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New Mexico Health Insurance

New Mexico Health Insurance - The Individual Market

In New Mexico, medical underwriting is allowed without restriction. There is a 6 month look back and exclusionary period for preexisting conditions.

High Risk Pool

New Mexico offers a high risk pool called the New Mexico Medical Insurance Pool. You may be eligible for this pool due to your HIPAA rights or if you are a resident of New Mexico and you have been denied health coverage, have been accepted for coverage but at a higher rate than the high risk pool, received a reduction in services for at least 12 months, were involuntarily dropped from your current coverage, or you have been diagnosed with one of the conditions listed on the pool application.

Coverage under this high risk pool insurance plan includes Hospital room and board, medical-surgical services including both in-hospital and out-of-hospital, diagnostic services, anesthesia, consultation services, professional services for the treatment of illness or injury provided by a physician, prosthesis other than dental, ambulance Services, rental, or purchase, of durable medical equipment, diagnostic x-rays and laboratory tests, oral surgery for partially or completely unerupted impacted teeth and dental accident care, services of a licensed physical, occupational, or speech therapist, blood and blood plasma, inpatient and outpatient services for the treatment of mental illness, alcoholism, and substance abuse, hospice care, prescription drugs, skilled nursing facility services, home health care services, routine mammograms, pap tests and prostate examinations, radium and other radioactive materials, oxygen, diabetic patient education program, heart, lung, pancreas, kidney, liver, cornea and bone marrow transplants for specific condition listed in the NMMIP policy.

New Mexico Group Health Insurance (Small Business: 2-50 employees)

In New Mexico, medical underwriting is allowed with plus or minus 25% of the indexed rate based on the health status of the group. There is a 6 month look back and exclusionary period limit for preexisting conditions for those without prior healthcare.

New Mexico COBRA Individual Health Coverage

New Mexico offers COBRA, the Consolidate Omnibus Budget Reconciliation Act of 1985. Many companies with 20 or more employees that offer health insurance are required to offer employees and their dependents continuation coverage for benefits that were lost due, for example, to job loss, reduction in hours worked, death or divorce.

Medicaid and Medicare in New Mexico

Medicaid is a state/federal program that pays for medical and long-term care services for low-income pregnant women, children, certain people on Medicare, disabled individuals and nursing home residents. These individuals must meet certain income and other requirements.

Income requirements

Children
Children (ages 1-5)-235% of the Federal Poverty Level
Children (Ages 6-19)-235% of the Federal Poverty Level

Pregnant Women and Infants
Pregnant Women-185% of the Federal Poverty Level
Infants (ages 0-1)-235% of the Federal Poverty Level

Parents
Non-Working Parents-30% of the Federal Poverty Level
Working Parents-69% of the Federal Poverty Level

Other populations
Supplemental Security Income Recipients- 74% of the Federal Poverty Level

Covered Services
Hospital outpatient, rural health clinic, federally qualified health centers, laboratory and x-ray, nursing home, physician services, dental, early periodic screening diagnosis and treatment, family planning, clinic services, prescription drugs, case management, medical transportation, nurse midwife, extended services for pregnant women, and ambulatory prenatal care.

Co-Payments

Co-payments vary. There are no co-payments if you are under 18, pregnant, living in a nursing home, or receiving family planning services.

You may learn more about New Mexico Medicaid at http://www.state.nm.us/hsd/mad/Index.html.

Click here for information on New Mexico Medicare plans and pricing.

Other New Mexico Health Insurance Programs

New Mexico offers the New Mexikids Program to children under the age of 19 whose family income is up to 235% of the Federal Poverty Level, and who are residents of New Mexico and U.S. citizens or legal residents. Please visit the New Mexikids website for more detailed information at http://www.hsd.state.nm.us/mad/CNewMexiKids.html