Health Insurance Options in New Mexico

In the past, people typically obtain health insurance from plans offered at work, public health plans (e.g. Medicare, Medicaid, and Children's Health Insurance Program [CHIP]), and private health care programs. As a result of the Affordable Care Act, New Mexico health insurance application is streamlined through New Mexico Health Insurance Exchange (NMHIX): This covers application for state- and federal-funded health insurance plan, including those in the expanded Medicaid program and new Marketplace. Applications can be made online, over the phone, in-person, and by mailing your application packet:-

  • Website: Be Well NM. Currently, online applications will be directed to HealthCare.gov Account Creation site, although the plan is to have Be Well NM to accept online applications.
  • Telephone: 1-855-99-NMHIX or 1-855-996-6449. This help is available 24/7.
  • Assistance: (Be Well NM Help): Depending on where you live in New Mexico, you may be able to get application assistance from an agent or a health care guide. From the site or by calling the NMHIX hotline (1-855-996-6449), you will be able to get a list of these individuals and organizations in your area, from which you will be able to get face-to-face assistance. Check for their operating hours. Most of them operate during regular office hours.
  • Mailing or faxing the form: If you wish to complete a paper form, you may request a form by contacting NMHIX hotline (1-855-996-6449), agents, or health care guide (see the previous two points).

According to HealthCare.gov, consumers can also buy health insurance plans directly from an insurance company, with a health insurance agent or broker, and from online health insurance companies. The site also noted that insurance plans inside and outside the Marketplace are "similar", and the main difference is: "The only way to get lower costs on your monthly premiums based on your income is through the Marketplace."

Expanded Health Insurance in New Mexico

The Affordable Care Act is expected to extend adequate health insurance coverage through:

  1. Medicaid expansion
  2. Exchange or Marketplace private health care coverage

People who are insured by Medicare (mostly, 65 years old and older) or employment will continue to be covered by these health plans. The aforementioned Medicaid expansion and Exchange will provide health coverage and additional health insurance financial subsidies to uninsured and underinsured individuals.

Medicaid Expansion

Your eligibility depends on federal poverty level (FPL), determined mainly by number of people in your household and household size, as depicted in Table 1. Individuals in NM who fall below 138%[1] FPL qualify for the Medicaid plan, which provides free health coverage. Individuals in New Mexico who are better off by the FPL would obtain financial support in their purchase of health care. Converting these numbers to annual income, an individual in New Mexico earning less than $45,000 or living in a household with less than $92,000 may get some assistance in healthcare insurance.

Exchange

While Medicaid provides free health coverage to low income households, Conducted via Marketplace, Exchange provides financial assistance for middle-class households. Lower income households who do not qualify for Medicaid qualify for two federally subsidized affordability provisions:

  1. Premium Tax Credits: Available to people with income between 100% and 400% FPL. This is for premium payments to keep you in the insurance plans.
  2. Cost-Sharing Reductions: Available to people with income between 100% and 250% FPL. Cost-sharing determines the out-of-pocket payments such as copayments for doctor's visit and office visits.
  3. Using the online health insurance marketplace system called Marketplace, people will be able to shop for health care plans as if they were shopping for flights or hotel reservations via Expedia, Hotwire, Travelocity, and Priceline. There will be four types of plans sold in the Exchange: bronze, silver, gold, and platinum - which determine monthly premium and copayments. The Marketplace website lets you compare different health insurance plans by main characteristics such as premium prices, copay/deductible levels, and covered benefits. Health insurance will still be sold outside Marketplace, but Marketplace is the only pace to get premium tax credits and cost-sharing reductions. These plans will take into account your last year's or expected Modified Adjusted Gross Income (MAGI).

    There are three parties who will utilize the Exchange:

    1. People who do not get health insurance through their job
    2. People who earn too much money to qualify for Medicaid
    3. Small businesses with less than 50 employees

    Tied to Taxes. The Exchange system will be highly tied to your taxes, which may be inferred by the premium tax credit. When enrolling online, in-person, mail, fax, or over-the-phone, people need to provide their income or last year's tax return so that projected premium tax credit can be calculated, similar to using W-4 to calculate the expected or correct amount of tax withholding. Make sure you elect to receive the premium tax credit in advance, otherwise, you will have to pay for the health insurance premium with you money upfront and get "reimbursed" with your tax refund, if any. You may have been overpaying or underpaying for your insurance plans. So, the health plan dollar reconciliation will be done when you file for your tax returns.

    Where to Enroll

    You can apply for Medicaid and Exchange health insurance plans starting on October 1, 2013 for coverage that begins as early as January 1st. However, you need to apply no later than March 31, 2014, otherwise you may be fined for being uninsured. Remember that you can get Medicaid even if your employer offers health insurance benefits. If you are not sure of your Medicaid and Exchange eligibility, just contact one of the listed contact information below. To apply for Medicaid or Exchange, you need to get in touch with at least one of these services:

    • New Mexico Human Services Department, Income Support Division (ISD) Office: 1-888-997-2583.
    • New Mexico Health Insurance Exchange
    • National Marketplace Toll-Free Call Center: 1-800-318-2596; (TTY 1-855-889-4325)
     
    [1] ACA provisions expand Medicaid eligibility to 133% FPL. A technical adjustment bumps the rate up to 138% FPL.