En español | Most New Mexico residents can buy health insurance through the New Mexico Health Insurance Exchange (or beWellnm), the state’s Affordable Care Act (ACA) marketplace, when open enrollment begins on Nov. 1, 2022. New Mexico shifted from a Healthcare.gov marketplace plan to a state-specific marketplace in 2022.
If you experience a qualifying life event — such as the birth of a child, a move, a marriage, a divorce or the loss of your employer-provided health insurance — you may be able to enroll or change your coverage outside of open enrollment. And you might be able to save money on premiums thanks to expanded federal tax credits available through 2022.
Most people already enrolled in ACA marketplace plans have seen their premiums go down because the American Rescue Plan increased tax credits for insurance premiums and expanded the number of households who qualify for them. Every household that pays more than 8.5 percent of their household income now qualifies for federal tax credits to help them afford health insurance. Prior to the new law, such tax credits were only available to people making up to 400 percent of the federal poverty level (around $51,000 for one person).
The average American with a marketplace plan can save $50 per month with the new assistance, the federal government says. As of now, this additional federal financial assistance will be available only through the end of 2022.
First, use beWellnm’s plan comparison tool to estimate costs and see what sorts of plans you may qualify for — or enter personal information like your name, phone number and zip code and set up a time to speak with a certified enrollment assister or insurance broker. Or call beWellnm’s customer engagement center at 833-862-3935 toll-free.
Once you’re approved for a plan, you’ll need to pay your first monthly premium for your coverage to begin. Your first payment is due by the 23rd of the month before your coverage kicks in, so by Dec. 23 for coverage that begins Jan. 1.
To apply and enroll:
Coverage and cost depend on where you live, the type of plan you choose, your estimated household income, and the age and disability status of you and your family.
If you qualify for Medicaid, you will be able to get free or low-cost coverage and may not need to worry about premiums or copays, depending on your level of income.
All beWellnm plans cover 10 “essential” benefits, including:
Insurance companies cannot deny coverage because of preexisting conditions. When you apply, you can identify your medical needs and choose a plan that makes financial sense for you and your family.
Most beWellnm plans cover basic dental services for children, including cleanings and exams. But adults who want dental coverage, or parents who want more substantial coverage for their kids, must add it to their policy.
Deductibles and out-of-pocket costs vary between plans.
Every eligible household that pays insurance premiums that exceed 8.5 percent of annual income qualifies for federal tax credits for insurance premiums through 2022.
For example, a single 64-year-old filer earning $51,000 per year in 2021 could potentially have saved more than $8,000 with the new tax credits, according to the Kaiser Family Foundation.
Yes. If you qualify for a premium tax credit, you may also qualify for a cost-sharing reduction that would help you pay for such out-of-pocket expenses as deductibles and copays. You must enroll in a Silver-level plan to get this assistance.
BeWellnm plans are organized into four categories:
The beWellnm plan comparison tool helps you estimate costs and benefits of various plans and check whether you might qualify for financial assistance. New Mexico residents younger than 30 can also apply for a catastrophic plan offering low premiums but with high deductibles.
If you already have coverage through your employer or directly through an insurance provider but are eligible for lower premiums, you can switch to beWellnm. But you may not qualify for tax credits if you opt out of your employer’s plan — unless those premiums exceed a certain portion of your household income. The premiums would need to be more than 9.61 percent of your household income for individual coverage to qualify for the tax credits.
If you lose coverage through the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), you may be able to sign up for a beWellnm plan during a 60-day special enrollment window. Try to apply and select your plan before your COBRA coverage ends to make sure there's no gap in coverage. If you’re not sure about whether making this switch makes sense for you, you can ask for free advice from a certified insurance broker or assister.
That depends. Major insurance providers, including Blue Cross Blue Shield of New Mexico, True Health and Molina, offer beWellnm plans, but not all doctors accept them. You can talk to your primary care physician to see whether he or she accepts a particular marketplace plan.
It depends. You can enroll as a family. But in some cases, some family members may also be eligible for subsidies or other programs such as Medicare, Medicaid or CHIP, depending on age, income and disability or caregiver status. Such families may choose to enroll separately. They may still be able to see the same doctor or go to the same medical practice, depending on the types of insurance plans accepted.
This guide was updated on April 25, 2022, with more information about premiums.
This story is provided by AARP New Mexico. Visit the AARP New Mexico page for more news, events, and programs affecting retirement, health care, and more.
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