Obamacare, officially known as the Affordable Care Act (ACA), was signed into effect nationwide in 2010 and enforcement began in 2014. The intent of Obamacare was to increase access to healthcare through expanding Medicaid programs, protecting consumers from being discriminated against due to pre-existing health conditions, opening a regulated Marketplace to shop for cost-efficient health insurance options, and requiring all U.S. citizens to have minimum health insurance coverage.
Obamacare’s Effect on New Mexico Health Insurance
In New Mexico, the Congressional delegation supported healthcare reform and opted to expand Medicaid. Through Medicaid expansion and availability of subsidies on the exchange, the uninsured rate has decreased from 24% before the Affordable Care Act to 12.8% in 2015. While still above the national average of 9.1%, there has been a clear annual improvement.
What New Mexico Residents Should Know About Obamacare in New Mexico
The Pros and Cons of New Mexico Obamacare
New Mexico Obamacare has made health insurance coverage available to many that could not previously afford care. This was possible through Medicaid expansion, which grew the New Mexico Medicaid population by 25%. In addition, 55,000 residents purchased coverage through the exchange and received subsidies to offset the cost. It has also been successful in stressing the importance of individuals owning their own care by taking advantage of wellness programs and early screenings.
There are criticisms of Obamacare in New Mexico from the number of changes in carriers available through the exchange. Carriers continue to see financial losses and as a result, rates increase annually and several carriers have dropped from the exchange in 2017. In addition, there has been a notable struggle in getting re-enrollments, especially for the healthy young adult population who would rather pay the fine for not having coverage than be responsible for monthly health insurance premiums they cannot afford.
Obamacare Health Plan Categories and How Much You Will Pay
When shopping in the New Mexico Obamacare Marketplace, there are four primary health plan categories you can choose from: bronze, silver, gold, and platinum. The categories determine the percentage of healthcare costs that the plan will pay for over a course of a year. The remaining percentage is what you will be expected to pay.
These percentage differences greatly impact how much you may expect to pay for care. Think about it this way: If the bronze plan pays for 60% of a benefit, then as the patient, you can expect to pay the remaining 40%. While this plan will cost you less monthly, it leaves you financially responsible for a larger dollar amount than a platinum plan, which pays for 90% of a benefit.
Here are the different kinds of Obamacare plans as well as the average amount of healthcare services each plan pays for:
- Bronze plan - 60%
- Silver plan - 70%
- Gold plan - 80%
- Platinum plan - 90%
How do I sign up for Obamacare in New Mexico?
The New Mexico Obamacare Marketplace and exchange can be accessed through the federal government website or by calling (800) 318-2596.
What are the Obamacare Marketplace and exchange?
The Marketplace is a central location to explore insurance options and enroll for selected coverage. In the case of Obamacare, New Mexico utilizes a State-Based Federal Platform, which means that the exchange is operated and managed by the State of New Mexico but they utilize the federal platform to enroll residents.
Do I need to use an exchange?
To access public health insurance, you will need to go through the government exchange. The only exception to personally using the exchange to sign up for Obamacare in New Mexico is if you are able to seek help from a New Mexico certified counselor or a private insurance agent who can discuss your options and select a plan, on your behalf, through the exchange.
How do I use an exchange?
You can use the exchange one of four ways:
- Visit healthcare.gov
- Use the telephone support assistance available by calling (800) 318-2596
- Find a local certified counselor
- Seek help from a private insurance agent
What does it mean to be on-exchange or off-exchange?
On-exchange generally refers to purchasing health insurance coverage from the Obamacare New Mexico Marketplace while off-exchange normally refers to purchasing private health insurance coverage from a third private company.
When is the Obamacare enrollment deadline and what do I do if I missed it?
The Obamacare open enrollment period for 2017 in New Mexico is from November 1, 2016 until January 31, 2017. If you miss enrollment, you would need to qualify for a special enrollment period due to a qualifying life event or purchase short-term individual private insurance to avoid a penalty.
What is the Obamacare penalty if I don’t buy health insurance?
If you do not buy Obamacare or other qualifying health coverage (also referred to as “minimum essential coverage”) you will be subject to a tax penalty for each month you go without coverage. This fee should be paid when you file your federal tax return. In some special cases, there are exemptions to this penalty.
The Obamacare penalty for 2016 is either 1) 2.5% of your household income, with a maximum of the price of a Bronze plan sold through the Marketplace, or 2) $695 per adult and $347.50 per child under 18 yrs of age with a maximum of $2,085. You will pay whichever of the two options is higher.
The Obamacare penalty for 2017 is fairly similar to 2016 with the percentage fee of 2.5% remaining the same, however, the flat fee will be adjusted for inflation.
What if I cannot afford Obamacare?
If you cannot afford to pay for Obamacare coverage, you may be able to qualify for a government subsidy. For more information on government subsidies visit the HealthCare.gov website.
What are the alternatives to Obamacare in New Mexico?
Any health insurance coverage that meets the minimum essential coverage, as set forth in the Affordable Care Act, can be used, whether this coverage is received through an employer, private insurance company, or purchased through a private exchange.