Medicare in New Mexico
Find affordable Medicare plans in New Mexico
Overview of Medicare Coverage options
More than 369,000 residents of New Mexico received Medicare coverage in 2015, according to the Centers for Medicare & Medicaid Services (CMS). If you are a Medicare beneficiary, you can choose from a variety of types of Medicare coverage in New Mexico. The types of coverage that may be available to you are described below.
Original Medicare is the government health insurance program offered to eligible American citizens and permanent legal residents (of five continuous years or longer) aged 65 and older as well as younger beneficiaries who qualify because of a disability, such as End Stage Renal Disease. Original Medicare includes Part A and Part B.
Part A covers inpatient hospital, skilled nursing and hospice care, and some home health care.
Part B helps pay for physician, outpatient, and some home health and preventive medical services.
Original Medicare does not pay for all care and treatments. For example, in most situations Original Medicare does not pay for prescription drugs. It does not pay for custodial long-term care and typically Original Medicare does not cover support services delivered at home, in a skilled nursing home or an assisted living facility. Original Medicare also does not pay for routine dental care, dentures or routine vision care.
Medigap (Medicare Supplement) plans are offered by private insurance companies and can help you pay your out-of-pocket costs for services covered under Original Medicare.
A Medicare Part D Prescription Drug Plan (PDP) can help pay your prescription drug costs. Designed to work alongside your Original Medicare coverage, Medicare Prescription Drug Plans are available from private insurance companies approved by CMS and doing business in New Mexico. Although Medicare Prescription Drug Plans may vary from county to county, you may want to explore the option of signing up with one if you choose Original Medicare coverage or a Medicare Advantage plan that does not include Part D prescription drug coverage.
Medicare Advantage plans are offered by private insurance companies that contract with CMS. Medicare Advantage plans are paid by Medicare to provide all Medicare benefits except hospice care, which is paid by Medicare Part A. Medicare Advantage plans are required to limit beneficiaries’ out-of-pocket spending for services covered under Medicare Parts A and B.
Many Medicare Advantage plans also include extra benefits such as routine dental and vision care. Plans may also include prescription drug coverage; these are called Medicare Advantage Prescription Drug (MA-PD) plans, and they deliver all your Medicare medical and prescription drug benefits through a single plan.
You may be eligible to enroll in a Medicare Advantage plan in New Mexico. To enroll, you must be enrolled in Medicare Part A and Part B, and you must live in the Medicare Advantage plan’s service area. Generally, Medicare Advantage members must pay their Medicare Part B premium; they may pay an additional premium directly to their plans, also. Because most Medicare Advantage plans deliver covered services by contracting with hospitals, physicians and other health care providers, you will want to check to see if your doctors and preferred hospitals are participating in the plan you are considering.
To identify the plans that are available in your area, enter your zip code in the Plan Finder on this page.
Medicare resources in New Mexico
New Mexico Aging and Long-Term Services Department – This state office is dedicated to assisting senior residents in New Mexico through a variety of programs and services, to help them live independently for as long as possible. In addition, the office provides information, education, and counseling services to Medicare beneficiaries in New Mexico.
Some of the programs under the department’s umbrella include:
State Health Insurance Assistance Program (SHIP) – This program offers assistance with questions about Medicare through an online benefits counseling reference booklet. In addition, the program provides personal counseling services to beneficiaries, as well as public informational presentations throughout the year.
Prescription Drug Assistance – Seniors having difficulty paying for their prescription medications can also find help through the New Mexico Aging and Long-Term Services Department. The department offers a prescription drug assistance program to help make medications affordable for qualified New Mexico residents.
Senior Medicare Patrol (SMP) – This program is designed to educate seniors about preventing Medicare fraud. It also provides information on detecting errors and how to report them on claims.
Aging and Disability Resource Center – This website has links to information on social services, adult protective services, long-term care options, and more.
Senior Citizens Law Office – This office has been providing legal services to New Mexico seniors for many years. In addition to information on estate planning, housing, and senior protection, the office provides assistance with health-care coverage, including Medicare plans. The office may be able to provide legal assistance in the event of a coverage conflict.
Medicare statistical trends in New Mexico
Medicare coverage was a significant benefit to New Mexico beneficiaries in 2015, as indicated by reports released by the Centers for Medicare & Medicaid Services (CMS):
- About 32% of Medicare beneficiaries in New Mexico (117,883 people) were enrolled in Medicare Advantage plans.
- 255,414 Medicare beneficiaries in New Mexico chose to have Medicare Part D prescription drug coverage. More than 50% of these individuals selected stand-alone Medicare Prescription Drug Plans; 112,227 people got their Part D prescription drug coverage from Medicare Advantage Prescription Drug plans.
- Many Original Medicare beneficiaries in New Mexico (92,255 people) got at least one Medicare preventive service at no cost.
CMS data also forecast Medicare coverage data for 2016.
- 94% of people with Medicare Part D prescription drug coverage in New Mexico have access to a plan with a lower premium than what they paid in 2015.
- 100% of people with Medicare have access to a Medicare Advantage plan in New Mexico.
- 24 Medicare Advantage plans are available state-wide.
- 27 Medicare Prescription Drug Plans are available state-wide
Statistical data from the Centers for Medicare & Medicaid Services, “On its 50th anniversary, more than 55 million Americans covered by Medicare” as of July 28, 2015; and “2016 MA Part D Landscape State-by-State Fact Sheet” as of September 21, 2015.
This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.
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