Medicare Advantage Plans In New Mexico

Fact Checked
Published: June 18, 2021

Medicare Advantage offers more flexibility than Original Medicare, which is managed by the federal government. Because Medicare Advantage Plans are sold by private insurance companies, they often pay for services that Original Medicare doesn't cover. As a bonus, most Medicare Advantage Plans include prescription drug coverage, eliminating the need to purchase a Medicare prescription supplement.





  • In 2019, there were 25 Medicare Advantage Plans available in New Mexico.
  • 33% of the total Medicare population in New Mexico was enrolled in Medicare Advantage Plans as of 2018.
  • In 2018, Original Medicare spent an average of $8,112 per beneficiary in New Mexico, which is 20% lower than the national average.
  • Available Medicare Advantage Plans range from three to 27 across New Mexico’s 33 counties.

Not all insurance companies offer coverage in every state, so plan availability depends greatly on where you live. It also depends on how many insurance providers have been approved to offer Medicare Advantage Plans. Each plan typically has a monthly premium, an annual deductible, and copays, and/or coinsurance for most services. Before choosing a plan, review your budget and determine which one is likely to leave you with the lowest out-of-pocket costs overall.

Medicare Advantage Plans in New Mexico

Types of Medicare Advantage Plans

Original Medicare is the same no matter where you live, but depending on which insurance companies are approved to offer Medicare Advantage Plans in your area of New Mexico, you may have access to up to four types of coverage. There’s no single plan that works for every beneficiary, so you must consider your medical needs, personal finances, and location before deciding which one is right for you.

Health Maintenance Organizations (HMO)

One of the most common types of plans included in New Mexico’s Medicare Advantage program is the health maintenance organization, or HMO for short. If you sign up for an HMO, you may have to choose a primary care provider, someone who oversees your medical care and refers you to specialists when needed. In most cases, you need to get care from providers who are in your plan’s network.

Preferred Provider Organizations (PPO)

Preferred provider organizations are less restrictive than HMOs. Your out-of-pocket costs are the lowest if you see an in-network provider, but you’re allowed to see out-of-network health care professionals if you’re willing to pick up a greater percentage of the costs. You don’t need to choose a primary care provider, and you may not need to ask for a referral to a cardiologist, rheumatologist, or another medical specialist. Many PPO plans also include prescription drug coverage.

Private Fee-For-Service Plans (PFFS)

Some New Mexico residents choose to enroll in private-fee-for-service plans, which pay a flat fee for each service provided by a qualified medical professional. If you enroll in a plan with a PFFS network, you can see any provider who participates in the plan. There’s also no need to choose a primary care provider or ask for a referral if you need to see a specialist. Nonparticipating providers must treat you if you have a medical emergency.

Special Needs Plans (SNP)

Special needs plans aren’t as common as HMO, PPO, and PFFS plans, but they may be an option if you have a chronic health problem. Each SNP is designed to meet the unique health needs of its members; for example, some companies offer SNPs for enrollees with chronic lung disorders. An SNP typically covers the services and medications needed to treat symptoms of the condition and prevent it from getting worse.

Enrollment and eligibility for Medicare Advantage Plans in New Mexico

Eligibility

To be eligible for Medicare Advantage, you must qualify for Original Medicare, live within your chosen plan’s service area, and not be enrolled in a Medicare Supplement Insurance (Medigap) plan. If you leave your home state for several months each year, make sure your plan covers any medical care you receive while you’re away.

Enrollment Periods

You can enroll in Medicare Advantage during the following periods:

  • Initial enrollment: The initial seven-month enrollment period starts three months before you turn 65 and ends three months following your 65th birthday month.
  • Open enrollment: Medicare Advantage open enrollment starts on October 15th and ends on December 7th each year. During open enrollment, you’re allowed to join Medicare Advantage for the first time or switch from one Medicare Advantage Plan to another. If you enroll during this period, your Medicare Advantage coverage will go into effect on January 1st of the following year.
  • Medicare Advantage enrollment: If you’re already enrolled in Medicare Advantage, you can switch plans or back to Original Medicare any time between January 1st and March 31st.

If you move out of your plan’s service area or lose your Medicare Advantage Plan for another reason, you may qualify for a special enrollment period whenever the loss of coverage occurs.

Prescription drug coverage

Most Medicare Advantage plans cover prescription drugs. If you choose a plan that doesn’t cover prescriptions, which is sometimes the case with PFFS plans, you may purchase a Medicare Part D supplement to reduce your out-of-pocket drug costs. Medicare Part D has a monthly premium and an annual deductible. Part D premiums vary based on your location, the amount of the deductible, and the copays charged for each medication. If your Medicare Advantage Plan includes prescription coverage and you enroll in Part D, you’ll be disenrolled from Medicare Advantage and switched to Original Medicare.

Medicare Advantage Resources in New Mexico

With several plan types available and different levels of coverage offered under each plan, it can be difficult to understand your options under the New Mexico Medicare Advantage program. Fortunately, the state has several resources available to help Medicare-eligible individuals compare plans, calculate their potential out-of-pocket costs, and determine which plan provides the right level of coverage at an affordable price. If you want to gain greater clarity about your Medicare options, reach out to the following resources.

New Mexico Aging and Long-Term Services Department

New Mexico ALTSD serves as the State Health Insurance Assistance Program for New Mexico residents. The agency aims to protect the rights of older adults, promote independence, and ensure that Medicare-eligible individuals and their loved ones have the information needed to make good medical and financial decisions. If you have questions about Medicare Advantage Plans, including covered services and plan costs, contact ALTSD for more information. Knowledgeable counselors are on hand to help you make the right choice.

Contact Information: Website | 800-432-2080

Office of the Superintendent of Insurance

Private insurance companies must be approved to offer Medicare Advantage Plans in New Mexico. Once you enroll in Medicare Advantage, your insurance provider must also abide by the terms of the plan. If an insurance company refuses to pay a claim as agreed or tries to make you pay more than your share of the costs, contact the Office of the Superintendent of Insurance to file a complaint. OSI agents will follow up and try to resolve the problem.

Contact Information: Website | 855-427-5674

New Mexico Area Agencies on Aging

New Mexico has four Area Agencies on Aging offering services to residents who are at least 60 years old (55 years old for tribal programs). These agencies exist to provide information and support to older adults living in New Mexico. If you have questions about Medicare or think that your health insurance company isn’t treating you fairly, you may qualify for free or low-cost legal assistance through your local AAA. The largest AAA in the state serves Albuquerque and other parts of Bernalillo County; New Mexico also has a Non-Metro AAA, a Navajo AAA, and an Indian AAA.

Contact Information: Website | 505-476-4799

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