Assisted living facilities primarily help residents with non-medical needs. Although minor and infrequent medical services, such as first-aid for a wound, can sometimes be met on-site by nurses. These communities may sometimes also be called ALFs, residential care facilities, retirement homes, or long-term care facilities.
The financial options available to help pay for senior care is dependent on, among other things, the type of care that is required. If you are just beginning the research process on how to pay for long-term care, it is helpful to have an idea about the type of care you or your loved one currently requires, as well as to anticipate future needs. In addition, it is important to be familiar with the associated eldercare terminology.
Can using home care technology help your family save money caring for an aging loved one? The answer is most certainly “Yes”. Our goal is not to provide a comprehensive list, but rather to make sense of those that are available on the market today and can reduce the care hours required by elderly persons. As such, they can reduce a family’s out-of-pocket care costs or reduce the hours they spend providing care themselves.
Medicare Advantage (Part C), a privately offered alternative to Original Medicare (Parts A and B), has grown in popularity over the years. Despite the growing popularity of Medicare Advantage, some seniors face obstacles that prevent them from truly understanding how it works and who it benefits. Common mistakes about Medicare Advantage include misunderstanding its differences from Original Medicare, getting it confused with other forms of private Medicare insurance (like Medigap or Part D), or not understanding how to look up or evaluate plans.
Originally known as the Medicare+Choice Program, Medicare Advantage was established under the Balanced Budget Act of 1997. The program’s name was changed to Medicare Advantage in 2003, giving Medicare-eligible residents in New Mexico access to a greater variety of plan options. Also known as Medicare Part C, Medicare Advantage combines the benefits of Original Medicare with the prescription benefits of Medicare Part D, giving enrollees more complete coverage.
A key difference between Original Medicare and Medicare Advantage is that Original Medicare enrollees have no annual out-of-pocket limit on health care expenses unless they purchase a separate Medicare supplement. In contrast, 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. Original Medicare enrollees have the same out-of-pocket costs, no matter where they live.
Approximately 42% of Medicare-eligible Americans are enrolled in Medicare Advantage Plans. With 202,066 individuals enrolled in a Medicare Advantage Plan out of 442,940 Medicare-eligible residents, New Mexico’s enrollment rate is slightly higher than the national rate — 45% in 2021.
This guide introduces the most popular Medicare Advantage Plans in New Mexico, explains the eligibility rules and provides an overview of what Medicare Advantage covers.
The Top 10 Medicare Advantage Plans in New Mexico
New Mexico residents have access to multiple types of Medicare Advantage Plans. The following table lists the 10 most popular Medicare Advantage Plans in the state, ranked according to each provider’s total enrollment numbers. Total enrollment for each provider was calculated by combining the enrollment data for all plans offered by that provider. To account for providers offering more than one plan, cost data is presented as a range, rather than an average. Cost and enrollment data were current as of April 2022. Any senior with questions about current pricing should visit Medicare.gov for up-to-date data on the plans available in each area.
Presbyterian Health Plan
HMO, PPO, PFFS
Blue Cross and Blue Shield of New Mexico
Blue Cross and Blue Shield of IL, NM
Wellcare by Allwell
Molina Healthcare of New Mexico, Inc.
Amerigroup Community Care of New Mexico
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.
Coverage Available With Medicare Parts A & B?
Coverage Available With Medicare Advantage?
Durable Medical Equipment
*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.
Initial Coverage Election Period
3 Months Before One’s 65th Birth Month
3 Months After One’s 65th Birth Month
Annual Election Period (AEP)
Medicare Advantage Open Enrollment Period
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.
New Mexico Aging and Long-Term Services Department
The New Mexico Aging and Long-Term Services Department is the headquarters for the state’s senior services, working with public and private agencies to inform, support and protect seniors and adults with disabilities in regards to aging-related resources, including various Medicare and Medicaid programs. The department collaborates with other programs and agencies, such as the Long-Term Care Ombudsman, Aging and Disability Resource Center and Area Agencies on Aging.
New Mexico’s Aging and Disability Resource Center (ADRC) is a centralized source for information and assistance with health care programs such as Medicare Advantage, long-term options counseling, prescription drug assistance and various local resources. Its Resource Directory provides the latest information about national, state and community programs.
New Mexico’s Long-Term Care Ombudsman Program advocates for residents of long-term care facilities. Volunteer ombudsmen work through grievances between residents, families and facilities to secure individual rights. They help clarify long-term care options and investigate Medicaid, Medicare and Social Security concerns. Ombudsmen also offer guidance on Medicaid and Medicare coverage stipulations, the application process and services covered.
Confidential help from an ombudsman can be arranged by calling 1-866-451-2091 toll free from anywhere in New Mexico.
State Health Insurance Assistance Program
New Mexico’s State Health Insurance Assistance Program(SHIP) program is available to address questions and concerns about Medicare and Medicaid. SHIP representatives provide seniors, family members and caregivers with up-to-date, unbiased information and do not promote or endorse any insurance plans.
To access free help with understanding or choosing a Medicare Advantage plan, call the ADRC at 1-800-432-2080 and ask for a SHIP representative.
Local Medicare Advantage Resources
Area Agencies on Aging
New Mexico has four Area Agencies on Aging (AAAs) that plan, support and oversee community-based initiatives for people ages 60 and older, or aged 55 and older in tribal communities. Most of these services are available locally. Each AAA acts as an information and referral hub to help seniors and their families make the most of benefits at their disposal, including Medicare and Medicaid programs. These agencies place a priority on minorities with low incomes, seniors who reside in rural areas, those with limited English proficiency, older citizens with dementia and individuals at risk of being institutionalized in a nursing home or other facility. Each AAA assists older New Mexicans in one of the state’s six regional Planning and Service Areas (PSAs).
The Senior Information and Assistance Program is a referral service for residents aged 50 and older in the city of Albuquerque and Bernalillo County. It connects seniors and their family members and caregivers with resources and programs regarding health insurance options and costs, including those of Medicare Advantage. The agency also publishes a free Quick Guide to Senior Services that offers information about key community-based services in the Albuquerque area.
The Deming Luna County Senior Citizens Center strives to be a one-stop information resource for seniors aged 60 and older living in Deming, Columbus and Luna County. The staff provides information and counseling about Medicare, Medicaid and other local, state and federal services and programs that benefit the senior population.