Guide to New Mexico Medicare Plans & Local Agents

There are close to half a million Medicare recipients across the state of New Mexico that require insurance assistance with their Medicare benefits every year. Medicare enrollment can be volatile as plans can change every year, making it important to review Medicare benefits annually.

If you’re a resident in NM, you have access to several types medical insurance plans including Medicare Advantage, Medicare Supplement insurance plans, and Medicare Part D (PDP) plans.

We get it, Medicare is overwhelming! Use this guide to better understand Medicare in New Mexico and what the right plan for your health care and Medicare coverage is.

Click below to learn more about New Mexico Medicare:

• What Does New Mexico Medicare Cover?
• Types of NM Medicare Plans
• New Mexico Medicare Advantage Plans
• New Mexico Medicare Supplement Plans
• Part D Plans in NM
• Can I Have Medicaid and Medicare in New Mexico?
• New Mexico Senior Programs
• NM Medicare Eligibility
• How to Apply for New Mexico Plans

Why Work With a Local Medicare Insurance Agent in New Mexico?

If you live in New Mexico, you have a number of choices when it comes to Medicare. The challenge is figuring out which coverage options actually make sense for you and are available where you live.

Medicare can be very local. The Medicare Advantage plans, insurance companies, provider networks, and prescription drug plans available to someone in Albuquerque may be different from the options available in Santa Fe, Las Cruces, Rio Rancho, Roswell, Farmington, or one of New Mexico’s rural communities.

That is where working with a local Medicare insurance agent can really help.

Our job as Medicare insurance agents is not to tell every New Mexico Medicare beneficiary to choose the same plan. It is to help you understand your Medicare coverage options and find coverage that fits your doctors, prescriptions, budget, and healthcare needs.

For some people, that may mean staying with Original Medicare and adding a Medicare Supplement and Medicare Part D plan. For others, it may mean comparing Medicare Advantage plans offered by private insurance companies in their county.

A licensed Medicare agent in New Mexico can help you:

• Compare plans and coverage options from multiple insurance companies serving your county
• Review provider networks to see if your doctors, specialists, clinics, and preferred hospitals participate
• Compare prescription drug plans and formularies based on the medications you take
• Understand your monthly premium, deductibles, copays, and out-of-pocket costs
• Explain how Part A, Part B, Part C, and Part D work
• Compare Medigap plans and Medicare Supplement insurance plans
• Review important enrollment deadlines, including Medicare Open Enrollment and special enrollment periods
• Look at whether you may be eligible for programs that can help with certain Medicare costs
• Review your Medicare coverage each year as your health needs, prescriptions, and available plans change

Medicare Help Available to New Mexico Residents

Some New Mexico Medicare beneficiaries may also qualify for assistance through New Mexico Medicaid, including Medicare Savings Programs that can help eligible residents with certain Medicare costs. New Mexico’s Medicaid managed care program is known as Turquoise Care.

If you qualify for both Medicare and Medicaid, understanding how the two programs work together can be especially important when evaluating your coverage options.

New Mexico residents can also receive free, unbiased Medicare counseling through the state’s State Health Insurance Assistance Program (SHIP). SHIP can help Medicare beneficiaries understand their Medicare benefits, enrollment options, Medicare Advantage, Medicare Supplement coverage, prescription drug coverage, and programs that may help with Medicare costs.

Having a Local Medicare Expert Matters

One of the biggest advantages of working with independent Medicare insurance agents or a Medicare broker is having someone you can actually call when you have a question.

Your plan can change. Your prescriptions can change. Provider networks can change. Insurance companies can change their benefits and costs from one year to the next.

Local knowledge can be especially valuable in New Mexico, where access to doctors, specialists, hospitals, and healthcare systems can vary considerably depending on where you live.

Your Medicare coverage should not be something you choose once and forget about.

Working with a local Medicare insurance agent in New Mexico gives you someone who understands the Medicare market in your part of the state and can help you compare your options as your needs change.

What Does New Mexico Medicare Cover?

New Mexico Medicare starts with Original Medicare (parts A and B).

• Medicare Part A covers services like hospital stays, nursing homes, hospice, and home health services.
• Medicare Part B covers ambulance travel, medical equipment, mental health, partial hospitalization, lab tests, and x-rays.

Once you enroll in parts A and B, you are eligible for other types of plans like Medicare Advantage (also known as Medicare Part C), Medicare Supplement insurance plans, and Part D.

Types of New Mexico Medicare Plans

The federal government regulates Original Medicare. This means that Part A and B are the same no matter where you live in the U.S. After you enroll in Original Medicare, you can start exploring plans specific to New Mexico and in your zip code. You should consider enrolling in some type of prescription drug coverage to avoid a late-enrollment penalty down the road. A Part D plan or Medicare Advantage plan can provide this coverage.

Note, plans can be different based on zip codes when zip codes cross over county lines. For example, Albuquerque NM residents need to verify their county and not just zip code.

New Mexico Medicare Advantage Plans

Medicare Advantage plans are sold through private insurance companies and are required to cover the same benefits as Original Medicare. However, most MA plans offer so much more. Some of the additional benefits include vision, hearing, dental, over-the-counter drugs, non-emergency transportation, and group fitness classes like SilverSneakers or Silver & Fit. Pricing for these plans will vary based on provider, location, and benefits.

Medicare Supplement Plans in New Mexico

Medicare Supplements, also known as Medigap policies, add financial benefits that supplement your Original Medicare. There are ten different types of plans (A, B, C, D, F, G, K, L, M, N), and each plan offers different coverage for a different price, meaning you can have fewer benefits for a lower premium or pay a bit more for additional financial protection. These benefits can include coverage for Part A coinsurance and hospital costs, Part B coinsurance and copayments, blood work copays (up to three pints), hospice coinsurance and copayments, skilled nursing facility coinsurance, the Part A deductible, the Part B deductible, Part B excess charges, and foreign emergency travel.

Depending on which plan you choose, coverage will be the same regardless of which carrier you enroll with, but the pricing can still vary based on when you enroll and your location. To help make sure you are not overpaying for your plan, you should speak with a licensed agent.

Part D Plans in NM

Part D plans provide prescription drug coverage. The four phases of coverage. This includes a deductible, initial coverage phase, coverage gap, and then catastrophic coverage.

If you enroll in a Part D plan, your annual deductible will reset each year ($415 in 2019). Plans can vary, and some may waive, reduce, or change the deductible upfront. Once you meet your deductible, your initial coverage phase will start. During this time, you will be responsible for a copay for each prescription drug you purchase. You will continue to pay these copays until you reach a spending limit ($3,820 in 2019).

Once you reach the spending limit, you will be in the “donut hole” and be responsible for 37% of your generic drug costs and 25% of your brand-name drug costs until your spending reaches $5,100. After this point, catastrophic coverage begins and 95% of your prescription costs will be covered. To learn more about Part D plans in your area, click here.

Can I Have Medicaid and Medicare in New Mexico?

Medicare and Medicaid services are two different programs, but each provides health coverage to different groups of people. Medicare is designed for older adults over the age of 65 and people with certain disabilities, whereas Medicaid is intended for low-income individuals and families.

It is possible to qualify for both programs. In fact, there are roughly 78,000 people in New Mexico who are enrolled in both programs. If you qualify for both programs you will likely be eligible for a Dual Special Needs Plan (DSNP). DSNPs are great because they provide extra benefits at lower costs. They also provide enrollees with a Special Enrollment Period (SEP). Most beneficiaries can only change their plan once per year during the Annual Enrollment Period, but SEPs allow you to get the coverage you need when you need it, no matter the time of year!

If you qualify for a DSNP, you may qualify for other programs like Medicare’s prescription drug program, Extra Help, or a Medicare Savings Program. The Extra Help program can help you save an upwards of $4,000/year on prescription drug costs. Medicare Savings Programs can help with other Medicare-related costs like Part A and B premiums, deductibles, copayments, and coinsurance. One of our licensed agents can help you apply for any programs you may be eligible for.

New Mexico Senior Programs

The New Mexico Agency on Aging provides several programs throughout the state to seniors, caregivers, and disabled people. These programs include:

Meals: The meal programs are offered in most areas of the state, based on the available funding and in accordance with program requirements. Meals are provided at least once a day, five days or more per week.

Employment: The Older Worker Program helps seniors supplement their income by helping them find not-for-profit part-time jobs in governmental agencies.

Transportation: There are several transportation programs throughout the state designed to help seniors and disabled individuals get where they need to go. This includes grocery stores, pharmacies, and doctor appointments.

Home Services: The home service programs help seniors stay in their homes as long as possible. These programs can help with in-home services like cooking, cleaning, and bathing.

Prevention: The prevention programs throughout New Mexico are designed to promote healthy lifestyles for seniors through education and awareness.

NM Medicare Eligibility

Most people qualify for Medicare by turning 65, but there are other ways to qualify. If you have ESRD (end-stand renal disease) or ALS (Lou Gehrig’s Disease), you may qualify regardless of your age. Plus, if you have been receiving SSDI (Social Security Disability Insurance) for at least two years, you will be automatically enrolled in Medicare during your 25th-month of SSDI benefits.

If you are planning on moving out of New Mexico to another state, you can find a local Medicare agent in that state using our national plan and agent directory.

How to Apply for New Mexico Plans

You can apply for NM Medicare through Social Security by visiting their website (www.SocialSecurity.gov), calling their office (1-800-772-1213), or applying in person at your local Social Security office.

If you are interested in enrolling in a Medicare Advantage, Medicare Supplement, or Part D plan, we can help! Our agents can talk to you about plans from all the major carriers, so there is no bias.  Call us today at (833) 567-3163.