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Medicare in New Mexico

October 6, 2016

Medicare, the government-sponsored health insurance program, offers coverage to people 65 or older and those with certain disabilities or conditions under the age of 65. If you’re a Medicare beneficiary in New Mexico, you may opt to receive your benefits under Original Medicare, which includes Medicare Part A hospital insurance) and Medicare Part B (medical insurance). You may also choose to receive your Part A and Part B coverage through Medicare Advantage (Part C) and sign up for a Medicare Advantage plan offered by a Medicare-approved private insurance company. In addition, you can enroll in a stand-alone Medicare Part D Prescription Drug Plan (also offered by Medicare-approved insurance companies) to obtain prescription drug benefits.

Original Medicare for New Mexico residents

Original Medicare consists of two parts: Medicare Part A (hospital insurance) and Medicare Part B (medical insurance).

Many people who are eligible for Medicare Part A are enrolled automatically when they become eligible for Social Security benefits. If you are not automatically enrolled, you can do so online, by telephone or in person:

  • Online at the Social Security website. Individuals applying for Medicare only (as opposed to applying for SSA benefits as well) can use the application located on this site.
  • By calling Social Security at 1-800-772-1213 (TTY users 1-800-325-0778). SSA representatives can be reached Monday through Friday, from 7AM to 7PM.
  • In person at a local Social Security office. To find office locations in New Mexico, click here.

In New Mexico, as in other states, you have an Initial Enrollment Period in which you can sign up for Medicare Part A and Part B. If you are eligible for Medicare based on age, your Initial Enrollment Period is a seven-month period beginning three months before the month you turn 65, including the month you turn 65, and ending  three months after your birth month.

Failure to enroll in Medicare during the Initial Enrollment Period may result in a late-enrollment penalty, which translates into higher premiums for as long as you remain enrolled in Medicare unless you qualify for a Special Enrollment Period.

If you miss your Initial Enrollment Period, you can sign up for Original Medicare during the General Enrollment Period, which runs from January 1 to March 31 each year, but you may  have to pay a late-enrollment penalty.

Enrollment in Medicare Part A is premium-free for people who paid Social Security taxes for at least 10 years.  People who don’t qualify for premium-free Medicare Part A usually have to pay a monthly premium of up to $411 in 2016 ($413 in 2017) to participate.

In New Mexico, as in other states, Medicare beneficiaries are eligible for the following benefits under Medicare Part A:

  • Hospital care
  • Skilled nursing facility care
  • Nursing home care
  • Hospice care
  • Home health services

Medicare Part B, which is medical insurance, doesn’t have an automatic enrollment, so you have to take steps to enroll and most people have to pay a monthly premium. Medicare Part B benefits include the following:

  • Doctors’ visits, including preventive care
  • Outpatient services, such as radiology and lab tests
  • Medicare-approved clinical research
  • Ambulance services
  • Durable medical equipment
  • Mental health services (inpatient, outpatient, and partial hospitalization)
  • Limited outpatient prescription drugs administered by a physician

Medicare plan options in New Mexico

In New Mexico you may choose to receive your Medicare benefits from a Medicare Advantage plan, which is provided by private insurance companies approved by Medicare. A Medicare Advantage plan in New Mexico, as in the rest of the United States, is required by the government to offer at least the same medical and hospitalization coverage as Original Medicare Part A and Part B (except hospice care, which continues to be covered by Part A). Some Medicare Advantage plans also offer extra coverage not available from Original Medicare, like hearing exams and aids, routine vision care, or dental care. You may also have the opportunity to enroll in a Medicare Advantage Prescription Drug plan, combining health and prescription drug coverage into a single plan. It’s a good idea to compare the Medicare Advantage plans available where you live in New Mexico to find the plan that best fits your individual health needs.

If you decide to stay with Original Medicare (Part A and Part B), another option you may have is to sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles.

If you have Original Medicare, with or without a Medigap plan, and would like to add prescription drug coverage, you may want to consider a stand-alone Medicare Part D Prescription Drug Plan. A Medicare Part D Prescription Drug Plan is offered by a private insurance company contracted with Medicare to provide Part D prescription drug coverage to help pay for medications your doctor prescribes. Costs for Medicare Part D Prescription Drug Plans in New Mexico vary depending upon the benefits offered by the different insurance companies offering the plans, but most plans require you to a pay a monthly premium, an annual deductible, and a copayment or coinsurance. When considering a stand-alone Medicare Part D Prescription Drug Plan, you’ll want to consider your current medications and your potential  prescription drug needs to assess which plans offer you the best coverage.

Remember that as a resident of New Mexico, your coverage options from Medicare Advantage plans, Medicare Part D Prescription Drug Plans, and Medicare Supplement plans may differ depending upon where you live. Different insurance companies offer different Medicare plans throughout the United States and within New Mexico, itself. Within New Mexico, for example, a resident of Albuquerque in Bernalillo County may have different Medicare plan offerings than a resident of another county. It’s always a good idea to compare Medicare plans available within your county of residence and based on your individual health and prescription needs.

Again, keep in mind that if you enroll in a Medicare Advantage, Medicare Advantage Prescription Drug, Medigap, or Medicare Prescription Drug Plan, you need to continue paying your Medicare Part B premiums in order to remain covered.

Resources for Medicare beneficiaries in New Mexico

As a New Mexico Medicare beneficiary, you have a number of resources available to help you with health- and Medicare-related concerns. Here’s a list of helpful resources from the Medicare.gov website:

Learn more about how Medicare plans work in New Mexico including:

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