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 Prescription Drug Plan (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?
There are several ways you can enroll in Medicare in New Mexico, including:
- Online through the Social Security Administration 
- In person at a local Social Security office. 
- 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. 
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
- $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
- $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
- $148.50 monthly and up
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
- Income-based; varies by plan
- Plan-based; not to exceed $445 in 2021
Copayments & coinsurance:
- Depends on plan specifics and drugs needed
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.
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)
- 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)
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:
- A Health Maintenance Organization (HMO) uses primary care physicians and provider networks to manage your care.
- Preferred Provider Organizations (PPO) use primary care physicians but offer some out-of-network coverage
- Private Fee-For-Service (PFFS) plans pay your providers each time you receive a service.
- Special Needs Plan (SNP) plans help enrollees living with specific health conditions.  D-SNP assists dual eligible individuals, and C-SNP is for people with chronic diseases.
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.
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 Aging & Long-Term Services Department
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)
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
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
What should I know about the New Mexico Department of Veterans Services?
The NMDVS can help you with housing, healthcare and legal 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