New Mexico Health Insurance Plans and Policies
In 2016, 54,865 New Mexico residents enrolled in a medical insurance plan through the public exchange. While this number has increased 5% over the previous year, there is still several thousand people that do not have health insurance today that would qualify for a subsidy to help them pay for a private insurance plan or for a government plan like Medicaid. With so many enrollees as well as options for private health insurance, it can be challenging to find the right one for you.
Common NM Health Insurance Plans and Policies
Below are the most common types of New Mexico health insurance plans and policies offered through various exchanges:
Individual Health Insurance
Individual medical insurance policies are those that are not affiliated with a place of employment. If you do not feel that your employer's benefits package covers your needs, you can decline coverage and opt for an individual health insurance plan instead. You may also purchase an individual health insurance plan if you are not offered individual health insurance through your employer. It is anticipated that individual health insurance rates will be increasing by 25% in 2017.
Learn more about individual health insurance quotes and options.
Group Health Insurance
Group New Mexico medical insurance policies can be affiliated in one of two ways. They are most commonly affiliated with a place of employment or to groups of individuals based on professional, religious or social ties who decide to create their own group health insurance plan for increased negotiating power.
Short Term Health Insurance
Short term health insurance is a temporary option for coverage when you find yourself in a small window or lapse in coverage. This plan is beneficial to safeguard against well-known or unknown medical bills that may pile up during a lapse in coverage. Short term health insurance, unfortunately, does not meet the minimum requirements of the Affordable Care Act, so you may have to pay a penalty for the time you are using it.
Learn more about Short Term health insurance rates and options.
Self-Employed Health Insurance
If you are self-employed with a fluctuating income, self-employed health insurance may be the route to take for your health insurance. This type of coverage is a great option for those who may need to modify their coverage during the year based on how well their personal business and finances do.
Learn more about Self-Employed health insurance quotes and options.
COBRA
COBRA is a federal law that temporarily allows you to continue the health insurance coverage that was provided by a previous employer. The downside of COBRA is that it requires that you pay 100% of your plan’s premiums in addition to an administrative fee.
Common New Mexico Health Insurance Plans and Policies
Thanks to The Affordable Care Act, the minimum benefits and coverage available through New Mexico private health insurance plans are the same whether the plan is on or off the exchange or on the public exchange. Health insurance New Mexico plans meet the Federal guidelines outlined in the Affordable Care Act that is applicable to consumer choice plans and employer plans.
Learn more about health insurance rates and options .
PPO Plans
What Is a PPO plan?
A PPO (Preferred Provider Organization) is a health plan that allows you to seek care from outside the network, but it will require you to pay an additional cost for that ability.
Currently, there are no PPO plans available in New Mexico due to the increased cost of coverage. This is a common theme across the nation.
Pros and Cons of PPO Plans
A benefit for utilizing a PPO is the ability to see a specialist without a referral. This option is normally more expensive and is generally being phased out due to the overall financial impact to the healthcare industry.
HMO Plans
What Is An HMO plan?
An HMO (Health Maintenance Organization) is a plan that requires you to seek care from within the HMO. You must get a referral from your primary care doctor to see a specialist.
Pros and Cons of HMO plans
HMOs are very focused on integrated care and normally have great coverage on preventative care or maintenance such as vaccines, well-woman exams, and physicals. Seeing your primary care doctor is normally very responsible. Unfortunately, you are only allowed to see who is within the HMO plan and you have to get a referral to see a specialist.
Difference Between HMO and PPO
HMOs are very focused on reducing the cost of care by having the primary care doctor be the gatekeeper to other more expensive points of entry into the healthcare system. A PPO, on the other hand, allows a patient to seek care outside the network at an additional out-of-pocket cost.
FSA Plans - Flexible Spending Accounts or Arrangements
What Is An FSA plan?
A Flexible Benefits Plan, also commonly referred to as a Cafeteria Plan, enables you to contribute pre-taxed wages into an account that can be used for dependent care expenses (i.e. day care or elderly care services).
Pros and Cons of FSA Plans
The benefit of using an FSA is the ability to budget medical care with wages that will not be taxed.
Unlike an HSA account, you cannot carry over FSA funds to the next year or to a new job. You either use it or lose it so there is little benefit to being over-prepared.
Flexible Benefits plan (Cafeteria Plan) (IRS 125 Plan)
What Is A Cafeteria Plan?
A Flexible Benefits Plan, also commonly referred to as a Cafeteria Plan, enables you to contribute pre-taxed wages into an account that can be used for dependent care expenses (i.e. day care or elderly care services).
Pros and Cons of A Cafeteria Plan
The benefit of a Cafeteria Plan is that it allows an individual to create their own benefits package in a way that is meaningful for their life situation whether that is additional dental coverage or child care by contributing pre-taxed wages.
HSA Plans - Health Savings Account Plans
What Is An HSA plan?
A Health Savings Account (HSA) allows you to contribute pre-taxed wages into an account that can be used for out-of-pocket medical expenses like copays and deductibles. This does not have to be set up through your employer. It can be done through any financial institute! This is a great supplement for high deductible plans.
Pros and Cons of HSA Plans
The benefit of using an HSA is that it allows you to take advantage of the lower premiums that come with high-deductible plans and still be able to pay the out-of-pocket financial commitment.
Unlike the FSA account, you can roll over balances to the next year and transfer it to a new account if you make an employment change.
Medical Savings Accounts (MSA)
What Is An MSA?
A Medical Savings Account gives self-employed individuals the ability to contribute pre-taxed wages into an account that can be used for out-of-pocket medical expenses like copays and deductibles. Just like an HSA, it is a great supplement for high deductible plans. There are two specific kinds of MSA accounts. The most common choice is the Archer MSA, but for those that qualify for Medicare, Medicare Advantage MSA should be used.
Pros and Cons of An MSA?
The benefits are very similar to an HSA in that you can take advantage of the lower premiums that come with high-deductible plans and balances can be rolled over year-after-year. The downside is that only one family member can contribute to the MSA account.
Indemnity Plans
What Are Indemnity Plans?
Indemnity plans are not common any longer, but they were prevalent before HMOs and PPOs. These plans were often called Fee-For-Service and the insurer and the insured would split a percentage of the total charges. If a procedure was $1,000, then you might be responsible for 20% and the insurance company would then be responsible for 80%. This means that you would pay $200. If the facility decided to increase prices, you would be expected to pay more out-of-pocket.
Why Would I Need an Indemnity Plan?
Because HMO and PPO plans have become more popular, indemnity plans are not commonly available and may not be recommended for most people.
New Mexico Health Insurance FAQs
- What is a qualified health plan?
A qualified health plan is one that has limits on cost sharing (e.g. deductibles, out-of-pocket maximums, copayments, etc.), provides the appropriate level of coverage by including the minimum essential coverage, and meets other requirements as determined by the Affordable Care Act, otherwise known as Obamacare. A qualified health plan must also be certified by the Health Insurance Marketplace. To avoid paying the health insurance penalty, a person must be covered by a qualified health plan.
- How do I know which health insurance plan is best for me?
As you are looking for the best plan for you, consider two major things: 1) your previous year's medical costs, any known upcoming healthcare costs, and any potential healthcare costs, and 2) each potential plan's premium cost, deductible amount, and out-of-pocket or co-pay amounts. As you evaluate these two things, try to find the sweet-spot between your upcoming healthcare needs and the benefits and coverage offered in each plan. We recommend that you find the health insurance option that makes your total cost of healthcare most affordable and that also gives you the best healthcare coverage. It is tempting to pick the option with the lowest monthly premiums, but if that results in you paying large dollar amounts for every visit to the doctor or hospital or to hit your deductible, it might not be the best option by the end of the year (learn more about how a deductible impacts you premium).
- What is open enrollment and how does it work?
Open enrollment is the annually designated period when you can enroll in an insurance plan or change your existing health insurance coverage from the previous year.
- When is the open enrollment deadline?
Insurance plans typically follow the open enrollment deadline of the Health Insurance Marketplace; for 2017 the deadline for enrollment is January 31, 2017. The open enrollment period starts November 1, 2016 and ends January 31, 2017.
- What if I missed the open enrollment deadline?
If the Marketplace open enrollment deadline has passed, you may be able to get health insurance coverage if you have had or will have a Qualifying Life Event (e.g. getting married or having a baby) that allows you to qualify for a Special Enrollment Period. You can also attempt to apply for short term health insurance, Medicaid, CHIP (the Medicaid Children's Health Insurance Program), or Medicare; all of these insurance programs accept applications all year long depending on your eligibility.
- How much do I have to pay if I don't have health insurance?
Since the 2014 enforcement of the Affordable Care Act or Obamacare, all individuals who reside in the United States are required to have active health insurance coverage through a qualified health plan. You will be required to pay a penalty for any time in which you do not have this minimum coverage. This penalty should be paid when you file your federal taxes for the tax year in which you did not have coverage. For the year 2016, the fee is 2.5% of your household income or $695.00 per adult and $347.50 per child under 18 (whichever is higher). The penalty for 2017 is fairly similar with the household income percentage fee of 2.5% remaining the same, while the flat fee will be adjusted for inflation.
- Where do I buy health insurance if I live or work in two different states?
If you live or work in two different states, seek a multi-state plan from either the private or public Marketplace. Multi-state plans will provide you with more coverage options as you move between states.
- How does a deductible impact your premium?
With health insurance, you will either pay more in your monthly premium or pay more out-of- pocket when accessing care. If you opt for a lower monthly premium payment, you will most likely be responsible to hit a higher deductible before insurance coverage kicks in and/or pay a higher co-pay or percentage of the cost of medical care.
- Can I be denied coverage for a pre-existing condition?
No, since the signing of the Affordable Care Act, or Obamacare, it is no longer legal for health insurance companies to deny anyone heatlh insurance coverage based on a pre-existing condition. Pre-existing conditions can include pregnancy and any medical condition that was diagnosed prior to enrollment in a health insurance plan.
- Is pregnancy a pre-existing condition?
Since the passing of Obamacare, the Affordable Care Act, you can no longer be denied health insurance coverage for pregnancy or any other pre-existing condition. All Medicaid and Marketplace plans are required to cover pregnancy, regardless of the timing of the pregnancy.
- How do I update my health insurance if I am recently divorced or widowed?
Any change in marital status, such as divorce or the death of a spouse is considered to be a Qualifying Life Event. These qualifying life events allow you to participate in a Special Enrollment Period 60 days before or after the date of the event. Find out how to update your insurance if you've had a Qualifying Life Events.
- Can I update my insurance if I get married or divorced, have a baby or adopt a child, or change jobs?
Significant life events such as a change in marital status, having a baby or adopting a child, or experiencing a change in employment are all categorized as Qualifying Life Events. When you have a qualifying life event, you have up to 60 days prior to or after that event to participate in a Special Enrollment Period. Check to see if your recent or upcoming life event is a Qualifying Life Event.
- Is health insurance tax deductible?
If you are self-employed, your health insurance premiums may be tax deductible. Deductions are for long-term, medical, dental insurance premiums that typically cover the self-employed individual, their spouses, and dependents. See if you qualify for deductions. According to the IRS, "You may deduct only the amount of your total medical expenses that exceed 10% of your adjusted gross income or 7.5% if you or your spouse is 65 or older. The 7.5% limitation is effective only from January 1, 2013 to December 31, 2016 for individuals age 65 and older and their spouses. You figure the amount you are allowed to deduct on Form 1040, Schedule A."
- What information and documents should I have when I'm signing up for health insurance?
When signing up for a health insurance plan, you will need to verify your annual income and U.S. citizenship or immigration status.
- Who can buy individual health insurance?
Anyone can opt to buy individual health insurance through a private Marketplace or through the federal Marketplace. Most typically, people buy individual health insurance when they do not feel that their company group insurance options adequately meet their needs or they are not offered group insurance benefits through their employer.
- Does health insurance auto renew each year like my auto insurance?
It depends, each health insurance provider and plan functions a bit differently. A majority of health insurance companies will require you to enroll or reenroll in an insurance plan each new year. There are some health insurance providers that will auto-renew you each year into the same plan you had and some may auto-renew you into a similar plan if your current plan does not exist that next year. All Medicare and most Medicaid plans and programs will not require reenrollment, unless your situation has changed from the previous coverage year.
- What does it mean to be on-exchange or off-exchange?
If you are on-exchange, then you purchased your coverage via the Health Insurance Marketplace. If you are off-exchange, then you opted to purchase your coverage via a private insurance. Learn more about exchanges and marketplaces.
- What is a Special Enrollment Period?
A Special Enrollment Period is granted to those individuals who have had or will have a Qualifying Life Event. The special enrollment period allows these individuals to enroll in a new public or private health insurance plan or update their current health insurance coverage up to 60 days before or after the qualifying life event.
- When is open enrollment for health insurance?
The 2017 health insurance open enrollment period runs from November 1, 2016 to January 31, 2017. These open enrollment dates apply to any public health insurance or private health insurance plans or programs in which you are interested in enrolling.
- What is health insurance?
Health insurance is a type of insurance that covers medical, surgical, hospital, and prescription expenses for the insured individual and/or their covered dependents. The level of healthcare coverage varies from plan to plan. This coverage determines the amount of the expense that the insured will be responsible to pay and how much the insurance provider will be responsible to pay.
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