Explore the Best Health Insurance Plans in New Mexico for 2024

New legislation in New Mexico has reshaped the health insurance landscape for 2024, introducing measures that significantly benefit policyholders, such as capping out-of-pocket costs for insulin at $25 for a 30-day supply and eliminating cost sharing for critical care including diagnostic breast exams and STI treatments ¹. Additionally, these laws ensure that diabetics have access to necessary care and supplies, marking a step forward in securing health coverage that caters to crucial healthcare needs ¹.

As New Mexico navigates these changes, small businesses, individuals, and families stand to gain from improved health insurance options and enhanced affordability and accessibility measures, such as the New Mexico Premium Assistance Program, which makes health coverage more attainable on the Health Insurance Marketplace³. These developments signal a promising shift towards more inclusive and accessible health insurance in New Mexico, offering a model for proactive health policy reform ³.

Key Changes and Their Implications for Policyholders

Expanded Coverage and Financial Assistance

1. Presbyterian Health Plan offers the lowest out-of-pocket costs and is the only HMO with nationwide coverage, ensuring broad accessibility and affordability ⁸.
2. Civil Rights Compliance ensures that the Presbyterian Health Plan does not discriminate on the basis of race, color, national origin, age, disability, or sexual orientation or gender expression ⁸.
3. Language Assistance Services are available at no cost, further supporting non-English speaking or hearing-impaired policyholders ⁸.
4. Eligibility Requirements specify that individuals must be U.S. citizens, nationals, or lawfully present non-citizens, not incarcerated, and residents of New Mexico ⁹.
5. Advanced Premium Tax Credits (APTC) are accessible to lawfully present individuals ineligible for Medicaid but with household incomes less than 100% FPL ⁹.
6. Additional Financial Assistance is available for those with a projected annual MAGI over 100% FPL, who file taxes and are not eligible for other qualifying MEC ⁹.

Enhanced Health Benefits

1. Cap on Insulin Costs ensures diabetics can obtain necessary supplies at an affordable rate, capped at $25 for a 30-day supply ¹.
2. Elimination of Cost Sharing for critical care areas like diagnostic breast exams and STI treatments promotes preventive health measures ¹.
3. Coverage for Mental Health equates to that for other types of care, addressing the critical need for mental health services ¹.
4. Prosthetics and Custom Orthotics must now be covered at least to the extent that Medicare does, enhancing support for those needing such medical aids ¹.
5. Chiropractic Care must be priced comparably to primary care if covered, preventing higher charges for these services ¹.

Financial Impact of Subsidies

1. Enhanced Subsidies available through 2025, ensure that any household paying more than 8.5% of its income on health insurance can qualify for federal tax credits ⁵.
2. Savings on Marketplace Plans average about $800 per year for most Americans, with those aged 50 to 64 seeing even greater savings ⁵.
3. Cost-Sharing Reductions are available for those enrolled in Silver-level plans, helping to manage out-of-pocket expenses effectively ⁵.

Coverage Limitations

1. State Oversight Limitations mean that not all insured New Mexicans will benefit from these changes, as the state can only regulate health insurance plans that are not federally regulated ¹.

Navigating the Health Insurance Market in New Mexico

Open Enrollment Details

1. Open Enrollment for beWellnm: Begins on November 1 and extends through January 15, allowing ample time for residents to select or change their health insurance plans ¹⁰.
2. Presbyterian Health Plan: Offers customer service support for plan benefits at (505) 923-5600 or 1-888-ASK-PRES, available Monday through Friday from 7 a.m. to 6 p.m. ⁸.
3. Medicaid Enrollment: The open enrollment period under the new Turquoise Care program spans from April 1, 2024, to May 31, 2024. Customers with existing plans through Presbyterian Health Plan and BlueCross BlueShield will be automatically re-enrolled unless they choose a new Managed Care Organization (MCO) ¹³.

Special Enrollment Periods

• Qualifying Life Events (QLEs): Events such as marriage, birth, adoption, or loss of employment-based health coverage allow for special enrollment periods, enabling changes outside the regular enrollment window ^6 12.
• Deadline for Changes: All changes made during the Open Enrollment are effective from January 1st, 2024, ensuring that coverage adjustments align with the calendar year ¹².

Financial Assistance and Coverage Options

• Subsidies and Premium Assistance: BeWellnm is the exclusive platform where New Mexicans can qualify for subsidies to reduce monthly premium costs. Eligibility for low-cost or no-cost coverage requires residency in New Mexico, not having insurance through employment, and not being eligible for Medicare or Medicaid ¹¹.
• Coverage and Costs: The type of plan, location, household income, and family demographics like age and disability status influence the coverage and associated costs. All plans cover essential health benefits including emergency services, hospitalization, and prescription drugs ⁵.
• Advanced Premium Tax Credits (APTC) and Cost-Sharing Reductions (CSR): Available for eligible individuals to help reduce premium costs and out-of-pocket expenses. Changes affecting eligibility must be reported within 30 days ⁹.

Educational and Enrollment Support

• Enrollment Events: BeWellnm organizes events where individuals can consult certified enrollment counselors to assist in plan selection ¹¹.
• Webinar Events: Registration for live carrier presentations and Q&A sessions is available, providing valuable information about benefits for the upcoming year ¹².

Insurance Plan Options

• Variety of Providers: Blue Cross and Blue Shield of New Mexico, among others, offer diverse health insurance options catering to different needs and budgets ⁴.
• Plan Comparison Tools: Tools available on beWellnm’s website help potential enrollees compare plans based on estimated costs and eligibility, facilitating informed decision-making ⁵.

Conclusion

Through an in-depth exploration of the shifting landscape of health insurance in New Mexico for 2024, we’ve navigated the considerable benefits and modifications introduced by new legislation. These pivotal changes, including the cap on insulin costs and the expansion of coverage areas such as mental health and preventive care, signify a progressive move towards more inclusive and accessible healthcare options for the residents. The introduction of financial assistance programs and the emphasis on non-discrimination within the health plans underscore a commitment to addressing the diverse needs of New Mexicans, ensuring that health insurance is more attainable and comprehensive.

As we delve into these enhancements, it’s clear that the implications for policyholders are profound, promising a model of health coverage that prioritizes affordability, accessibility, and equity. While there are limitations in state oversight, the overall trajectory towards improved health insurance viability in New Mexico is evident. This evolution encourages a closer examination and continued advocacy for policies that meet the essential healthcare needs of all residents, urging stakeholders to engage in dialogue and actions that support the sustainability and expansion of these benefits.

FAQs

What is the typical monthly cost for health insurance in New Mexico? The monthly cost for health insurance in New Mexico can vary widely based on several factors, including the specific plan, the insured’s age, and the level of coverage. To get an accurate estimate, individuals should obtain quotes from various insurance providers.

Which health insurance company is considered the best? The best health insurance company for 2024 is subjective and depends on individual needs, but some top choices include:

• Best Overall: Blue Cross Blue Shield
• Highest Quality Plans: Kaiser Permanente
• Most Health Management Programs: Oscar
• Best for Same-Day Care: Aetna CVS Health

What are the two most popular types of health insurance plans? The two most common health insurance plans are:

• Preferred Provider Organization (PPO) plans
• Health Maintenance Organization (HMO) plans

Are PPO plans available in New Mexico? Yes, PPO plans are available in New Mexico. For more detailed information tailored to large groups in the state, you can select “State of New Mexico” from the Large Groups drop-down menu on the homepage of health insurance providers. There, you will find a description of the PPO Plans offered.