New Mexico Health Insurance
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Facts and Figures
-
Place in State
Health Report Card 34th - Insured 1,515,283
- Uninsured 449,000
-
Insurance
Carriers 11 -
Number of
Primary Care Physicians 3480 -
Number of
Hospitals 37 -
Average Cost of
Health Insurance* $950
Breakdown of Insureds
- Employer-sponsored health insurance 51%
- Private plans 5%
- Medicaid 24%
- Medicare 15%
- Others 5%
Insurance Carriers
- Assurant Health
- BCBS of New Mexico
- Celtic
- Golden Rule Insurance Company
- Great American Health Insurance Company
- Humana
- John Alden Life Insurance
- Lovelace Health Plan
- Presbyterian Health Insurance
- Standard Security Life Health Insurance
- Time Insurance
State Health Report Card
There are 285,000 adult smokers in New Mexico. Down from 23.6 percent to 18.5 percent from ten years ago.
There are 394,000 obese adults in New Mexico. This number is up from 19.3 percent to 25.6 percent in the last ten years.
There are 131,000 adults living with diabetes in the state. This number is up from 7.3 percent to 8.5 percent in the past five years.
In the last five years, violent crime rate is down from 646 to 589 offenses per 100,000 population.
Preventable hospitalization rate is down from 58.6 to 56.3 discharges per 1,000 Medicare enrollees in the past year.
New Mexico Health Insurance Laws and Regulations
New Mexico health insurance plans must be sold with a guaranteed renewability clause. This means that policyholders in the state always have the option of renewing their contracts when they are about to expire. However, policyholders must keep up with the premium payments and must not violate terms and conditions of the contract. In addition, health insurers are not permitted to cancel coverage on the grounds of serious injury or illness. When writing new New Mexico health insurance plans, insurers can exclude coverage for a pre-existing condition. For a period of up to six months, any costs associated with the pre-existing condition will not be covered by the insurer. The exclusion period will not last for more than six months even if you move from one policy to another, provided you maintain continuous coverage. Health insurers in New Mexico can deny health coverage based on the applicant’s health status. However, a successful applicant’s health cannot be taken into account when determining premium rates. Generally, age, family health history, and other risk factors are used when calculating premiums. Small businesses with two to fifty employees are qualified to purchase a group health insurance available to other small businesses in the state. To maintain these group plans, small businesses are required to meet certain conditions like having a minimum number of participants and minimum employer contribution. New Mexico health insurance quotes for group coverage can vary according to the risk factors of its members. State laws are in place to control excessive price fluctuations. Group health plans cannot be cancelled should a member get seriously injured or sick. Self-employed individuals in the state are not qualified to purchase group health plans similar to what is being offered to small businesses. Instead, they can opt for individual health plans. With these plans, subscribers can deduct a portion of their premium payments from their tax liabilities.
Heath Care Reform
With the new health care law, children under the age of 26 can choose to stay under their parent’s New Mexico health insurance as long as they are not offered an employer-based health insurance. This provision enabled 2.5 million young adults to have insurance nationwide. In New Mexico, 21,456 young adults have insurance coverage through this provision as of June 2011.
The new health care law allowed 19,957 Medicare policyholders in New Mexico to receive a $250 rebate check to help with prescription drug costs when they fell into the Medicare gap in 2010. In 2011, 18,755 Medicare plan holders were given a 50% discount on brand-name prescription drugs covered by their plans when they hit the donut hole. An average of $491 per person or a total of $9,199,904 was saved in New Mexico.
Previously uninsured individuals without health coverage because of a pre-existing condition can now apply for a Pre-Existing Condition Insurance Plan. This plan is available to U.S. citizens or legal residents with a pre-existing condition and have been uninsured for at least 6 months. In 2011, 805 individuals in New Mexico have benefited from this new law.
When looking at New Mexico health insurance quotes, applicants are assured that at least 80 percent of the price will go directly to health care services and other related improvements. A rebate or premium discount shall be provided if the minimum is not met. Around 406,000 private policyholders in New Mexico will get greater value for their premium payments because of this 80/20 rule.
Preventive care services like immunizations, colonoscopies, mammograms, or annual wellness doctor visits must be included in all New Mexico health insurance with no deductibles or co-pays. In 2011, 194,287 Medicare subscribers and 285,000 individuals with private policies received such services in New Mexico.
Under the new law, insurance companies are no longer allowed to impose an annual dollar limit — a cap on the yearly spending for your benefits, or a lifetime dollar limit — a lifetime cap for spending for your covered benefits. This law frees chronically ill individuals like cancer patients from worrying about getting further treatment because of such limitations. In 2011, 555,000 New Mexico residents have benefited from this law.
If insurance companies want to raise their premium rates by ten percent or more, they are required by federal law to publicly announce and justify their actions. To guard against such unreasonable increases, the state of New Mexico received a total of $4 million.
All fifty states receive increases in funding for community health centers under the Affordable Care Act. This will help construct new health centers, provide medical services to more patients, improve preventive and primary health care services, and fund infrastructure projects. In New Mexico, 140 community health centers received a total of $47.6 million to fund these improvements.
In 2010, the Affordable Care Act created the Prevention and Public Health Fund. This new fund was created for wellness promotion, disease prevention, and protection against public health emergencies. New Mexico has already received a total of $9.4 million to support its policies, programs, and communities to help its residents lead healthier lives.
State Government Insurance Programs Offered
State Coverage Insurance (SCI) www.insurenewmexico.state. nm.us/SCIHome.htm
888-997-2583
The State Coverage Insurance (SCI) offers assistance to small employers to provide health coverage for their employees. There is a $100,000 limit on benefits per member each year. Benefits covered include inpatient and outpatient hospital care, home health, preventive services, emergency and urgent services, prescription drugs, medical supplies, diabetes treatment, therapy (physical, occupational, and speech), and behavioral and substance abuse. Eligibility: Employers: Business must be operated in New Mexico, have 2 to 50 eligible employees, and not offering health insurance at the time of application. Individuals: Must be a U.S. citizen or qualified resident living in New Mexico, between 19 and 64 years old, must be uninsured. Must not have cancelled health coverage voluntarily within the last six months, must be ineligible for certain government health programs. Income must not exceed 200% of the FPL.
New Mexico Medical Insurance Pool (NMMIP) 866-622-4711 505-424-7105 www.nmmip.org
The New Mexico Medical Insurance Pool (NMMIP) provides access to health insurance coverage to New Mexico residents who are denied health insurance and are deemed uninsurable. Benefits of the plan include physician medical visits, hospital services, diagnostic services, prescription drugs, inpatient and outpatient surgery, transplant services, and many more. An optional maternity coverage is also available. Certain benefits have lifetime maximum limits. Eligibility: Must be U.S. citizens or qualified residents living in New Mexico, and; 1. Do not have health insurance coverage for at least six months prior to application, or 2. Have a qualified pre-existing condition, or 3. Reached the maximum coverage limit of current health plan, or 4. Denied coverage due to a pre-existing condition, or 5. Offered limited benefits, or 6. With premiums more expensive than NMMIP.
Medicaid www.hsd.state.nm.us/mad
888-997-2583
505-827-3100
Medicaid provides assistance to qualified individuals and families who lack the means to pay for medical care. Benefits of the program include physician services; hospital care; laboratory and x-ray services; early periodic screening, diagnosis, and treatment (EPSDT); nursing home care; nursing services; and many more. Eligibility: 1. Must be U.S. citizen or qualified residents living in New Mexico. 2. Must not exceed income limits: Pregnant women: 235% of the FPL Children aged 0 to 18 years: 185% of the FPL. Aged, blind, and disabled: 75% of the FPL with assets not exceeding $2,000 for singles; 83% FPL and asset not exceeding $3,000 for couples.
Premium Assistance for Kids (PAK) www.insurenewmexico.net (Search: PAK)
888-997-2583
Premium Assistance for Kids (PAK) in New Mexico offers assistance to uninsured children whose income disqualifies them from Medicaid coverage. PAK offers subsidy for commercial and comprehensive plans that cover inpatient and outpatient hospital care; laboratory and X-ray; preventive, primary, and specialty care; pharmacy; and physical, occupational, and speech therapies. Eligibility: 1. Must be a U.S. citizen or qualified resident living in New Mexico. 2. Must be under 12 years old (children up to 18 years can qualify if they have an eligible sibling). 3. Must be uninsured and ineligible for Medicaid and SCHIP. 4. Must not have voluntarily dropped health insurance in the past six months prior to application.
Premium Assistance for Maternity (PAM) www.insurenewmexico. state.nm.us (Search: PAM) Enrollment ended for PAM effective September 1, 2010 due to budget.
888-997-2583
Premium Assistance for Maternity (PAM) in New Mexico offers assistance to uninsured pregnant women whose income disqualifies them from Medicaid coverage. Services covered include prenatal and postnatal care, delivery, and other pregnancy-related health services. Eligibility: 1. Must be pregnant and a U.S. citizen or qualified resident living in New Mexico. 2. Must not be eligible for Medicaid coverage due to high income.
Indian Health Services www.ihs.gov (Search: Albuquerque or Navajo)
505-248-4500
Indian Health Service (IHS) provides medical and public health services to American Indians and Alaska Natives. IHS provides a broad range of inpatient and outpatient services through health facilities which include hospitals, health centers, field clinics located near population centers. Eligibility Members of a Federally recognized Tribe are eligible for IHS health services. You may qualify if you are not excluded by law, and: 1. Are of Indian and/or Alaska Native descent; or 2. Are an Indian of Canadian or Mexican origin; or 3. Are a non-Indian pregnant woman carrying an eligible Indian’s child. Coverage can be up to 6 weeks post partum; or 4. Are a non-Indian who belongs to an eligible Indian’s household and the medical officer decides that services are needed for public health safety.
Pre-Existing Condition Insurance Plan (PCIP) Federal program run by NMMIP www.nmmip.org www.PCIP.gov
877-573-3676
This is a federal high-risk pool created by the Health Care Reform and in New Mexico the program is run by the New Mexico Medical Insurance Pool. This program provides coverage for individuals with a pre-existing condition who have a hard time finding private coverage. Coverage includes a wide range of benefits which includes hospital care, primary care, specialty care, and prescription drugs. Eligibility: 1. Must be a U.S. resident living in New Mexico. 2. Must be uninsured for at least six months. 3. Must have a qualified pre-existing health condition.
Women-Infant-Children (WIC) www.health.state.nm.us (Search: WIC)
866-867-3124
Women-Infant-Children is funded by the federal government and offers health and nutrition programs for women, infants, and children. Benefits include health screening, medical history, body measurement, nutrition assessment and education, breast feeding support and education, hemoglobin check, and vouchers for food supplements. Eligibility: 1. Must be a resident of New Mexico. 2. Must be pregnant or postpartum women and children not more than 5 years. 3. Must have nutritional or medical risk. 4. Must not exceed income limits of 185% of the FPL.
Breast & Cervical Cancer Early Detection Program (BCC) www.cancernm.org/bcc
877-852-2585
The New Mexico Breast and Cervical Cancer Program offers free breast and cervical cancer screening to eligible women living in the state. Benefits of the program include mammograms, breast exams, pelvic exams, and Pap tests. Treatment may be covered for women who have been diagnosed with cancer. Eligibility: 1. Must be women at least 30 years old. 2. Must be U.S. citizens or qualified residents living in New Mexico. 3. Income must not exceed 250% of the FPL. 4. Must be uninsured or current insurance has more expensive deductibles and co-pays.
New Mexico Health Insurance Alliance (The “Alliance”) www.nmhia.com
800-204-4700
888-997-2583
The New Mexico Health Insurance Alliance (NMHIA) is a non-profit organization that provides access to individuals and small businesses health coverage not offered in the commercial market. NMHIA offers several plans including HMO, HMO Hybrid, and PPO plans through various carriers. Eligibility: Individuals: 1. Previously held group health plan, church plan, or government plan, and used up either State Continuation Insurance or COBRA. 2. Must not have lapse in coverage for more than 95 days. 3. Must have at least 18 months of creditable coverage prior to application. 4. Must not have an employer health plan available. Groups: 1. Small businesses with 50 or fewer eligible employees. 2. For groups with just one applicant, employer must have an enrolled dependent; or a group with two members with one member waiving coverage for another. 3. Fifty percent of the net eligible employees must participate. 4. Business headquarters must be located in New Mexico and at least half of the employees must live in the state.