Medicare Plan Options
You have a few options if you’re a New Mexico senior newly eligible for Medicare or considering making changes to your coverage. Original Medicare, also called traditional Medicare, is the government-run choice. There’s also New Mexico’s Medicare Advantage program, a privately operated alternative. Plus, some policies add more coverage to Medicare, including Part D plans and Medicare Supplement Insurance.
Original Medicare is the traditional option managed by the federal government. Most seniors sign up for both of its parts, Part A and Part B. The former covers inpatient hospital care, home health care and hospice care, as well as limited nursing facility care. The latter covers a broad range of services that aim to diagnose, treat or prevent health problems, such as doctors’ services and screening tests. You may be eligible for Original Medicare if one of the following applies:
- You’re 65 or older.
- You’re under 65 and have a qualifying disability.
- You have end-stage renal disease.
Medicare Advantage Plans
An alternative to the government’s Original Medicare program, Medicare Advantage Plans are sold by private companies. These plans are regulated by Medicare and must offer the same Part A and Part B benefits as Original Medicare, at a minimum. However, many plans include prescription drug coverage and other extra benefits that may appeal to seniors, such as hearing, vision and dental coverage. Medicare-eligible New Mexicans can opt for a Medicare Advantage Plan if you’ve enrolled in both Part A and Part B and live within the plan’s service area.
Medicare Prescription Drug Coverage Plans
Prescription drug coverage, also known as Medicare Part D, is optional for Medicare enrollees. This coverage is often bundled into Medicare Advantage Plans, and for seniors with Original Medicare, it can be purchased through a standalone Part D plan. In both cases, Part D includes coverage for generic and brand-name prescription drugs. The specific drugs covered vary between plans, but all plans need to have two or more drugs in each commonly prescribed category. Plans must cover all drugs in some protected categories, such as antidepressants.
Medicare Supplement Insurance Plans
Medicare Supplement Insurance, commonly known as Medigap, is optional coverage for people with Original Medicare. It helps seniors pay for costs that aren’t covered by Original Medicare. The 10 standardized Medigap plans are identified by the letters A, B, C, D, F, G, K, L, M, and N. Depending on the plan, benefits may include full or partial coverage of coinsurance, copayments, and deductibles. Some Medigap plans also cover Part B excess charges or emergency medical care received outside of the United States. You can’t get a Medigap policy with a Medicare Advantage Plan, only traditional Medicare.
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|
|260,872||Plan A: $0 to $471 per month*
Plan B: $148.50 per month**
*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
You don’t have to navigate complex Medicare decisions on your own. There are many resources in New Mexico that can help you understand Medicare and choose the right plan for your needs. If you already have Medicare, available resources can help you evaluate coverage, reduce you out-of-pocket costs and protect yourself from fraud.
The City of Albuquerque/Bernalillo County Area Agency on Aging
This Area Agency on Aging provides information and assistance services for older adults who live in Bernalillo County, the state’s most populous county. Its Senior Assistance Hotline helps seniors find local resources that may meet their needs, including those offering Medicare assistance. You can contact the AAA in your area for similar services if you live outside of Bernalillo County.
Contact Information: Website | 505-764-6400
Senior Citizens’ Law Office
The Senior Citizens’ Law Office delivers free legal assistance to seniors in the Albuquerque area. Seniors who live in Bernalillo, Sandoval, Torrance or Valencia counties can contact the law office for help resolving Medicare problems, such as coverage denials and improper billing. The office can also assist you with Medicaid, Social Security and other public benefits, as well as other issues such as debt collection and identity theft.
Contact Information: Website | 505-265-2300
New Mexico Senior Health Insurance Assistance Program
This federally funded program is administered by the state’s Aging and Disability Resource Center. It provides unbiased and up-to-date information about all types of health insurance. Seniors can contact the ARDC for questions about Medicare or help evaluating plan options. You can also receive one-on-one counseling about other types of insurance such as Medicaid or retiree coverage from an employer. To learn more or to schedule an appointment, call the ARDC.
Contact Information: Website | 1-800-432-2080
New Mexico Senior Medicare Patrol
Senior Medicare Patrol is a national program that helps protect Medicare beneficiaries from health care fraud. Seniors can use Senior Medicare Patrol to learn about preventing and detecting common types of Medicare fraud schemes, such as medical identity theft and Medicare enrollment fraud. If you suspect health care fraud, report your concerns to the SMP, who will refer you to the appropriate authorities if necessary. The state’s SMP program is operated by New Mexico’s Aging and Disability Resource Center.
Contact Information: Website | 1-800-432-2080
New Mexico Human Services Department
The state’s Human Services Department can help eligible seniors access financial assistance programs. These include Medicare Savings Programs that can help you pay Medicare premiums, such as the Qualified Medicare Beneficiaries and Specified Low-Income Medicare Beneficiaries programs. The department can also help you enroll in Centennial Care, the state’s Medicaid program. Its field offices are open daily from 10 a.m. until noon, and seniors can apply online at any time.
Contact Information: Website | 1-800-283-4465
Learn More From Our Sources
- Medicare | How Original Medicare works
- HHS | What does Part B of Medicare (Medical Insurance) cover?
- Medicare | Medicare Advantage Plans
- Medicare | How to get prescription drug coverage
- Medicare | How do Medicare Advantage Plans work?
- CMS | Medicare Advantage and Part D Drug Pricing Final Rule
- Medicare | What’s Medicare Supplement Insurance (Medigap)?
- Medicare | How to compare Medigap policies