Medicare offers healthcare coverage to New Mexico residents age 65 or older, or to those New Mexico residents that suffer from certain medical disabilities. In 2016, 384,000 people are enrolled in Medicare in New Mexico, accounting for 18.7% of the population in New Mexico. In 2009 about $8,120 was spent per Medicare enrollee in New Mexico, approximately 21.66% lower than the national average of $10,365. Between 2015 to 2030 the number of seniors in New Mexico is expected to rise by an estimated 61.57% according to calculations based off of the 2000 Census. Therefore the number of eligible Medicare beneficiaries in the state is also expected to grow.
Medicare beneficiaries, their families, and their caregivers in New Mexico can receive free, one-on-one, and unbiased health insurance counseling from the State Health Insurance Assistance Program (SHIP). New Mexico’s Department for Aging and Disability Resource Center’s (ADRC) Senior Medicare Patrol (SMP) is another program which helps Medicare beneficiaries prevent, avoid, detect, and report healthcare fraud.
Individuals that qualify for Medicare can sign up for Medicare Part A (hospital services) and Part B (medical services) through the Federal government. Part A is generally paid for by paycheck deductions from their working years (or their spouse's) but most Medicare beneficiaries pay for Part B through monthly premiums unless they qualify for financial assistance. If you are eligible for Original Medicare (Parts A & B) or if you are already enrolled in it, you also have the option to enroll in a Medicare Advantage plan (Part C) instead of Original Medicare or add a stand alone prescription drug plan (Part D) to your current Original Medicare coverage. Medicare Advantage and Medicare Part D insurance plans are sold by private insurance companies that have a contract with Medicare. Original Medicare offers its beneficiaries flexibility in choosing their providers and you are not limited to a network. However, there is no limit on out-of-pocket medical expenses and you must always pay 20% coinsurance for medical service costs. Medicare Advantage plans require you to stay in network but some plans will also cover out-of-network care at a higher cost. Additional benefits of Medicare Advantage plans such as dental, vision, or hearing coverage can help reduce out-of-pocket expenses for seniors with certain medical needs.
Using CMS data HealthPocket found that:
- The average total monthly premium for a 2017 Medicare Advantage plan in New Mexico is $79.13, 26.65% greater than the national average of $62.48. 29.32% of 2017 Medicare Part C insurance plans in New Mexico have a $0 monthly premium.
- The maximum possible annual drug deductible in any 2017 Medicare Advantage plan with a drug component is $400, but in New Mexico the average annual drug deductible for Medicare Part C insurance plans with drug components is $182.55. 36.7% of 2017 Medicare Part C insurance plans with a drug component in New Mexico have a $0 annual drug deductible.
- The average total monthly premium for a 2017 Medicare Advantage plan without a drug component in New Mexico is $51.39. 45.9% of 2017 Medicare Part C insurance plans without a drug component in New Mexico have a $0 monthly premium.
- The average medical out-of-pocket limit for 2017 Medicare Part C insurance plans in New Mexico is $4,527.06. 9.64% of 2017 Medicare Advantage plans in New Mexico had a medical out-of-pocket limit of $3,400 or less.
To assist seniors in choosing Medicare plans, CMS assigns star ratings to Medicare Part C and Part D plans each year based on preventive care, chronic condition management, customer service, member satisfaction, and drug pricing. Ratings range from 1 star (a poor plan) to 5 stars (an excellent plan).
- The average overall CMS star rating assigned to Medicare Part C insurance plans in New Mexico was 3.5 stars in 2017.
- Among New Mexico's 2017 Medicare Advantage plans with CMS star ratings:
- 6.02% earned a score of 4 or 4.5 stars
- 92.77% earned a score of 3 or 3.5 stars
- 1.2% of plans are “Not enough data available” or “Too new to be measured”.
Data on Medicare eligibility, enrollment, and spending by state from Kaiser Family Foundation