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Medicare in New Mexico

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Overview of Medicare Coverage options

More than 403,400 residents of New Mexico received Medicare coverage in 2018, 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) insurance 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.

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 2018, as indicated by reports released by the Centers for Medicare & Medicaid Services (CMS):

  • About 35% of Medicare beneficiaries in New Mexico (141,251 people) were enrolled in Medicare Advantage plans and other Health plans
  • 290,773 Medicare beneficiaries in New Mexico chose to have Medicare Part D prescription drug coverage. More than 54% of these individuals selected stand-alone Medicare Prescription Drug Plans; 133,424 people got their Part D prescription drug coverage from Medicare Advantage Prescription Drug plans.

CMS data also forecast Medicare coverage data for 2018.

  • 91% 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 2017.
  • 100% of people with Medicare have access to a Medicare Advantage plan in New Mexico.
  • 30Medicare Advantage plans are available state-wide.
  • 24Medicare Prescription Drug Plans are available state-wide

Statistical data from the Centers for Medicare & Medicaid Services, Medicare Enrollment Dashboard and “2018 MA Part D Landscape State-by-State Fact Sheet”

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.

The product and service descriptions, if any, provided on these eHealth Insurance Web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/co-insurance may change on January 1 of each year.

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