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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.
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 Fall Open Enrollment, also known as 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 a Medicare Advantage plan back to Original Medicare, Part A and Part B, you may do so during the Medicare Advantage Open Enrollment Period, which runs from January 1 to March 31 in New Mexico and the rest of the United States. If you do this, you can also join a stand-alone prescription drug plan to go alongside your Original Medicare. You can also change from one Medicare Advantage plan to another during this period.
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:
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.
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.
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.