Medicare in New Mexico

Medicare is a government-funded program that provides healthcare coverage to seniors who are at least 65 or individuals who meet specific disability criteria. In New Mexico, 19.1% of residents meet the age requirements for Medicare eligibility, 49% of whom get their healthcare needs met through a Medicare Advantage Plan as an alternative to traditional Medicare.

Original Medicare is made up of two parts, labeled as Part A and Part B. Part A covers most healthcare facility costs, such as inpatient services within a hospital, skilled nursing facilities and hospice care for at-home end of life management. Part B focuses on medical providers, supplies and equipment, along with some preventative services. When signing up for Medicare, Part A is automatically included, while Part B must be requested. Part D is another option that can be added and provides coverage for prescriptions. All three parts carry their own premiums and other associated costs, though Part A is often free if the individual or a qualifying spouse has at least 10 years of payments into the program through employment taxes over their lifetime.

Medicare Part C is more commonly known as a Medicare Advantage. These plans are offered through private insurance companies and provide the same coverage as traditional Medicare. However, because these private insurers are competing with one another for enrollees, these plans often include additional coverage such as vision, dental and prescriptions, without charging separate premiums. As of July 2023, there are just under 220,000 New Mexico seniors who have chosen Medicare Advantage to handle their healthcare coverage. That’s about 49% of the eligible population, which is a 3% increase from 2022, aligning with the national rise.

Seniors seeking additional information about their Medicare options can begin their research using this guide. Here, they will find information about the different Medicare parts available, some guidelines for choosing between them and details about some of the Medicare Advantage Plans offered to eligible New Mexico residents. 

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, run by CMS, serves seniors 65+ and individuals under 65 with disabilities or end-stage kidney disease. Part A covers hospital and nursing care, while Part B handles medical services such as mental health and emergency transport. Unlike private plans, Original Medicare isn’t geographically restricted but generally doesn’t cover services received internationally.

In 2023, Part A has a $1,600 deductible, up from $1,556, and $0 starting premium. Part B costs $164.90 monthly with a $226 deductible, down from $233. After the deductible, Part B covers 80% of eligible costs; beneficiaries pay 20%. Part A has its own inpatient cost-sharing. 

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, offered by CMS-approved private insurers. These plans must offer at least the same benefits as Original Medicare, excluding hospice care, but often add extras like gym memberships and standard prescription drug coverage (Part D). Unlike Original Medicare, Part C plans have insurer-chosen healthcare providers.

Premiums for Part C start at $0 and saw an average 18% decrease from $14.62 in 2022 to $11.98 in 2023. The number of these plans in New Mexico grew from 69 to 72, providing residents with more options to suit 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 August of 2023. 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 2023 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.