New Mexico Health Insurance Consumer Guide

To be eligible to enroll in private health coverage through beWellnm, you must:⁶

• Be lawfully present in the United States, and live in New Mexico
• Not be incarcerated
• Not be enrolled in Medicare

So most New Mexico residents are able to enroll in a health plan through the exchange.⁷ But a more pressing question for most people is eligibility for financial assistance in the form of state and federal subsidies through beWellnm. 

To qualify for income-based federal Advance Premium Tax Credits (APTC), New Mexico Premium Assistance, federal cost-sharing reductions (CSR), or New Mexico’s State Out-of-Pocket Assistance (SOPA), you must:

• Not have access to an affordable plan offered by an employer. If you are eligible to sign up for an employer’s plan and aren’t sure whether it’s considered affordable, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies via beWellnm. 
• Not be eligible for New Mexico Centennial Care (Medicaid).

In addition to those basic parameters, beWellnm premium subsidy eligibility will depend on your household’s income and how that compares with the cost of the second-lowest-cost Silver plan in your area – which depends on your age and location. 

In New Mexico, the open enrollment period begins November 1 and continues through January 15.⁸ 

For 2024 coverage, enrollments must be completed by December 23, 2023 in order to have coverage effective January 1, and enrollments completed between December 24 and January 15 will have coverage effective February 1. But the deadline for a January 1 effective date could change in future years. 

After the open enrollment period ends, you may still be able to enroll or make a plan change if you experience a qualifying life event, such as giving birth or losing other health coverage. 

New Mexico also has an Easy Enrollment Program that allows people to start the health insurance enrollment process via state tax returns. 

And some people can enroll year-round even without a specific qualifying life event. This includes the low-income special enrollment period, which is available to applicants with household income up to 200% of the poverty level in New Mexico.⁹ (The household income cutoff for this SEP is 150% in most states.) 

Enrollment in New Mexico Centennial Care (Medicaid) is available year-round.

To enroll in an ACA Marketplace/exchange plan in New Mexico, you can: 

• Visit beWellnm –  New Mexico’s health insurance exchange – to compare the health plans available in your area, determine whether you’re eligible for financial assistance (including federal and state subsidies), and enroll in coverage during open enrollment or during a special enrollment period. 
• Enroll in a beWellnm plan with the help of an insurance agent or broker, Navigators, certified application counselors or an approved enhanced direct enrollment entity.¹⁰
  

You can reach the beWellnm call center at 1-833-862-3935.

When you enroll in coverage through beWellnm, you may find that you’re eligible for financial assistance. And the assistance may be more robust than it is in many other states, as both federal and state subsidy programs are available in New Mexico.

As a result of the Affordable Care Act (ACA), federal premium subsidies (advance premium tax credits, or APTC) are available depending on your income. If you’re eligible for APTC, it will reduce the amount you pay for your health coverage each month, as long as you enroll in a metal-level plan through beWellnm.

Seventy-nine percent of beWellnm enrollees were receiving APTC as of early 2023. These subsidies averaged $534 /month, reducing the average enrollee’s premium to $91/month.¹¹

Applicants with household income up to 250% of the federal poverty level are also eligible for federal cost-sharing reductions (CSR), which will reduce the deductible and other out-of-pocket expenses for Silver-level plans. Seventeen percent of beWellnm enrollees were receiving CSR benefits as of 2023.¹¹

And New Mexico is among the states where additional state-funded subsidies are available. As of 2023, New Mexico began offering state-funded premium subsidies (for applicants with income up to 400% of the poverty level) and cost-sharing assistance (for applicants with income up to 300% of the poverty level), in addition to the federal premium subsidies and cost-sharing reductions.¹²

New Mexico’s cost-sharing reductions (state out-of-pocket assistance, or SOPA) are being expanded for 2024, ensuring that people with household income up to 300% of the poverty level can get plans with 90% actuarial value (ie, platinum-level coverage).¹³

Plans with reduced cost-sharing, including federal CSR and SOPA benefits, are known as “Turquoise plans” in New Mexico, to make it easier for consumers to identify them. 

Starting with the 2024 plan year, New Mexico will have standardized plans available at the Silver, Gold, and Turquoise level.¹⁴ 

Depending on your income and circumstances, you may be able to enroll in free or low-cost health coverage through Centennial Care (New Mexico Medicaid). Learn more about whether you might be eligible for Medicaid in New Mexico.

Source: CMS.gov¹⁵

For 2023, there are four insurers offering plans on New Mexico’s exchange:¹⁶

For 2024 coverage, five insurers will offer exchange plans in New Mexico,¹⁷ with coverage areas that vary by insurer:

• Blue Cross Blue Shield of New Mexico (Health Care Service Corporation)
• Molina
• Presbyterian Health Plan
• Western Sky Community Care (Ambetter/Centene)
• UnitedHealthcare of New Mexico (new for 2024)

For 2024, New Mexico’s Marketplace insurers have proposed the following average rate changes:¹⁶

Source: HealthCare.gov¹⁶

A reminder that average rate changes apply to full-price premiums, and most enrollees do not pay full price. Seventy-nine percent of beWellnm enrollees were receiving federal premium subsidies in 2023.¹¹ And many beWellnm enrollees also receive additional state-funded premium subsidies.

During the open enrollment period for 2023 coverage, 40,778 people selected private plans through beWellnm.¹¹

Source: 2014,¹⁸ 2015, ¹⁹ 2016,²⁰ 2017,²¹  2018,²² 2019,²³ 2020,²⁴ 2021,²⁵ 2022,²⁶ 2023,¹¹ 2024²⁷

beWellnm
The state’s exchange for small businesses, individuals, and families.

Health Action New Mexico
A consumer advocacy organization working to improve healthcare access and affordability in New Mexico.

New Mexico Human Services Department
Administers Centennial Care (Medicaid) and various other social services programs in the state. 

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.

New Mexico State Health Insurance Assistance Program
A resource for New Mexico Medicare beneficiaries and their caregivers.