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Medicare Advantage in New Mexico

Last Updated on

October 6, 2016

As a Medicare beneficiary in New Mexico, you may have the option to receive your health benefits through Medicare Advantage (Medicare Part C), which is provided by Medicare-approved private insurance companies, rather than through Original Medicare, Part A and Part B.

How Medicare Advantage works in New Mexico

If you need more extensive coverage than what’s provided under Original Medicare, you may find a Medicare Advantage plan in New Mexico is a viable option. To start, it’s helpful to understand some of the key features that distinguish Medicare Advantage from Original Medicare.

First, Original Medicare is administered by the federal government.  Medicare Advantage plans are offered by private insurance companies approved by Medicare.

Second, Medicare Advantage plans may offer additional benefits beyond what Medicare Part A and Part B provide. While Medicare Advantage plans are required to provide at least the same coverage as Part A and Part B (except hospice care, which remains covered under Part A), many Medicare Advantage plans offer more coverage, such as lower deductibles, copayments and coinsurance amounts that reduce plan members’ out-of-pocket costs, or added benefits for routine vision care, dental care or Medicare prescription drug coverage.

Third, Medicare Advantage plans have different, and a broader range of monthly premiums than Original Medicare.

Finally, Original Medicare is available throughout the U.S. and its territories.  Medicare Advantage plans are available only within their defined service areas: you cannot select any Medicare Advantage plan; you can only choose a Medicare Advantage plan that provides coverage where you live in New Mexico.

If you want to enroll in a Medicare Advantage plan in New Mexico, you must be enrolled or eligible to enroll in Original Medicare, Part A and Part B. A good time to sign up for Original Medicare in New Mexico is during your Initial Enrollment Period, which begins three months before you turn 65, includes your birthday month, and ends three months after that month. Some individuals may qualify for Medicare before 65 if they have certain conditions, such as end-stage renal disease or amyotrophic lateral sclerosis (also known as ALS, or Lou Gehrig’s disease). You may also be automatically enrolled into Medicare after 24 months of receiving disability benefits.

Failure to enroll in Medicare during your seven-month Initial Enrollment Period may result in a late-enrollment penalty, which translates into higher premiums. You may enroll in Medicare during the annual General Enrollment Period, which runs from January 1 to March 31, but you could still be liable for the late-enrollment penalty.

If you’re already enrolled in a Medicare Advantage plan in New Mexico and want to switch to another plan, you’re allowed to make the change during the Annual Election Period, which runs from October 15 to December 7. Your new coverage goes into effect on January 1 of the following year. Another time you may switch Medicare Advantage plans in New Mexico is during Special Election Periods, but only if you experience certain life-changing events. These life-changing events include, but are not limited to, losing your current coverage, undergoing changes in your current plan that affect your health benefits, or moving to a new address where your old plan may not be available. Special Election Periods in New Mexico and the rest of the United States vary depending on the reason you need to switch plans and on the specific health plan you select.

If you want to switch from Medicare Advantage back to Original Medicare, Part A and Part B, you may do so during the annual Medicare Advantage Disenrollment Period, which runs from January 1 to February 14 in New Mexico and the rest of the United States.

Types of Medicare Advantage plans in New Mexico

Before you choose a Medicare Advantage plan, it may be a good idea to familiarize yourself with the main types of Medicare Advantage plans available. Here’s a quick rundown of Medicare Advantage plans in New Mexico:

  • Health Maintenance Organization (HMO): An HMO plan requires you to visit doctors, health-care providers, and hospitals included in your plan’s network, except in emergency situations or when approved by the plan. You may also need to get a referral from your primary doctor to receive coverage for certain health services.
  • HMO Point-of-Service: An HMO-POS plan is a slightly more flexible option than an HMO, allowing you to go out of network for most health services, but generally at a higher out-of-pocket cost.
  • Preferred Provider Organization (PPO)*: A PPO plan offers great flexibility, allowing you to choose doctors, health care providers, and hospitals outside of your plan’s network, but at a higher out-of-pocket cost.
  • Private Fee-for-Service (PFFS): A Private Fee-for-Service plan may offer a partial or full network of providers, and sometimes does not involve any networks at all. It is important to check with the provider to see if they accept the plan because not all providers accept it.
  • Medical Savings Account (MSA): A Medical Savings Account plan combines a high deductible with a savings account that you can use to pay for your health care expenses.
  • Medicare Special Needs Plan (SNP): A Medicare SNP limits enrollment to beneficiaries with special health needs, offering coverage tailored to suit those specific situations. There are Medicare SNPs for people with chronic conditions, those living in institutions (like nursing homes), and people who qualify for both Medicare and Medicaid.
  • Medicare Advantage Prescription Drug (MAPD) plan: A MAPD plan combines health and prescription drug coverage into a single insurance plan.

Not all types of Medicare Advantage plans may be available where you live in New Mexico.  You may have a choice in types of Medicare Advantage plans, however.  Recognizing the type or types of Medicare Advantage plans you have available can be helpful to your understanding of how you access health care and effectively use your Medicare Advantage benefits.

Finally, if you enroll in a Medicare Advantage plan in New Mexico, you must remain enrolled in Original Medicare, and continue paying your Medicare Part B premium, in order to avoid being dis-enrolled from Medicare and losing your health coverage.

Comparing Medicare Advantage plans available in New Mexico

As a Medicare beneficiary in New Mexico, you may find it useful to compare the various Medicare Advantage plans available in your area.

The availability and cost of Medicare Advantage plans generally varies depending on your state and county of residence. It’s common for premiums of a Medicare Advantage plan with the same coverage and benefits to vary between different counties within the state of New Mexico. You may find that some Medicare Advantage plans in New Mexico offer premiums as low as $0; but always remember that you must continue paying your Medicare Part B premium, no matter which Medicare Advantage plan you choose, in order to keep your Medicare insurance coverage.

Some Medicare Advantage plans may offer additional benefits beyond what is included in Original Medicare, Part A and Part B, so you will need to determine exactly what kind of coverage you may require, plus whether or not you want prescription drug coverage through a Medicare Advantage Prescription Drug plan. With so many health insurance options available, you can understand why it may be smart to compare each Medicare Advantage plan in New Mexico that offers benefits and costs suited to your personal requirements.

To start comparing Medicare Advantage plans in New Mexico today, enter your zip code above for a customized list of plans available in your area. You can also enter your prescription drug needs to further customize your search and cost estimates.

Visit the following pages for additional details about Medicare in New Mexico:

*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.