Medicare in New Mexico
Key Takeaways
Medicare in New Mexico is a federal program available to all legal U.S. residents aged 65 and older.
Original Medicare’s Parts A and B cover hospital and medical services. Medicare Advantage in New Mexico is an alternative that often bundles Part D 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 all New Mexicans 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 to make if you’re close to 65 or older: 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
- 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.
What are the New Medicare Benefits for 2022?
There are several changes to Medicare in 2022 that you’ll want to know about, including new services and screenings that may apply to your health.
Medicare pricing for 2022
Medicaid also implemented its annual price adjustments in 2022.
Medicare in NM: Part A
Premium:
- $0 if you or your spouse worked 10 or more years
- $274 a month if you worked between 7.5 and 10 years
- $499 a month if you worked fewer than 7.5 years
Deductible:
- $1,556 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:
- $170.10 monthly and up
- Income-based
Deductible:
- $233
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 $480 in 2022
Copayments & coinsurance:
- Depends on plan specifics and drugs needed
What Is the Best Medicare Plan for 2022?
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:
- 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.
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 404,382 people are enrolled in Medicare Part A and B in New Mexico. The total number of beneficiaries enrolled in Medicare Advantage Increased from 162,355 to 179,136 year over year. Medicare Advantage participation in New Mexico went from 41.33% to 44.30% 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.
Medicare
New Mexico
404,382 Beneficiaries with Part A & Part B
179,136 Medicare Advantage Beneficiaries
44.30% Meducare Advantage Participation Rate
52.58% Female
47.42% Male
61.70% Non-Hispanic White
1.54% African American
26.95% Hispanic
9.81% Other/Unknown
20.59% Eligible for Medicaid
0.89 Average HCC Score
$8,317.44 Actual Per Capita Costs
16.08% Hospital Readmission Rate
24.55% of Beneficiaries with an Emergency Department Visit
162,355 Medicare Advantage Beneficiaries, Previous Year
Increased Medicare Advantage, Year over year
41.33% Meducare Advantage Participation Rate, Previous Year
See more +
Table reflects the latest Beneficiary Demographics Data: Medicare Geographic Variation – by National, State & County
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 $8,806.07 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:
Nationwide Resources
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.
Medicare guide
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement
Medicare guide
Medicare Plans Guide
Costs, coverage and enrollment details for each Medicare plan
Medicare guide
Medicare Beneficiary Guide
For those currently enrolled in Medicare
Medicare guide
Low Income and Medicare Guide
For individuals with a qualifying income status
Medicare guide
A Caregiver’s Guide
For individuals with a qualifying income status
