Medicare Advantage Plans in New Mexico

Medicare Advantage plans in New Mexico, also known as Medicare Part C, are sold by private insurance companies that work with Medicare. Part C plans bundle Medicare Part A and Medicare Part B benefits into one plan, and they usually include prescription drug coverage (Medicare Part D). It is also common for Part C plans to have extra advantages like hearing, vision, and dental care that aren’t included in Original Medicare.

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Top-Rated Medicare Advantage Providers in New Mexico

  • Aetna.
  • Amerigroup Community Care of New Mexico.
  • Blue Cross Blue Shield of NM.
  • Cigna.
  • Humana.
  • Lasso Healthcare.
  • Molina Healthcare of New Mexico.
  • UnitedHealthcare.

Popular Medicare Advantage Plan Types in New Mexico

Best for network freedom: Medicare Advantage PPO plans

  • PPOs have a broader network of healthcare providers for Medicare beneficiaries.
  • Enrollees don’t require referrals from primary care physicians to see specialists.
  • Premiums run between $0 and $100.00 per month.

Best for low out-of-pocket costs: Medicare Advantage HMO plans

  • Most HMOs have zero monthly premiums.
  • HMOs use network providers and require referrals which helps keep costs low.

Best for low-income or chronic health conditions: Medicare Advantage D-SNP

  • D-SNPs are Dual Eligible Special Needs Plans that benefit people living on low incomes or with chronic health issues like end-stage renal disease.
  • Dual eligible beneficiaries qualify for both Medicare and Medicaid health care coverage. D-SNPs help beneficiaries by covering expenses such as copayments, coinsurance, premiums, and deductibles.

Medicare Enrollment Facts:

  • Total lives with Medicare Advantage plans in New Mexico: 134,985
  • Enrolled in Local HMO plans: 83,435
  • Enrolled in Local PPOs: 50,783
  • Enrolled in Regional PPOs: 0
  • The Medicare population enrolled in Medicare Advantage in New Mexico is 33 percent.
  • The number of lives enrolled in Medicare Advantage nationwide
  • exceeds 26 million.
  • The total number of lives enrolled in Medicare Advantage plans nationwide is over 26 million.
  • The percentage of Medicare beneficiaries enrolled in Medicare Advantage nationwide is 42 percent.

How much does Medicare Advantage in New Mexico cost?

In New Mexico, insurers offer HMO plans with zero monthly premiums. In some service areas, consumers can also find PPOs with zero premiums, although they are not as common.

New Mexico ranks 40 in the US for Medicare Advantage Prescription Drug plans (MAPDs). The average cost of a monthly premium for an MAPD in New Mexico is $28.11. The average annual deductible of MAPDs in New Mexico is $235.15.

A licensed insurance agent representing a private insurance company in your service area can give you more details about monthly costs for plans in your county.

How much do Advantage Plans cost in New Mexico?

PPO Plan $0.00 to $28.11

HMO Plan $0.00

When can I enroll in a Medicare Advantage plan?

You can enroll in a New Mexico Medicare Advantage plan without penalty during the following enrollment periods:

1. Initial Enrollment Period

At the age of 65:

  • If you get Social Security retirement benefits at age 65, the Social Security Administration automatically enrolls you in Original Medicare Parts A and B. You can switch to Medicare Part C coverage during this enrollment period.
  • Your initial enrollment period lasts seven months, beginning three months before your 65th birthday and ending three months after the month of your birthday.

Younger than 65:

  • If you have been receiving Social Security disability benefits for 24 months.
  • Your enrollment period begins three months before the 25th month of disability benefits and ends three months after that.
  • Benefits begin immediately after diagnosis of end-stage renal disease or ALS

2. Open Enrollment or Annual Election Period

Changes made to Medicare coverage during the Open Enrollment Period kick in on January 1. During the OEP or AEP from October 15 to December 7 every year, eligible beneficiaries can do the following:

  • Enroll in a new Medicare Advantage plan.
  • Switch to a different Medicare Advantage plan.
  • Return to Original Medicare Part A and Part B and enroll in a stand-alone Medicare Part D plan.

3. Medicare Advantage Open Enrollment Period

During the Medicare Advantage Open Enrollment Period, which runs from January 1 to March 31 every year, those eligible cans:

  • Leave Part C plans and go back to Original Medicare coverage.
  • Switch over to a different Medicare Advantage plan.

4. Special Enrollment Periods

During special enrollment periods, you can do the following:

  • Purchase a Medicare Advantage plan.
  • Purchase a Medicare prescription drug plan.
  • Change your current health care plan by upgrading or adding new coverage options.

You may be eligible for special enrollment if you meet any of the following conditions:

  • You move out of your current service area.
  • You move back to the US after living abroad.
  • You move into or out of skilled nursing care or long-term care facilities.
  • You leave prison.
  • You lose Medicaid coverage.
  • You become dual eligible for Medicare and Medicaid.
  • Your Medicare Advantage plan ends.
  • You switch coverage from Original Medicare and Medigap to Medicare Advantage.

5. Five-star Special Enrollment Period

Medicare Advantage beneficiaries can upgrade their coverage to a plan with a five-star rating.

6. Special Enrollment Period for Medicare “Extra Help” Programs

People in an Extra Help program or who have Medicaid can change their coverage during any of these periods:

  • January – March
  • April – June
  • July – September

Medicare Advantage Highlights:

Here are some more details about Medicare Advantage in New Mexico:

  • It is mandatory for all Medicare Advantage insurance plans to cover at least every benefit that Original Medicare Part A and Part B provide.
  • The private insurance company you choose as your provider takes over responsibility for your health care claims, customer service, and the administration of your insurance.
  • Medicare Advantage enrollees pay a monthly premium for their Medicare Advantage plan and their monthly Part B premium.
  • The standard monthly Part B premium paid to Medicare is $164.90 in 2023.
  • The annual Part B deducible is $226 in 2023.
  • Medicare Advantage plans in New Mexico are gaining popularity as an alternative to Medicare Part A and Medicare Part B coverage.
  • Most Medicare Advantage health care plans use network providers for health care services.
  • Most plans have additional coverage for Part D plans (prescription drug coverage).

Ready to Learn More?

We help educate Medicare beneficiaries on their Medicare Advantage options and help them go through the process of reviewing and comparing plans. We work with most of the nation’s top-rated Medicare Advantage carriers. Call us today, or request a quote online to learn more about plan options.

Medicare Supplement Cost in Florida:
Plan G $152.00
Plan N $125.00
Plan F $200.00

Key Takeaways

  • In New Mexico, PPO Medicare Advantage plans are very popular for many Medicare beneficiaries.
  • Medicare Advantage Plans, also known as Medicare Part C, are sold by private insurance companies that work with Medicare. Part C plans bundle Medicare Part A and Medicare Part B benefits into one plan, and they usually include prescription drug coverage (Medicare Part D).
  • Medicare Advantage enrollees pay a monthly premium for their Medicare Advantage plan and their monthly Part B premium. The standard monthly Part B premium paid to Medicare is $170.10 in 2022. The annual Part B deducible is $233 in 2022.
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