Medicare in New Mexico

Medicare is a federal health insurance program for residents aged 65 and older and people with certain disabilities or diagnosed with end-stage renal disease. The Centers for Medicare and Medicaid Services (CMS) reveal that in 2022, 437,844 New Mexico residents benefit from Medicare, which is almost 20.7% of its 2,117,522 inhabitants. Of these, 60.6% have Original Medicare, which is below the national average of 63.8%, while the remainder is enrolled in a Medicare Advantage plan.

There are two types of insurance: Original Medicare and Medicare Advantage. The former has two parts: Part A and Part B. Part A covers inpatient care in a hospital, skilled nursing facility care, nursing home care, hospice care types of home health care; Part B covers some costs for doctors, preventative services and medical supplies. 

Part D covers prescription drug costs. It can be added to Original Medicare and is often included in Medicare Advantage plans. 

The premiums for each vary, with Part A generally free for residents who paid toward Medicare for at least 10 working years, while the standard premium Part B costs $170.10 per month (as of 2022). Part D is dependent on income and other factors unique to the policyholder.

Part C delivers all the coverage provided by Parts A and B (except hospice care, which Part A covers) and is better known as Medicare Advantage. Unlike the federally controlled Original Medicare, CMS-approved private health insurance companies manage Part C plans. Premiums start at $0 but are often higher as residents take advantage of optional plans, such as coverage for dental, vision and hearing services. Private insurance companies also offer Medigap, which covers expenses Original Medicare doesn’t pay for, such as copays and deductibles.

There’s more information about Medicare in New Mexico in this guide, including how seniors can personalize plans. Additionally, there’s a list of organizations that can help residents navigate the wealth of information and the growing number of offered plans.

Options for Medicare Coverage in New Mexico

Original Medicare provides coverage for a range of medical needs, but it can’t cover every possible eventuality. However, this doesn’t mean New Mexico’s residents can’t get the coverage they need, as the CMS has approved multiple private insurance companies, allowing them to offer tailored Medicare Advantage plans. Consequently, eligible residents can personalize their plan with an insurance provider and get coverage for their anticipated needs.

Original Medicare (Parts A & B)

Original Medicare is administered by the Centers for Medicare & Medicaid Services (CMS) and is open to seniors aged 65 and over, along with those under 65 years old, but with certain disabilities or end-stage kidney disease. It includes two parts. Part A covers inpatient hospital care, nursing home and skilled nursing care, hospice and home health care. Part B, or medical coverage, pays for medically necessary goods and services such as durable medical equipment, mental health services and emergency medical transportation. 

Unlike most private Medicare plans, Original Medicare’s provider network isn’t limited to the beneficiary’s geographic region, making it easier to obtain services while traveling within the country. In most cases, Medicare doesn’t pay for health services the individual receives outside the United States. 

Under this program, seniors pay for services as they receive them. They must pay an annual deductible, which is $1,556 for Part A and $233 for Part B in 2022. After they’ve paid this amount, Medicare covers all eligible services at 80%. Beneficiaries pay the remaining 20% out of pocket.

Who Should Consider Original Medicare

Original Medicare may be a good option for those who:

• Travel frequently within the United States
• Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
• Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

Medicare Advantage (Part C) is an alternative to Original Medicare, provided by CMS-approved private insurance companies. A Part C plan must deliver the same coverage as Parts A and B (except for hospice care, which Part A covers) and provide at least the same quality care. Medicare Advantage differs from Original Medicare because the insurance company chooses the medical care providers, and Part C plans are more flexible, such as covering gym memberships and offering Part D (drug coverage)as standard.

Like Original Medicare, Part C plans also start with premiums at $0, although the average premium for New Mexico is $14.73 because beneficiaries often get extra coverage, such as dental services. As of 2022, there are 69 Medicare Advantage plans in New Mexico, a leap of 23 from the previous year, making it more likely residents will find coverage that suits their needs.

Who Should Consider Medicare Advantage

Medicare Advantage recipients are often people who:

• Are generally healthy , so may get lower premiums
• Require more coverage, such as hearing services
• Are satisfied with managed care
• Want to limit their out-of-pocket expenses

The Top 10 Medicare Advantage Plans in New Mexico

With so many plans available, choosing the right one can be challenging. This top 10 list reflects the most in-demand plans in New Mexico as of April 2022. It bases ranking on each provider’s plan enrollment numbers, with a column for each plan’s monthly cost range. To get more information, visit Medicare Advantage Plans in New Mexico. 

Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later.

Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.

Who Should Consider Medicare Prescription Drug Coverage

Seniors who may benefit from prescription drug coverage include those who:

• Currently take prescription medication or expect to in the future
• Want to avoid late enrollment penalties
• Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.

For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2022 page.

Who Should Consider Medicare Supplement Insurance

Good candidates for Medigap may be those who:

• Have ongoing health issues and expenses
• Travel overseas often
• Want to access an expanded network of health care providers
• Expect to need health services not covered by Original Medicare

Medicare Resources in New Mexico

There are many ways New Mexico’s residents can get more information about Medicare free of charge. The resources provided here offer information, advice and support through one-on-one assistance by phone or face-to-face or via online portals. Each provider’s trained staff can clarify confusing aspects of Medicare, answer questions and offer personalized advice based on the unique circumstances. They can also discuss supplementary plans, such as Medigap, and several can support residents denied Medicare.