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Medicare in New Mexico

Info for making the right Medicare choice in New Mexico, including costs, options and more

Reviewed by: Shikita Nunnery, Licensed Insurance Agent. Written by: Aaron Garcia.

Key Takeaways

  • Medicare in New Mexico is a federal program available to all legal U.S. residents aged 65 and older.

  • Original Medicare’sOriginal Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). Parts A and B cover hospital and medical services. Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). in New Mexico is an alternative that often bundles Part DMedicare Part D is prescription drug coverage for people enrolled in Medicare. Part D is optional and is offered by private insurance companies. and other services.

  • The pricing for Medicare plans in New Mexico is based on standard costs and personal details like your work history and income.

 

Red or green chile — it’s the fundamental question for all New Mexicans, and one you often have to answer several times a day. And let’s face it, it doesn’t matter what you decide, as long as it’s not “Christmas-style” or “mild.”

But there’s another critical decision if you’re close to 65 or older. The decision is how to receive your Medicare in New Mexico. Not making the right choice can do a lot more than ruin a meal — it can leave you feeling downright disenchanted. Instead, ask yourself some important questions: What are the different kinds of Medicare? How much does Medicare cost? Does Medicare Advantage in New Mexico make sense for me?

How Do I Apply for Medicare in New Mexico?

There are several ways you can enroll in Medicare in New Mexico, including:

  • Online through the Social Security Administration [1]
  • In person at a local Social Security office. [2]
  • Over the phone at 1-800-772-1213 (TTY: 1-800-325-0778)

If you’re already receiving Social Security or Railroad Retirement Board (RRB) benefits, you may be automatically enrolled when you turn 65. If not, you’ll probably need to enroll yourself. Your first chance to sign yourself up is known as your Initial Enrollment Period (IEP). This is a seven-month window that includes your birth month, plus the three months before and after.

With Medicare, timing can be everything, so you’ll want to know more about your IEP and Medicare’s other enrollment periods.

What Is the Income Limit for Medicaid in New Mexico?

It’s important to know that Medicaid is not the same as Medicare in New Mexico. Medicaid is a state and federal program designed to help low-income adults, children and seniors. In New Mexico, this also applies to Native Americans living in tribal and non-tribal areas. There are several programs, and eligibility depends on your income and household size. [3]

What Are the New Medicare Benefits for 2021?

Medicare introduced some exciting changes in 2021, including:

  • Patients with End Stage Renal Disease (ESRD) can now enroll in Medicare Advantage
  • Reduced charges for insulin

Medicare pricing for 2021

Medicaid also implemented its regular price adjustments in 2021.

Medicare in NM: Part A

Premium:

  • $0 if you or your spouse worked 10 or more years
  • $259 a month if you worked between 7.5 and 10 years
  • $471 a month if you worked fewer than 7.5 years

Deductible:

  • $1,484 each plan period

Copayments & coinsurance:

  • Hospital stays: $0 copay for Days 1-60 following deductible payment; daily charges for Days 61 and after
  • Skilled Nursing Facility: $0 for Days 1-20 (each plan period); daily charges for Days 21 and after

Medicare in NM: Part B

Premium:

  • $148.50 monthly and up
  • Income-based

Deductible:

  • $203

Copayments & coinsurance:

  • None for most preventative services.
  • 20% of the Medicare-approved costs for other services.
  • 35% for outpatient health services.

Medicare in NM: Part D

Premium:

  • Income-based; varies by plan

Deductible:

  • Plan-based; not to exceed $445 in 2021

Copayments & coinsurance:

  • Depends on plan specifics and drugs needed

What Is the Best Medicare Plan for 2021?

The answer to this question is completely based on you and your needs. Choosing between Medicare plans in New Mexico should start with understanding your options.

There are two main ways to receive Medicare in New Mexico: Original Medicare (Parts A and B) and Medicare Advantage (Part C). Here’s how they work:

 

Original Medicare (Parts A and B)

Original Medicare is made up of Parts A and B. They work separately and provide a base level of care.

  • Part A: Helps cover stays at hospitals, nursing homes, skilled nursing facilities, hospice care and some home health care.
  • Part B: This portion helps cover medically necessary and preventive services from doctors and other providers

Medicare Advantage (Part C)

Medicare Advantage (Part C) replaces Original Medicare (Part A & B), but offers the same Part A and B benefits or coverage as Original Medicare.

  • Along with receiving Part A and B benefits, Medicare Part C often bundles additional services like dental, hearing, vision and prescription drug coverage.

 

While Medicare Advantage in New Mexico often features lower costs and Part D coverage, being enrolled in Original Medicare alone can leave you with high out-of-pocket charges and doesn’t cover your prescription drugs. Because of this, many New Mexicans also enroll in Medicare Prescription Drug Plan (Part D) and Medicare Supplement Insurance (Medigap).

Medicare Prescription Drug Plan (Part D)

Part D provides prescription drug coverage as a stand-alone plan purchased separately from Original Medicare. Again, Medicare Advantage plans in New Mexico typically include Part D coverage.

Medicare Supplement Insurance (Medigap)

Medigap policies are sold separately by private insurance plans and help cover “gaps” in Original Medicare. These gaps refer to the range of high out-of-pocket costs that can come with Parts A and B, such as deductibles, coinsurance and copays. Like Part D, Original Medicare enrollees pay their Medigap premiums separately from Original Medicare.

What Are the Disadvantages of Medicare Advantage Plans?

While this question gets asked pretty often, the answer really depends on what you need out of your plan. It doesn’t matter whether you have Medicare Advantage or Original Medicare in New Mexico; what may be an advantage for someone in Las Cruces could be a downside for folks in Farmington. To help, here are some resources to figure out how the Medicare plans in New Mexico stack up for you:

  • Enrollment Checklist: Assess your budget, coverage needs and enrollment timing
  • Medicare Star Rating System: See what other enrollees think of their plans
  • Pros and Cons: What to know about Original Medicare vs. Medicare Advantage in New Mexico
  • Pro Tips: Little-known pointers you’ll want to know
  • Contact GoHealth: Our licensed insurance agents are available to shop plans and explain the differences you need to know.

What Are the Top 3 Medicare Advantage Plans?

There are several different Medicare Advantage plans to choose from in New Mexico. Finding the top, though, really comes down to what fits your specific needs. In other words, it’s not a popularity contest. Instead, here are some tools that break down the different types of Medicare Advantage in New Mexico, and how they work:

Again, finding the right Medicare approach for you comes down to your needs and which plans are available in your area. If you need help exploring Medicare plans in New Mexico and how they’ll work for you, give GoHealth a call. Our licensed insurance agents will talk through your needs and options to find a plan that works for you.

Medicare in New Mexico by the Numbers

Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 381,816 people are enrolled in Medicare in New Mexico. The total number of beneficiaries enrolled in Medicare Advantage in New Mexico is 150,307. The previous year, 141,629 enrolled in Medicare Advantage. Medicare Advantage participation in New Mexico went from 38.21% to 39.37% year over year. If you’d like to dive deeper into how Medicare in New Mexico breaks down across the state, we provide a glance at who is using Medicare, and how.

Outline of New Mexico
381,816
Beneficiaries with Part A & Part B
150,307
Medicare Advantage Beneficiaries
39.37%
Medicare Advantage Participation Rate
52.50%
% Female
47.50%
% Male
0.91
Average HCC Score
$8,403.63
Actual Per Capita Costs
24.33%
% Eligible for Medicaid
29.19%
% of Beneficiaries with an Emergency Department Visit
15.73%
Hospital Readmission Rate
60.83%
% Non-Hispanic White
1.61%
% African American
28.02%
% Hispanic
9.54%
% Other/Unknown

Table reflects the latest Beneficiary Demographics data: 2018, All Beneficiaries by State, Centers of Medicare & Medicaid Services (CMS)

Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.

New Mexico Medicare Resources & Contacts

Beneficiaries spend an average of $8,403.63 each year on Medicare in New Mexico. To be certain you are not leaving anything on the table, let us help. A GoHealth licensed insurance agent can assess your coverage or explain which New Mexico-based resources, like these, may be able to help:

New Mexico Aging & Long-Term Services Department

1-800-432-2080

http://www.nmaging.state.nm.us/default.aspx

What should I know about the New Mexico Aging & Long-Term Services Department?

Connect with the Aging & Disability Resource Center for info on saving on your Part D

Centennial Care (Medicaid)

1-800-283-4465

https://www.hsd.state.nm.us/lookingforassistance/centennial-care-overview/

What should I know about Centennial Care?

Low-income New Mexicans and Native Americans may qualify for health, community and long-term benefits

New Mexico Human Services Department

1-855-227-5485 (TTY)

https://www.hsd.state.nm.us/

What should I know about the New Mexico Department of Health and Human Services?

Report fraud and stay current on local New Mexico health conditions

New Mexico Department of Veterans Services

1-505-383-2400

http://www.nmdvs.org/

What should I know about the New Mexico Department of Veterans Services?

The NMDVS can help you with housing, healthcare and legal resources

 

Nationwide Resources

Speak with an insurance agent that is licensed in New Mexico about your Medicare questions.

1-855-792-0088 TTY: 711

Monday - Friday, 8 AM - 9 PM CT

Medicare & Medicaid

If you have general questions about Medicare in NM, or need help with current Medicare benefits.

1-800-MEDICARE (1-800-633-4227)

Social Security Administration

You can reach the SSA by phone for general questions. Not all questions can be answered over the phone.

Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online

Speak to SSA Representative, Monday - Friday, 8 AM - 7 PM ET

Medicare Learning Guides

Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.

Previous Next

New to Medicare Guide

Helpful information to get you started with enrolling in Medicare.

Medicare Beneficiary Guide

For those currently enrolled in Medicare.

Medicare Plans Guide

Costs, coverage and enrollment details for each Medicare plan.

Low Income & Medicare Guide

For individuals with a qualifying income status.

A Caregiver’s Guide

For those helping a loved one with Medicare.