New Mexico Health Insurance

Health insurance in New Mexico

● New Mexico operates a state-run health insurance market, but uses HealthCare.gov's federal enrollment platform for individual enrollment (the exchange plans to operate its own platform by fall 2021).

● Open enrollment for 2021 health plans will run out from November 1 to December 15, 2020. Residents with qualifying events can sign up outside that window.

● Short-term health insurance plans are no longer available in New Mexico.

● Five insurers offer 2021 coverage in the New Mexico health insurance market (the CO-OP is closing in late 2020, but two other insurers will join).

● New Mexico implemented the expansion of the ACA's Medicaid coverage in 2014; enrollment grew by 67%.

● Nearly 432,000 New Mexico residents were enrolled in Medicare plans in December 2020.

This page is designed to be an overview of the various types of health coverage available in New Mexico, including individual (self-purchased), Medicaid, and Medicare market plans. Employer-sponsored plans are used by most people of working age, but are designed by employers themselves and are not available to individuals unless they are employed by a company that offers them. Our overview includes details about open enrollment periods that apply to individual market and Medicare plans, as well as the state's experience with Medicaid expansion.

New Mexico's health insurance marketplace

Under the Affordable Care Act (Obamacare), each state has a health insurance exchange (marketplace) where individuals and families can get self-purchased health insurance.

New Mexico has a state-run health insurance market that uses HealthCare.gov's federal registration platform (known as SBE-FP, for "state-based exchange-federal platform"). As of fall 2021, however, the state plans to operate its own registration platform and will have a fully state-run exchange at that point.

For small businesses, New Mexico has its own SHOP exchange registration platform where employers can select a small-group plan for their employees.

Five health insurance companies will offer individual market plans through new Mexico's health insurance market for 2021: New Mexico's Blue Cross Blue Shield, Molina, True Health and two newcomers: Western Sky (Ambetter) and Friday Health Plans.

Four insurers offer plans in the New Mexico exchange in 2020, but New Mexico Health Connections (one of only four CO-POs created by ACA still operating in the United States starting in 2020) will close its doors at the end of 2020, leaving only three CO-OPs operating nationwide.

Overall, average premiums for 2020 (before subsidies were applied) increased by just under 1% in the state's individual market, after falling by about 1% for 2019.

New Mexico opens enrollment period and dates

Open enrollment in New Mexico for 2021 health plans will run out from November 1, 2020 to December 15, 2020. This window is an opportunity for individuals and families to sign up for new health coverage or renew or modify an existing plan for next year.

New Mexico residents with qualified events can sign up outside the open enrollment period.

Although small-group health plans are available through the New Mexico State SHOP exchange (beWellnm for small businesses), employers are not limited to buying coverage during a certain time of year. The SHOP exchange loosened its rules on employer contributions in 2019, allowing more small businesses to get coverage for their employees, even though they needed employees to cover most of the costs. For people employed in a company - small or large - that offers health benefits, the employer sets the schedule for the annual open enrollment period, giving employees time to make changes to their coverage for the next plan year if they wish.

Medicaid expansion in New Mexico

New Mexico agreed to accept federal funding to expand eligibility for Medicaid coverage under the Affordable Care Act and, in early 2014, it was estimated that nearly 48% of the uninsured population in New Mexico would be eligible for extended Medicaid coverage.

As expected, Medicaid enrollment initially grew rapidly, only to stabilize. By the end of 2017, it was about 63% higher than in 2013. But as of May 2020, an estimated 764,165 New Mexico residents were enrolled in Medicaid plans - up 67% from fall 2013 and reflecting an increase in enrollment driven by the coronavirus pandemic.

A significant number of New Mexico Medicaid enrollees are eligible because of the state's Medicaid expansion under the ACA. As of May 2019, 258,061 New Mexico residents were enrolled in Medicaid under expanded eligibility guidelines. That number is likely to have grown higher in 2020 due to job and income losses caused by the pandemic.

Short-term health insurance in New Mexico

New Mexico used to default on federal regulations for short-term health insurance plans. But after the Trump administration changed the rules, allowing short-term health insurance plans to have longer coverage periods, New Mexico changed its rules. As of December 2019, the state only allows short-term health insurance plans to have a term of up to three months, prohibits renewals, and does not allow the plans to be sold to anyone who has had short-term coverage in the past 12 months. After the new state regulations were applied, insurers stopped offering short-term health insurance plans in New Mexico, and the state is now one of 11 where there are no short-term plans for sale.

How did Obamacare help New Mexico?

In the past, New Mexico has struggled with public health and a high uninsured population. But under the Affordable Care Act, the state has implemented Medicaid expansion and a federally supported state market and appears to be moving in a better direction.

According to U.S. Census data, the uns insured rate in New Mexico was 18.6% in 2013, but was reduced by more than half - to 9.2% - by 2016. But it had grown to 9.5% by 2018 and 10% by 2019, in line with the national trend of an unseaded rising rate under the Trump administration.

As of December 2019, there were more than 258,000 New Mexico residents enrolled in expanded Medicaid, all eligible for this coverage as a result of the ACA.

And as of 2020, there were nearly 40,000 New Mexico residents with private health plans selected through the exchange, all with coverage for the ACA's essential health benefits. And more than three-quarters have premium subsidies that make their monthly premium costs more affordable.

New Mexico Health Assessments

When it comes to health, New Mexico faces several challenges that place it firmly toward the bottom half of most rankings.

New Mexico ranked 37th in the 2019 edition of the U.S. health rankings and 35th in the Commonwealth Fund's 2019 scorecard on state health care system performance.

Does New Mexico have a high-risk pool?

Prior to the ACA, individual health insurance was taken out in almost all states, which meant that pre-existing conditions could prevent a person from getting a policy or could result in significantly higher premiums or policy exclusions. The New Mexico Medical Insurance Pool (NMMIP) was created to offer people an alternative if they were unable to get individual health insurance because of their medical history.

Now that the ACA has been implemented, all health insurance plans are guaranteed, making high-risk pools largely obsolete. But NMMIP is one of the few state-managed risk pools that is still operational. 2020 rates for NMMIP are available here.

Although there were once again more than 10,500 people enrolled in NMMIP coverage, enrollment had dropped to 2,500 by the end of 2017, due to the transition of people to Centennial Care (Medicaid) or individual market plans. NMMIP remains an important source of coverage for disabled New Mexico residents under the age of 65 and enroll in Medicare (with Medicare eligibility triggered by their disability), as the state does not require private Medicare Supplement (Medigap) insurers to offer coverage to enrollees under the age of 65 (about 16% of Medicare beneficiaries in New Mexico are under 65).

NMMIP also serves as a critical safety net during the COVID-19 pandemic, as the state is allowing people without access to other health insurance to enroll in NMMIP coverage during the pandemic.

Medicare coverage and enrollment in New Mexico

As of August 2020, there were 431,894 New Mexico residents enrolled in Medicare plans, including those with Original Medicare and those with Medicare Advantage plans. Most Medicare beneficiaries are eligible because of their age, but 16% of New Mexico's Medicare population is under 65 and entitled due to a disability.

New Mexico Health Insurance Resources

● Health action New Mexico

● beWellnm - The state's exchange with small businesses (in the fall of 2021, individuals and families will also use this platform to enroll in health coverage; until then, they use HealthCare.gov).

● New Mexico Aging and Disability Resource Center

● New Mexico Office of the Superintendent of Insurance — Licenses and regulates health insurance companies in New Mexico, as well as brokers and agents; can provide assistance and information to consumers who have questions or complaints about regulated entities.

Health reform legislation in New Mexico

Some important pieces of legislation were enacted in 2019 in New Mexico, including HB436, which encodes ACA consumer protections in state law, and SB337, which protects consumers from surprise billing (i.e. balancing billing from off-network providers in emergency situations or when the patient goes to a networked facility but is treated by an off-network provider, unknowingly or when a networked provider is not available).

Codifying the ACA's consumer protections is an idea of the possibility that the ACA could be overturned by the supreme court in California v. Texas (Texas v. Azar/US), but without federal funding for premium subsidies and Medicaid expansion, however, states are unlikely to realistically maintain consumer protections, as premium subsidies are needed for most enrollees in order to make guaranteed emissions health insurance affordable.

New Mexico attracted national attention during the 2019 legislative session because of H.B,416 and S.B,405, which would have allowed people to buy into the state's Medicaid program even if they were otherwise ineligible. Neither bill has passed, but they could be revisited in the future.

Legislation to create a health safety plan (HB295 and SB279) has not been brought forward to a vote in either chamber. But lawmakers passed HM92, directing the legislative finance committee to conduct a tax analysis of a health security plan. The results of the analysis will be communicated to the legislator by July 2021. Three consulting entities (KNG Health Consulting, IHS Markit, and Lee Reynis, an Albuquerque-based researcher) received a $390,000 contract to conduct the study. 

New Mexico also made headlines in 2020 with legislation that would essentially extend the federal health insurance tax (which is eliminated in late 2020) and used the money to make coverage more accessible to New Mexico residents. The bill passed the House in the 2020 session, but died in the Senate.

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