New Mexico Medicare Guide

Get free, personalized advice from an unbiased Medicare advisor! Schedule a consultation with one of our licensed New Mexico Medicare Advisors or give us a call at (888) 604-0055 to get started.

This New Mexico Medicare Guide will help you understand when and how to enroll in Medicare, how to cover the 20% of costs that Original Medicare doesn’t cover, and how to get the most from your Medicare coverage.

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A Snapshot of Medicare in New Mexico

There are 439,390 New Mexico Medicare beneficiaries, making up 21% of the state’s total population. Most New Mexico residents age into Medicare when they turn 65, but about 14% are on Medicare due to disability. 23% of Medicare enrollees are dually eligible, meaning they also receive Medicaid benefits to help them pay for some or all of their healthcare costs.

Medicare beneficiaries have options and can either stay on Original Medicare or switch to a Medicare Advantage plan. In New Mexico, 57% choose to remain on Original Medicare and 43% enroll in a Medicare Advantage plan.

New Mexico Medicare Eligibility and Enrollment Steps

All US citizens have the same Medicare eligibility requirements. If you’re 65 or older, you’re eligible. You also may be eligible if you have certain disabilities, including ALS and End-Stage Kidney Disease.

Medicare Enrollment Steps

1. Enroll in Original Medicare (Part A & Part B)

If you’re already drawing from Social Security, you’ll be automatically enrolled in Medicare. If you aren’t automatically enrolled, you should enroll during your Initial Enrollment Period (IEP). Your IEP is a 7-month period that starts three months before the month you turn 65 and ends three months after it.

If you’re still working when you turn 65, you may choose to delay enrollment in Part B. If you do, just be sure you’re eligible for the Part B Special Enrollment Period, or you may have to pay a late enrollment penalty!

2. Compare additional coverage options

Once you’re signed up, you can choose to stay on Original Medicare or move to Medicare Advantage. Medicare Advantage bundles together Part A, Part B, and usually Part D coverage. If you stay on Original Medicare, you can choose to add a Medicare Supplement plan and/or Part D plan to your coverage. It’s important to know that there’s not one path that’s “best” for everyone. You should base your Medicare decisions on your unique health and financial situation. If you ever need guidance, that’s what we do best! Schedule a consultation or give us a call at (888) 604-0055 to get unbiased advice.

3. Get the most value from Medicare

Once you’ve enrolled in Medicare, there are two actions to ensure you get the most value from Medicare:

Use your Medicare coverage, including your preventive care services.
Review your Medicare coverage each year during the Medicare Open Enrollment Period (October 15 - December 7). Learn more about this annual Medicare enrollment period here.

New Mexico Medicare Advantage Plans

There are 49 Medicare Advantage plans in New Mexico, but the plans available to you will vary based on the county you live in. For example, there are 50 Medicare Advantage plans available from 12 different insurance carriers in Bernalillo County, NM. Doña Ana County only has 31 plans available from 8 insurance carriers.

Medicare Advantage plans provide an alternative to Original Medicare, and therefore are legally required to cover at least the same amount as Part A and Part B. Many Medicare beneficiaries choose to enroll in Medicare Advantage plans because they like the bundled approach and extra benefits that come with these plans. Some of these extra benefits include:

Part D (prescription drug) coverage
Dental, vision, and hearing coverage
Transportation services
Fitness perks
Flex cards
Part B cash give backs

These extra benefits are popular among Medicare beneficiaries. Before you enroll, however, make sure you know the common complaints about Medicare Advantage plans:

Network restrictions limit the doctors you can see
Pre-authorization requirements and denials limit your access to care
Cost structures often lead to high out-of-pocket costs

If you decide Medicare Advantage is right for you, we’ll ensure we find the right plan that allows you to see your preferred providers and gets you the best value! Reach out to our licensed New Mexico Medicare Advisors to discuss specific Medicare Advantage plans, as well as your other Medicare options.

New Mexico Medicare Supplement Plans

Many people choose to add a Medicare Supplement (also known as Medigap) plan to their Original Medicare coverage. These plans help cover the 20% of costs not paid by Original Medicare.

New Mexico Medicare beneficiaries can choose from ten types of Medicare Supplement plans, labeled by letters A through N. Each plan of the same letter (e.g., every Plan A) has identical coverage, regardless of the insurance carrier and premium amount. Medigap Plan G is the most comprehensive plan, and is therefore considered the best. Below you’ll find a complete comparison of the different Medigap plans available in Montana.

Three key advantages Medigap plans have over Medicare Advantage plans are:

There are no provider networks, so you can see any doctor who accepts Medicare nationwide
You won’t be required to get prior authorization for Medicare-covered services
Your out-of-pocket costs are incredibly low

In New Mexico, the best time to enroll in a Medigap plan is during your six-month Medigap Open Enrollment Period, which starts after your Part B effective date. During this period, insurance carriers are not allowed to ask you questions about your medical history and cannot deny you coverage. In other words, you are guaranteed acceptance. Outside of your Medigap Open Enrollment Period and a handful of other guaranteed issue periods, insurance companies can ask you questions about your health and may reject your Medigap application.

New Mexico Part D Plans

Most Medicare Advantage plans provide prescription coverage. If you’re on Original Medicare, you should get a standalone Part D (prescription drug) plan. There are 24 stand-alone drug plans in New Mexico. Like with Medicare Advantage, specific plan pricing and availability depends on which county you live in.

Even if you don't have any prescriptions when you first enroll in Medicare, we recommend enrolling in a low-cost Part D plan to avoid paying a Medicare penalty!

If you have questions about Medicare options or want to compare plan benefits and pricing, schedule a free consultation with one of our licensed New Mexico Medicare Advisors or give us a call at (888) 604-0055.

Get help paying for Medicare in New Mexico

Healthcare costs can be overwhelming for many Americans. These three government programs help low-income New Mexico Medicare beneficiaries pay for health-related expenses.

New Mexico Medicaid for Medicare Beneficiaries

The New Mexico Human Services Department manages the operations of the state’s Medicaid program. New Mexico has a set of programs available for residents who are aged, blind, or disabled. Most notable, and offered in every state, are the Medicare Savings Programs.

New Mexico Medicare Savings Programs

About 14% of New Mexico Medicare recipients receive benefits from Medicare Savings programs. Low-income Medicare beneficiaries may be eligible for one of the three Medicare Savings Programs:

The Qualified Medicare Beneficiary (QMB) program pays for Medicare Part A premiums (if applicable), Part B premiums, deductibles, and coinsurance.
The Specified Low Income Medicare Beneficiary (SLIMB) program pays for Medicare Part B premiums only.
The Qualified Individuals (Q1-1) program pays for Medicare Part B premiums only.

While most states have both income and resource limits to determine eligibility for Medicare Savings Programs, New Mexico has eliminated the resource restriction. Learn more about the income limits here.

You can apply for these programs online yes.state.nm.us. If you need assistance determining if you’re eligible, applying, or accessing your benefits, reach out to our New Mexico Medicare advisors at (888) 604-0055.

Medicare Extra Help

Extra Help is a federal program that helps pay for costs associated with prescription drug coverage, including premiums, deductibles, and coinsurance. It’s also commonly called the Part D Low-Income Subsidy (LIS).

You automatically qualify for Extra Help if you:

Receive full Medicaid coverage from New Mexico
New Mexico pays your Part B premium
Are eligible for Supplemental Security Income (SSI)

If you don’t automatically receive Extra Help, one of our licensed New Mexico Medicare Advisors can help you figure out if you’re eligible and guide you through your application process.

Supplemental Security Income (SSI) Benefits

Eligible US citizens receive monthly payments from the SSI program. You’re considered eligible if you meet the following criteria:

You are 65 and older, blind, or have a disability
You have limited income and limited resources

You can apply for SSI Benefits online or by calling 1-800-772-1213 / TTY 1-800-325-0778.

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