Medicare Advantage Plans in New Mexico

Medicare Advantage was established under the original name Medicare+Choice in 1997 to offer seniors more options in their health insurance. Also known as Part C, Medicare Advantage is managed by private companies and overseen by the federal government. Medicare Advantage Plans must provide all the benefits of Original Medicare Part A and B. However, they can offer additional benefits that enhance the health of older New Mexicans, such as dental, hearing and vision coverage. Most Part C plans include prescription drug coverage as part of the plan, offering seniors more complete coverage. 

One key difference between Original Medicare and Medicare Advantage is the way out-of-pocket expenses work. Original Medicare enrollees have no annual out-of-pocket limit on health care expenses unless they purchase a separate Medicare supplement while Medicare Advantage Plans have yearly limits for Part A and Part B services. Medicare Advantage providers are also allowed to set their own premiums, copays and deductibles. An older adult’s out-of-pocket expenses will depend on their Medicare Advantage Plan, as opposed to Original Medicare enrollees who all have the same out-of-pocket costs.

The number of Medicare Advantage enrollees in New Mexico has grown by 9% from 2022 to 2023. This means that 49% of New Mexicans on Medicare currently have a Part C plan. This is a slight rise from 2022, when 46% of enrollees had a Part C plan. New Mexico’s Medicare Advantage enrollment remains close to the national average. Across the country, 48% of Medicare enrollees have chosen a Medicare Advantage Plan. This number has been growing steadily since the program was introduced.

This guide can help seniors decide whether Medicare Advantage is the right choice for their health care. It lists the top 10 Medicare Advantage providers in New Mexico and explains the types of plans available, eligibility rules and what’s covered. 

The Top 10 Medicare Advantage Plans in New Mexico

There are a variety of Medicare Advantage Plans offered to New Mexico residents. The table below lists the 12 most popular Medicare Advantage providers in the state, based on the total number of enrollments. Costs are presented as a range rather than an average, as most providers offer multiple plans. The table also shows the customer satisfaction ranking out of five stars. This information is current as of July 2023. Older adults can find up-to-date information on plans available and current pricing on Medicare.gov.

How Medicare Advantage Plans Work in New Mexico

Medicare Advantage providers typically offer multiple types of coverage. The plan selected affects a beneficiary’s total out-of-pocket costs and ability to seek care from out-of-network providers, so it’s important to compare Medicare Advantage Plans carefully. The graphic below describes the most common types of Medicare Advantage Plans available in New Mexico.

What Medicare Advantage Plans Cover in New Mexico

Although Medicare Advantage doesn’t cover hospice care, it does cover all other medically necessary services that would be covered by Medicare Part A or Part B. This includes lab tests, X-rays, doctor visits, immunizations, emergency care and services received during a hospital stay. Some New Mexico residents decide to enroll in Medicare Advantage because of the extra benefits offered by some providers. Many plans cover eyeglasses, dental cleanings, hearing aids, dentures and other things that aren’t covered under Original Medicare. Getting these extra benefits can help New Mexico’s Medicare beneficiaries reduce their out-of-pocket costs for care.

*Select plans offer this coverage

** Most plans offer this coverage

Eligibility for Medicare Advantage in New Mexico

Before enrolling in Medicare Advantage, an applicant must qualify for Medicare Part A and Part B, which requires U.S. citizenship or lawful immigrant status. To be eligible for Medicare, an individual must also be at least 65 years old or have end-stage renal disease or another type of disability that makes them eligible for Social Security disability benefits. Once an applicant meets these requirements, they may enroll in a Medicare Advantage Plan if they live in the plan’s service area.

Medicare has limited enrollment periods, which means Medicare-eligible New Mexico residents must apply for coverage within a specific timeframe. Enrollees should also be aware of deadlines for switching Medicare Advantage Plans or leaving Medicare Advantage and enrolling in Original Medicare. More information about Medicare enrollment periods is available in the list below.

• Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
• Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
• Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.

Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.

How to Find & Choose a Medicare Advantage Plan in New Mexico

Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.

First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.

State-Wide Medicare Advantage Resources

Local Medicare Advantage Resources