There are close to 415,000 beneficiaries across the state of New Mexico. Beneficiaries have access to several types of NM Medicare plans including Medicare Advantage, Medicare Supplements, and Part D plans. We get it, Medicare is overwhelming! Use this guide to better understand Medicare in New Mexico.
New Mexico Medicare starts with Original Medicare (parts A and B). Part A covers services like hospital stays, nursing homes, hospice, and home health services. 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, Medicare Supplements, and Part D.
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.
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. If you’re interested in learning about plans in your area, click here or give us a call at 833-438-3676.
Medicare Supplements, also known as Medigap, 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. Click here or give us a call at 833-438-3676.
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.
The cost of Original Medicare is the same regardless of where you live in the U.S. Most people will have premium-free Part A as long as you have worked and paid Medicare taxes for at least 40 quarters. If you worked for 30-39 quarters, you will have to pay $240/month. For any amount of time worked under 30 quarters, you will have to pay $437/month.
The standard Part B premium is $135.50/month in 2019, but this can change based on your income. Costs for Medicare Advantage, Medicare Supplements, and Part D plans vary based on carrier, location, and benefits.
Medicare and Medicaid 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. Click here or call 833-438-3676.
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.
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 have questions regarding your eligibility, click here or give us a call at 833-438-3676.
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. Click here or give us a call at 833-438-3676.
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