users pay more for health insurance due to the high risks from smoking. About 17 percent of NM residents are smokers, the 21st lowest rate in the country.
Age
According to HealthCare.gov, older people tend to pay up to three times more for health care than younger people. NM residents who used QuoteWizard to shop for health insurance are, on average, 43 years old.
Location
Where you live plays a big role in your rates. All states have different rules, regulations, and providers surrounding their health care.
Also, health insurance rates are community rated. That means that costs are based in part on the combined claims that everyone files. So, if your state files an abnormal number of claims, your prices could skyrocket.
That’s why living in a health-conscious state helps keep your premiums low. According to America’s Health Rankings, NM is the 36th healthiest state in the country.
New Mexico health insurance laws
The Affordable Care Act determines what insurance companies can use to price your policy.
- Pre-existing conditions: Before the ACA, people with pre-existing conditions paid more for health insurance. Now, insurance companies can’t charge higher rates because of a pre-existing condition.
- Gender: The ACA mandates that insurance companies can’t charge women and men different prices for the same plan. That’s good news, especially because women historically pay more for health care.
- Insurance and medical history: Insurance companies would also analyze your medical history and your past insurance coverage. The ACA no longer allows providers to base your prices on previous medical problems or lapses in insurance.
There’s a limit to how much you’ll be paying out-of-pocket for a marketplace plan. In 2020, the out-of-pocket maximum is $8,150 for an individual plan and $16,300 for a family plan.
State law requires health insurance companies to provide at least some coverage for the following services:
- Maternity transport
- Autism spectrum disorder diagnosis and treatment
- Immunization coverage
- Cancer screenings
- Diabetes
- Hearing aid coverage for children
- Cancer clinical trials
There are additional services that providers need to offer. Find the full list on cms.gov.
Medicare and Medicaid in New Mexico
Medicare and Medicaid are both government-funded health care programs that cater to two different groups of people. Medicare covers seniors, and Medicaid helps low-income families and children.
Medicare
NM residents 65 and older qualify for Medicare. The program has multiple coverage options, including parts A, B, C, D, and supplemental coverage plans. You may also qualify for one of these Medicare Savings Programs:
- Individual monthly income limit: $1,456
- Married couple monthly income limit: $1,960
Medicaid
The number of uninsured Americans has seen dramatic improvement since the Affordable Care Act (ACA) became law in 2010. Here’s how a key component of that legislation, Medicaid expansion, helped decrease New Mexico's uninsured rate over the last decade.
In 2008, 416,900 New Mexico residents, or 22% of the state’s population, were uninsured. Between when the state expanded its Medicaid program in 2014 and 2018, New Mexico’s uninsured rate dropped to 9%. Driving this reduction was a 87% increase in Medicaid enrollment — to 673,300 New Mexico residents — from 2008 to 2018.
Low-income families and children are eligible for Medicaid. These are the state’s Medicaid financial requirements:
| Household Size | Maximum Yearly Income |
|---|---|
| 1 | $16,971 |
| 2 | $22,930 |
| 3 | $28,888 |
| 4 | $34,846 |
| 5 | $40,805 |
| 6 | $46,763 |
| 7 | $52,722 |
| 8 | $58,680 |
New Mexico Office of Superintendent of Insurance
- Website:
- Homepage
- Insurance Commissioner:
- John G. Franchini
- Insurance Hotline:
- (855) 427 - 5674
- Office Hours:
- Monday - Friday
9:00 am to 5:00 pm
- File a Consumer Insurance Complaint
- Complaint Page
Sources:
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