Finding Medicare Plans in New Mexico
New Mexico has many Medicare plans to choose from. However, sorting through them all to find the right coverage can be difficult. But we don’t think it should be. That’s why we’ve created this guide, to help you sort through the Medicare plans in New Mexico and find the right coverage for you.
What Is Medicare and What Does It Cover?
Medicare is a government-sponsored health insurance program that provides healthcare benefits to those who qualify. Medicare is available to people 65 or older and certain people under 65 with a qualifying disability or illness.
To see what’s covered, we’ll look at the four parts of Medicare individually.
Original Medicare (Parts A and B)
Original Medicare is the federal component of Medicare, which has two parts:
Part A (Hospital Insurance) covers inpatient services, like hospital care, hospice, skilled nursing facility care, and nursing home care (as long as custodial care isn’t the only care needed).
Part B (Medical Insurance) covers outpatient services and supplies, like mental health, ambulance services, and durable medical equipment (blood sugar monitors, walkers, canes, etc). Part B also covers certain services that prevent or detect illnesses early, like flu shots, cardiovascular and diabetes screenings.
Original Medicare doesn’t cover everything. Services generally not covered by Original Medicare include:
- Long term care (custodial care)
- Most outpatient prescription drugs
- Hearing aids
- Eye exams and eyeglasses
- Most dental care and dentures
- Routine foot care
- Cosmetic surgery
Medicare doesn’t cover everything and isn’t intended to pay 100% of your medical bills. Instead, Medicare beneficiaries typically pay a portion of medical expenses in the form of deductibles, coinsurance, and copayments. That’s why there is a wide variety of additional Medicare plans in New Mexico to choose from to expand your coverage.
Medicare Advantage Plans (Part C)
Medicare Advantage plans are available through Medicare-approved private insurance companies and offer all the same coverage as Original Medicare. These plans can also come with additional benefits, such as dental, vision, and prescription drug coverage. Medicare Advantage plans that include prescription drug coverage are called Medicare Advantage Prescription Drug (MAPD) plans.
In order to qualify for a Medicare Advantage plan, you must be enrolled in both parts of Original Medicare (Parts A and B). Premiums for these plans can start at $0, increasing according to the level of coverage selected. You will continue paying your Part B premium along with the premium charged by the Part C plan selected.
Medicare Prescription Drug Plans (Part D)
Prescription drugs are not covered by Original Medicare (Parts A and B) or Medigap plans, so stand-alone Medicare Prescription Drug plans are offered by Medicare-approved private insurance companies. These plans work alongside Original Medicare to limit your out-of-pocket costs for medications. Medications are put into tiers, each tier with a certain copay or coinsurance. Each Part D plan provides a formulary, so you can see what the coinsurance/copay would be for each drug. This way, you can select the plan that best matches your prescription needs.
Medicare Supplement Plans (Medigap)
As we mentioned earlier, Medicare beneficiaries are still responsible for paying a portion of their medical bills. This is where Medicare Supplement plans come in. Medigap plans are available through private insurance companies and work in tandem with your Original Medicare. They help to reduce your out-of-pocket expenses by covering certain expenses, like copayments. coinsurance, and deductibles.
Am I Eligible for Medicare Plans in New Mexico?
To qualify for Medicare, you must be eligible for Social Security benefits. Most people first become eligible for Medicare when they turn 65 years old.
If you’re 65 or older, you may qualify for Medicare if:
- You are a citizen or permanent resident (having lived in the US for at least 5 years), and
- You or your spouse worked at a job that paid towards your Medicare through Social Security deductions for at least 10 years.
If you’re under 65, you may qualify for Medicare if you have:
- been diagnosed with Amyotrophic Lateral Sclerosis (ALS) or End-Stage Renal Disease (ESRD)
- received Social Security Disability Insurance (SSDI) for at least 24 months
If you’re unsure about your eligibility or will be turning 65 within the next six months, we’re here to help. You can view local plans online or speak with a licensed insurance agent by calling the number above.
When Can I Enroll in A Medicare Plan?
Medicare Advantage and Prescription Drug Plans
Your Initial Enrollment Period (IEP) is your first opportunity to enroll in Medicare. This IEP is a seven-month period, starting three months before your 65th birthday month.
You can then make changes to your Medicare Advantage or Medicare Prescription Drug coverage during the Annual Election Period (AEP). This period runs from October 15th to December 7th every year.
Key Fact: The General Enrollment Period offers another chance to enroll in Original Medicare, in case you missed your IEP. This period occurs each year from January 1st to March 31st. If you choose to enroll in a Medicare Advantage plan, you can do so from April 1st to June 30th every year.
Medicare Supplement Plans
You are guaranteed the Medicare Supplement plan of your choice if you enroll during your Medigap Open Enrollment Period. This six-month period begins at the start of your 65th birthday month, assuming you’ve enrolled in Medicare Part B. Otherwise, your Medigap Open Enrollment Period would start the same month as your Medicare Part B coverage.
Important Note: You could be charged higher premiums or be denied coverage entirely if you don’t enroll in a Medigap plan during your Medigap Open Enrollment Period.
Special Enrollment Periods
If you’ve recently experienced a qualifying life event, you may be eligible for a Special Enrollment Period. Special Enrollment Periods allow you to make changes to your Medicare coverage outside of the periods discussed above. Qualifying life events include moving outside of your plan’s coverage area, moving into or out of a care facility, and more. Our licensed insurance agents can help determine whether you qualify for a Special Enrollment Period.
How Do I Select a Medicare Plan?
We’ll help you sort through the many Medicare plans in New Mexico to find the right coverage for you. You can compare plans online by using the form below or give us a call to speak to a licensed insurance agent.