Health Insurance in New Mexico

What’s at the top of your priorities list right now? If you’re reading this, getting affordable and comprehensive healthcare is probably up there. But how do you know which plan is best for you and your family? We have insurance experts from all over the country working hard to provide helpful information that can help you make a decision today. If you’re ready to learn more about major medical insurance coverage through the ACA, short-term health insurance, indemnity plans, and more, then you’re in the right place. We can also help you find quick, accurate quotes so that you know which plan will give you the best deal.

Major Medical Insurance in New Mexico

After the Affordable Care Act passed in 2010, the Health Insurance Marketplace was established a few short years later in 2014. And ever since, most individuals and families in America have had their health insurance coverage needs met by either the ACA Marketplace or qualifying health insurance through their employer. In New Mexico, people have been registering through HealthCare.gov since the marketplace was established; however, New Mexico is one of many states which will be establishing its own unique state exchange at the end of 2020 for coverage that starts in 2021. Keep checking back for updates as this situation progresses if you’d like more information on registering on the new state exchange in time for health coverage in 2021. 

One unique thing about the ACA plans is the fact that they are guaranteed issue. This means when you apply for coverage, your insurance provider cannot reject you, even if you are in less than perfect health and have pre-existing conditions. Almost no other health insurance plans in the entire country have this feature. On top of that, a guaranteed-issue policy means that you cannot be charged more for your monthly premiums based on your health conditions – only on the following four factors:

• Your age 
• Your location
• Your use of tobacco products
• Whether you are applying for an individual policy or a family policy

You’ll also receive a comprehensive list of benefits that you won’t find anywhere else. As a matter of fact, there’s a name for these benefits: the guaranteed Essential Health Benefits. There are a ton of them, and it’s rare to find an insurance policy outside of the marketplace that has all of them, or an insurance company who is willing to sell you all of these coverages: 

• Ambulatory/outpatient services
• Emergency services
• Hospitalization
• maternity/newborn care
• Mental health and substance abuse
• Prescription drugs
• hab/rehab services and devices
• Lab tests
• Preventive and wellness services and chronic disease management
• Pediatrics (including oral and vision)

Both guaranteed issue and essential health benefits are not cheap products for insurance companies to offer. In fact, if it weren’t for the premium tax credits, these forms of health insurance would be virtually impossible to afford for most working Americans. Thankfully, if you make at least 138% of the federal poverty limit, you can qualify for a premium tax credit that will substantially lower your monthly premiums. If you’re unsure whether or not you might qualify for one of these tax credits, take a look at the chart below. It’ll help you figure out where your income falls on that spectrum based on household size.

Luckily for New Mexico residents, your state has been an adopter of the Medicaid expansion for quite a while. This means that they have accepted federal funds which they use to make sure people who fall below the 138% threshold can get free or discounted access to the state’s Medicaid services. For more information on Medicaid in New Mexico, as well as whether or not you qualify (it’s not always as easy to qualify for Medicaid as it is for a premium tax credit), you can visit the New Mexico Centennial Care website, which is the official site for Medicaid services in the state.

Short Term Health Insurance in New Mexico

Unlike most other states, if you don’t qualify for an ACA policy or don’t wish to purchase one, you won’t have short-term health insurance to fall back on. The powers that be in the state of New Mexico have decided to pass certain laws which regulate short-term health insurance a lot more closely than they do in other states. Certain state governments don’t like the fact that short-term health insurance requires medical underwriting, which is the opposite of guaranteed issue. They also don’t like the fact that these Insurance products usually don’t sell all of the Essential Health Benefits which come with insurance policies that are sold through the marketplace. They feel that these lack of protections shortchange consumers and don’t give residents the health care coverage they deserve. Of course, passing these regulations and scaring short-term health insurance companies out of the state leaves residents with fewer choices; but the law is what it is, and until it changes more favorably for insurance companies, short-term health insurance products won’t be sold within the state of New Mexico.

Christian Health Plans/Health-Sharing Plans in New Mexico

Instead, you might want to try a health share plan (commonly referred to as a Christian health plan). These plans are usually offered from non-profit religious organizations. Because of their religious status, they are not very closely regulated by the government at all. But this also means you have fewer consumer protections, such as legal arbitration if they unjustly fail to pay out on your claims. These plans were very popular during the early years of the Health Insurance Marketplace because the religious status allowed consumers an exemption to the individual mandate. Although the individual mandate is no longer enforced, the lack of short-term health insurance options in the state of New Mexico means that consumers have something to fall back on if they don’t or won’t purchase insurance through the Marketplace.

Christian health plans actually have a lot in common with short-term health insurance. Here are some examples of all their similarities:

• These plans are NOT guaranteed issue
• They have unlimited out-of-pocket costs
• They have lifetime and annual benefit caps
• They likely won’t have all of the guaranteed essential health benefits
• Their “monthly share amount” can cost up to 1/3 less than an unsubsidized ACA major medical monthly premium

But you should familiarize yourself with all of their differences just so you know what you’re getting into. We already discussed the consumer protections (or lack thereof). But there are also participation guidelines you will have to follow, like declaring allegiance to the specific faith of the organization providing your health plan or stopping all tobacco use so that it costs them less money to help you get medical care. You may also have to follow other biblical rules in order to remain in good standing. The language is a bit different, with members paying a “monthly share amount” instead of a premium and an “unshared amount” or a “personal responsibility amount” instead of fees like co-pays, coinsurance, or deductibles. But these plans do come with fairly hefty deductibles more often than not, so it’s important to budget accordingly if you decide to go this route.

Fixed Indemnity Plans in New Mexico

Then there are fixed indemnity plans. If you decide to purchase a fixed indemnity plan in New Mexico, make sure you do so for the right reasons. Some people purchase fixed indemnity plans in order to save money by avoiding the Health Insurance Marketplace – but this might not be the best idea. A Health Insurance Marketplace plan will cover at least 60% of your total medical costs; a fixed indemnity plan, on the other hand, will only pay a fixed amount and nothing more. They pay out claims based on a per day, per week, per month, per visit, or per incident basis. And once they pay out that fixed amount of money, that’s it – the rest of your medical costs are up to you.

The indemnity plan you purchase will vary depending on what your needs are. There are all types of different fixed indemnity plans such as doctor indemnity plans, hospital indemnity plans, and even dental indemnity plans. Like in many other insurance products outside of the marketplace, you will have lifetime and annual benefit caps on your indemnity benefits – but no caps on your total out-of-pocket costs. As a matter of fact, most people purchase an indemnity plan alongside a Health Insurance Marketplace plan in order to reduce the share of their medical costs that their insurance company won’t pay for. This is the best case scenario for a fixed indemnity plan. That being said, purchasing a fixed indemnity plan solo is better than nothing – especially if you can’t afford a health insurance plan through the Marketplace.

Discount Cards in New Mexico

Another thing someone might want to purchase alongside major medical coverage is a medical discount card. And we sat “alongside” instead of “as a replacement for” because contrary to what some people might believe, medical discount cards are not a replacement for major medical coverage. Trust us – anyone who says differently is likely trying to run a scam. Another sure sign of a scammer is anyone advertising too-good-to-be-true discounts, or anyone claiming to have a really large network of providers. The good news is that it’s really easy to call around and check to see who these medical discount card providers are working with and whether or not the discounts they advertise are genuine. You can save yourself a lot of money by doing a little homework first before you purchase a membership with a medical discount card.

If you find a medical discount card provider whose membership team is less than the amount of money you could save with their discounts, then it might be a smart idea to buy. These cards work in a very similar manner to something like the AAA club or the AARP. You will have to pay a membership fee, usually on a monthly or an annual basis, and they will send you your medical discount card in the mail. Then you present that card whenever you make a purchase at a participating retailer or medical provider. You will receive your discount right there at the register – there are no claims to file, no reimbursements to wait for, or anything like that. It’s a simple and effective way to help lower your out-of-pocket costs whether you sign up for major medical coverage, a Christian health plan, or rely on a fixed indemnity plan to keep your out-of-pocket costs low.