Understand Medicare in New Mexico
Medicare, the United States federal medical insurance program, provides coverage for more than 440,000 people in New Mexico who qualify for Medicare. You can get Medicare if you’re 65 or older or have a qualifying disability.
Your disability typically qualifies if you’ve received at least 24 Social Security or Railroad Retirement Board (RRB) disability insurance payments. You can also enroll in Medicare Advantage Plans if you have End-Stage Renal Disease (ESRD) or amyotrophic lateral sclerosis (ALS).
Most people have premium-free Part A but, if you have to buy it, the cost can reach up to $506 per month in 2023. Part B costs $164.90 per month but can be more if you have higher income. There are 72 Medicare Advantage Plans in the state that are an alternative to Original Medicare. Learn more about your Medicare options in New Mexico.
Medicare Plans in New Mexico
Compare ratings of New Mexico’s Medicare plan providers: | ||||
Insurance company | Medicare rating | A.M. Best rating | BBB rating | J.D. Power ranking |
Aetna | 4 stars | A+ | A+ | 6th out of 9 |
Humana | 4 stars | A- | A+ | 2nd out of 9 |
UnitedHealthcare | 3.5 stars | A- | A- | 4th out of 9 |
Medicare Plan Options in New Mexico
Residents of New Mexico have multiple Medicare plans to choose from. Many are tiered to help New Mexicons find the plan that is best suited to your lifestyle and medical needs. For example, seniors and individuals with disabilities who don’t need much coverage can apply for Original Medicare. New Mexico’s Medicare Advantage program might be a better option if you need more comprehensive insurance. Some Medicare policies offer additional prescription drug add-ons or supplementary coverage.
Original Medicare (Parts A and B) | Original Medicare is the basic Medicare plan, which is a fee-for-service form of insurance. It has two parts: Part A hospital insurance and Part B medical insurance. Part A covers hospital stays and periods spent at skilled nursing facilities, lab tests an individual has performed, and hospice care. Part B covers doctor’s office visits and home health care services. It may also cover some preventive care, such as screenings for cancers and mental illnesses, including depression. With Original Medicare, you’ll pay a deductible along with your share of the fees incurred during an inpatient or outpatient visit:
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Medicare Advantage Plans (Part C) | Medicare Advantage plans, also known as Part C, are an alternative to Original Medicare offered by private insurance companies. These plans include both Part A and Part B coverage, except for hospice care. Most services are provided by network providers, and you may need primary care physicians, referrals for specialists, and prior authorizations for treatment and medications. Medicare Advantage offers additional coverage for essential needs, such as prescription drugs, dental and vision care. Some Medicare Advantage Plans also cover gym memberships and transportation to and from medical appointments. Part C may also pay for adult day care services:
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Medicare Prescription Drug Coverage Plans (Part D) | Many Medicare Advantage policies add Part D drug coverage automatically to their package, but you can also add Medicare prescription drug coverage to Original Medicare. Medicare prescription drug coverage is offered to all Medicare enrollees, but you may have to pay a penalty if you wait to enroll after being initially eligible. Medicare Part D plans may not all cover the same drugs or have the same costs as Medicare Advantage policies. Standalone Part D coverage is provided by Medicare-approved private insurers. Most plans require a deductible and a copay for each prescription drug:
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Medicare Supplement Insurance Plans (Medigap) | Some New Mexico seniors purchase a Medicare Supplement Insurance policy, also known as Medigap. These plans are intended to fill in the gaps Original Medicare doesn’t cover. Some of these gaps include medical coverage while overseas, Part A and Part B copays, and excess Part B charges. Medigap doesn’t pay for anything related to Medicare Advantage. You cannot have a Medigap plan and a Medicare Advantage Plan at the same time.
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Medicare in New Mexico by the Numbers
People enrolled in Original Medicare | Average plan cost | Annual state spending per beneficiary | Spending per beneficiary compared to the national average |
262,010 | Part A: $0 to $506 per month*
Part B: $164.90 per month** |
$9,194 | -21.2% |
*Most people pay no premium, but this can vary depending on how long they paid Medicare taxes.
**This is the average number, but it can vary based on income.
Medicare Resources in New Mexico
Getting support can help when you’re making Medicare decisions. New Mexico has numerous locations where enrollees can receive help through the State Health Insurance Program (SHIP). New Mexico’s SHIP has counselors throughout the state that work with local nonprofits and public health agencies, as well as Area Agencies on Aging (AAAs), to provide seniors with Medicare information.
New Mexico Aging and Disability Resource Center ADRC
The New Mexico ADRC helps elders and people with disabilities access the services and resources they need to live independently and well. Available services include information on the programs and services offered, benefits counseling, prescription drug assistance through the New Mexico MEDBANK Program, health care fraud prevention through the Senior Medicare Patrol (SMP) and health care fraud prevention. You can also get help with the New Mexico Health Exchange (NMHIX) that helps residents access affordable health coverage.
Contact information: Website | 1-800-432-2080
New Mexico Department of Health
The New Mexico Department of Health works to promote health and wellness among state residents, and aims to ensure residents have a health safety net when they need it. Department programs include health facility licensing and certification, immunization program and a developmental disabilities support division that provides services to children and adults with intellectual disabilities.
Contact information: Website | 1-800-432-2080
Area Agencies on Aging
There are four designated Area Agencies on Aging (AAA) in New Mexico. These Agencies are responsible for administering, planning and supporting community-based services for residents age 60 and older or age 55 and older in tribal programs. The AAAs offer a wide array of services, including homemaker service, caregiver support, legal services and health promotion and disease prevention. Most of these services are provided at the local level and may vary by location.
Contact information: Website | 1-800-432-2080