Information about Medicare Advantage Plans in New Mexico

Quick links:

• Average 2019 Costs
• Eligibility & Enrollment
• Finding Top-Rated Plans
• List of Plans Available
  • Plans by Carrier
  • Plans by County
  • Plans by Type
• Local Resources

34 percent of Medicare beneficiaries in New Mexico were enrolled in a Medicare Advantage (Medicare Part C) plan in 2019.¹

There are 218 different New Mexico Medicare Advantage plans in 2019.¹ Not every plan is available in each county, so it's important to find out which ones are offered where you live.

A licensed insurance agent can help you compare the availability, benefits and costs of Medicare Advantage plans in your area of New Mexico. You can also learn more about Medicare Advantage in New Mexico by reading below.

Other types of Medicare plans may be available where you live, such as:

• New Mexico Medicare Supplement Plans
• New Mexico Medicare Part D Plans

Average costs of Medicare Advantage in New Mexico

The average Medicare Advantage premium paid by beneficiaries in New Mexico was $21 per month in 2019.

Of the 218 available MA plans in New Mexico in 2019, 63 plans offered $0 monthly premiums.

• Average monthly premium cost in 2019 (weighted): $21
• Average in-network out-of-pocket spending limit: $4,576
• Average deductible in 2019 (weighted): $157.94¹

The cost of a Medicare Advantage plan can vary depending on where you live.

The average 2019 New Mexico Medicare Advantage plan premiums are listed by county below in this guide.

A licensed insurance agent can help you compare Medicare Advantage plan costs in your area.

Or call 1-800-557-6059 1-800-557-6059 TTY Users: 711 24/7 to speak with a licensed insurance agent.

Medicare Eligibility & Enrollment in NM

You may not sign up for a Medicare Advantage plan in New Mexico without first enrolling in Medicare Part A and Part B, otherwise known as Original Medicare.

In order to enroll in Original Medicare at age 65, you must:

• You must be a U.S. citizen or permanent legal resident who has lived in the U.S. for five consecutive years.
  
  
• You or your spouse must be eligible for Social Security or Railroad Retirement benefits.
  
  
• You or your spouse must be government employees or retirees who have paid Medicare payroll taxes.

You may be eligible for Medicare benefits before you reach age 65 if:

• You have been receiving Social Security disability benefits or certain Railroad Retirement Board disability benefits for at least 24 months.
  
  
• You have ALS (amyotrophic lateral sclerosis, or Lou Gehrig's disease).
  
  
• You have End-Stage Renal Disease (ESRD), and you or your spouse have paid Social Security taxes for a certain length of time.

If you have ESRD, you may not be eligible for most Medicare Advantage plans, but you may be able to enroll in a New Mexico Medicare Special Needs Plan (SNP) that is specifically designed to help meet your health care needs.

How to sign up for a Medicare Advantage Plan in New Mexico

You can typically enroll in a New Mexico Medicare Part C plan during your Medicare Initial Enrollment Period (IEP).

Your Medicare IEP starts three months before your 65^th birthday, continues during the month of your 65^th birthday and then continues for another three months after your birthday.

You may also be able to sign up for a Medicare Advantage plan during the following Medicare enrollment periods:

Medicare Advantage Open Enrollment Period: January 1 – March 31

During the Medicare Advantage Open Enrollment Period, you may switch Medicare Advantage plans or drop your Medicare Advantage plan and return to Original Medicare.

If you return to Original Medicare during this period, you can typically also join a Medicare standalone prescription drug plan (Medicare Part D).

Medicare Annual Enrollment Period (AEP): October 15 – December 7

From October 15 to December 7 every year, you may enroll in a Medicare Advantage plan or switch from one Medicare Advantage plan to another.

During this period, you may also drop your existing Medicare Advantage plan and return to Original Medicare.

You may also join, switch or drop a Medicare Part D plan during AEP.

Medicare Special Enrollment Periods (SEP)

You may potentially be granted a Medicare Special Enrollment Period (SEP) at any time throughout the year, but only if you meet certain criteria.

A licensed insurance agent can help you find out if you qualify for a Medicare Special Enrollment Period.

Or call 1-800-557-6059 1-800-557-6059 TTY Users: 711 24/7 to speak with a licensed insurance agent.

Top-rated Medicare Advantage Plans in New Mexico 2020

The Centers for Medicare & Medicaid Services (CMS) issues Star Ratings every year to show how each Medicare Advantage plan rates across several key areas, using a system of one to five stars.²

In order for a Medicare Advantage plan to be considered a top-rated plan, it must have four or more stars out of five stars.

There are 71 top-rated 2019 Medicare Advantage plans in New Mexico that are rated four stars or higher.

Medicare Advantage plans are rated based on the following five categories:

• Preventive care and health maintenance
• Chronic conditions management
• Member experiences and ratings of the plan
• Member complaints and plan performance
• Customer service

The information for the star ratings is gathered from information that is submitted to Medicare, Medicare’s regular monitoring activities and member surveys.

List of Medicare Advantage Plans Available in New Mexico in 2020

To view a list of plans offered in your area within New Mexico, use our plan comparison tool.

Or call 1-800-557-6059 1-800-557-6059 TTY Users: 711 24/7 to speak with a licensed insurance agent.

Private insurance companies offer Medicare Advantage plans in New Mexico

Several insurance companies may offer Medicare Advantage plans in New Mexico, but the availability of plans in your area can depend on where you live.

Private insurance companies offer Medicare Advantage plans that may be unique to the plan area they serve.

You can call and speak with a licensed insurance agent to learn more about the Medicare Advantage plans that are sold by insurance companies in your area.

The following information can also help you learn more about plans as you're shopping for a Medicare Advantage option that fits your needs:

• The Medicare Star Ratings can give you an idea of a plan’s overall quality.
  
  
• Agencies like A.M. Best, Moody’s and Standard & Poor’s can provide information about an insurance company’s credit rating and financial standing.
  
  
• Websites such as the Better Business Bureau and Consumer Reports can teach you about a company’s reputation among its customers.
  
  
• You can read through Medicare Advantage plan reviews and testimonials from customers.

New Mexico Medicare Advantage plans by county

The chart below provides some more information about 2019 New Mexico Medicare Advantage plans by county.¹

• Santa Fe County, Bernalillo County and Sandoval County had the most $0 premium plans in New Mexico in 2019, with 6 such plans in each county.

NM Medicare Advantage enrollees by plan type

The chart below illustrates the percentage of 2019 New Mexico Medicare Advantage enrollees that are enrolled in each primary type of Medicare Advantage plan.¹

The major types of Medicare Advantage plans include:

• HMO
  If you have a Health Maintenance Organization (HMO) plan, you are usually required to use health care providers and pharmacies that are part of the plan’s network (except in the case of emergencies).
  
  You'll also typically need a referral from a primary care doctor in order to see a specialist.
  
  
• PPO
  Medicare Advantage beneficiaries in a Preferred Provider Organization (PPO) plan are typically able to see providers outside of their plan’s network, though it's often at a higher cost.
  
  PPO plan beneficiaries typically pay less out of pocket if they choose to receive medical services from providers within their plan’s network.
  
  PPO plans typically do not require patients to get a referral before visiting with a specialist.
  
  
• PFFS
  A Private Fee-For-Service (PFFS) plan determines how much you pay for services at the point when care is received.
  
  With a PFFS plan, you can typically receive care from any doctor, hospital or health care provider that accepts Medicare and your plan’s terms. Not all providers will accept these terms, however.
  
  
• SNP
  A Special Needs Plan (SNP) is a type of Medicare Advantage plan with limited enrollment that is designed to serve people with certain chronic conditions and other specific characteristics.
  
  Typically, you must receive care from health care providers and hospitals within your SNP network, except for in cases when you need emergency or urgent care and when someone who has End-Stage Renal Disease (ESRD) needs out-of-area kidney dialysis.

Not all of these types of plans may be available in your area. A licensed insurance agent can help you compare the types of 2019 New Mexico Medicare Advantage plans that are available where you live.

Local health insurance resources in New Mexico

• The State Health Insurance Assistance Program in New Mexico is part of a nationwide program that provides personal counseling and assistance to people with Medicare and their families.
  
  The service is free and unbiased, and it helps provide a way for New Mexico’s Medicare beneficiaries to better understand their insurance and make the most use of their coverage. The program may be contacted at 800-432-2080.   
  
  
• You can also explore more information about the insurance industry in New Mexico by visiting the state’s Department of Insurance website.
  
  
• New Mexico Prescription Drug Assistance Programs
  The state of New Mexico has a number of programs designed to help with the cost of prescription drugs. There are programs for both Medicare beneficiaries and non-Medicare beneficiaries alike that can cover the cost of premiums and cost-sharing or even lower the cost of the drugs themselves.