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Medicare in New Mexico

Medicare is a health insurance program from the federal government for people age 65 or older; people under age 65 with certain disabilities; and people of any age with end-stage renal disease. Original Medicare, which includes Medicare Part A and Part B, offers hospital insurance and medical insurance, respectively. Like Medicare beneficiaries in other US states, New Mexico-based beneficiaries can also choose to enroll in private Medicare health insurance plans to get their hospital and medical benefits, and, if they wish, prescription drug benefits.

The private Medicare insurance plans are called:

Original Medicare for New Mexico residents

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

In New Mexico, as in other states, you have an Initial Enrollment Period in which you can enroll in Medicare Part A and Part B without penalty. If you qualify for Medicare based on age, your Initial Enrollment Period is a seven-month period beginning the three months before the month you turn 65, including the month you turn 65, and including the three months after your birth month.

Many people who are eligible for Medicare Part A are enrolled automatically. If you aren’t among those, you’ll have to enroll yourself. 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. If you do 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 still have to pay the late-enrollment penalty.

Enrollment in Medicare Part A is free for people who paid Social Security taxes for at least 10 years or are married to someone who did. People who don’t qualify for free Medicare Part A usually have to pay a monthly premium of up to $407 in 2016 to enroll. 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 do have to take steps to enroll and most people have to pay a monthly premium. The Medicare Part B monthly premium starts at $104.90 in 2016, and can be higher based on your income. Medicare Part B benefits include the following:

  • Clinical research
  • Ambulance services
  • Durable medical equipment
  • Mental health services (inpatient, outpatient, and partial hospitalization)
  • Second opinion before surgery
  • Limited outpatient prescription drugs

Medicare private insurance in New Mexico

There are several Medicare Advantage (Part C) plans offered by private insurance companies in New Mexico, which can be a suitable option for some people who have Original Medicare. If you enroll in a Medicare Advantage plans available in New Mexico, you will get your benefits through that plan and not through Original Medicare. Note that if you choose to enroll in any of Medicare Advantage plans, you do have to continue paying your Medicare Part B premium in order to retain your health insurance coverage.

Medicare Advantage plans offered in New Mexico are required by law to cover at least the same hospitalization and medical benefits as Original Medicare, and may also offer additional benefits such as vision, dental, and hearing coverage. Some Medicare Advantage plans also include coverage for prescription drugs, and are called Medicare Advantage Prescription Drug plans.

Original Medicare beneficiaries in New Mexico can, if they prefer, sign up for a Medicare Supplement plan (also known as a Medigap plan). Medigap plans help beneficiaries pay for costs not covered by Original Medicare, like copayments, coinsurance, and deductibles. Medigap plans are also offered by private insurance companies.

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 Medicare stand-alone prescription drug plan (Part D). A prescription drug plan is also private health insurance, and it covers the medications your doctor may prescribe for you. Costs for each Medicare Prescription Drug Plan in New Mexico vary, but most require you to a pay a monthly premium, an annual deductible, and a copayment or coinsurance at the point of sale. When considering a Medicare prescription drug plan, you’ll want to consider your current needs and your potential drug needs for the plan year.

Remember that as a resident of New Mexico, your Medicare Advantage, Prescription Drug, and Medigap coverage options may differ from those in other states. Similarly, within New Mexico, a resident of Albuquerque in Bernalillo County may have different Medicare plan offerings than a resident of Las Cruces in Doña Ana County. So, it’s always a good idea for New Mexico Medicare beneficiaries to compare Medicare plans and benefits based on their individual health and prescription needs and also on the county in which they reside.

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 in New Mexico for Medicare beneficiaries

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 website:

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