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Medicare Plans in New Mexico

Most people work hard their entire lives hoping to live a comfortable life after retirement. More often than not, even after diligently planning all the finances, the entire plan could go haywire. Given the exorbitantly high healthcare costs in America, even a single excessive medical bill can become an inevitable setback, leading them quickly to bankruptcy.

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It has been reported that countless Americans aged 65 and above are facing medical debt and bankruptcy after experiencing varying health issues. The figures are even more alarming for people with disabilities and chronic conditions, as the severity of their medical needs results in a higher level of debt accumulation than other individuals.

However, medical debt isn’t limited to any demographic group but happens more commonly to people who have disabilities or do not have sufficient funds to pay for their medical treatments. Hence, the Medicare health insurance program was initiated to give people the chance to have a comfortable retirement without having to go through financial trouble because of a medical health emergency.

Medicare proves to be a viable solution for these individuals who deserve nothing but the best when it comes to healthcare accessibility. The program offers health insurance with coverage options that help bring down their medical bills significantly.

Medicare beneficiaries in New Mexico can sign up for several Medicare Plans, such as Medigap or Medicare Advantage. Since there are so many healthcare programs to choose from, it’s essential to opt for a coverage plan that meets all of your special requirements and financial situation. But searching for the right healthcare program can be challenging and requires a lot of extensive research. This is where our certified Medicare insurance agents at Integrity Now Insurance Brokers come in.

Our insurance agents are accredited annually by America’s Health Insurance Plan (AHIP), and you’re in safe hands with us. With our in-depth knowledge of the dynamics and complexities of the industry, we will help you streamline a robust healthcare plan that will help you stay debt-free. Our New Mexico Medicare insurance agents promise to go above and beyond to help you find the best health coverage plan that covers all the bases. Give us a quick call to get the conversation started.


Medicare Eligibility in New Mexico

Most people in the US get automatically enrolled in the Medicare program after they reach the age of 65. Any person who has received at least 24 disability benefits from the Railroad Retirement Board and has regular kidney dialysis, kidney transplant, renal failure, end-stage renal disease, or ALS is also eligible for this healthcare plan as long as they’re a permanent and legal US citizen. If you’ve been diagnosed with Lou Gehrig’s disease, you will start receiving Medicare benefits in the first month of getting disability benefits.

Medicare Options in New Mexico

Original Medicare

The Original Medicare, also known as the traditional Medicare, includes Medicare Part A and Part B. Part A deals with health care services in a hospital, providing coverage for hospital inpatient treatments, specialized nursing facilities, nursing home care (that isn’t custodial or long-term), hospice care, lab tests, and home healthcare.

Part B covers necessary medical services required to diagnose or treat the medical condition. And preventive services like healthcare to prevent illnesses and detection of illness at an early stage. Medicare Part B includes a monthly deductible that you’re expected to pay if your financial situation allows it.

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Outpatient care, doctor appointments, mental health, in-home care, partial hospitalization, and certain medical equipment are also covered. It also includes certain preventive care, such as vaccines and screenings, to maintain your health and prevent illnesses from worsening. However, Original Medicare doesn’t cover the prescription drugs, plus there are virtually no limits on the annual out-of-pocket expenses.

Medicare Part C (Medicare Advantage)

Many senior citizens in New Mexico prefer the Medicare Part C option because it is an all-in-one solution for all of their medical requirements. Medicare insurance agents can help streamline a complete package consisting of all the benefits of Part A, Part B, and Part D (prescription drug coverage). Private insurers who work under contract with Medicare provide this insurance plan, widely known as Medicare Advantage.

This healthcare plan offers many additional benefits, like coverage for vision, dental, hearing, and fitness programs, including gym membership and discounts, transportation to and from doctor appointments, over-the-counter drugs, and other health and wellness programs.

There are four types of Medicare Advantage Plans available in New Mexico.

Health Maintenance Organization (HMO)

HMOs mandate their subscribers to only opt for in-network providers for receiving healthcare services. It covers medical treatments by physicians and hospitals that work on their terms and conditions. To be eligible for the HMO, you must have a primary care provider (PCP), a specialty referral, and get approval for certain treatments and medications.

Preferred Provider Organization (PPO)

Medicare PPO plans have a recommended provider network you can choose from. You can also opt for an out-of-network healthcare provider for a higher price.

To qualify, you do not require any specialty referrals or a primary care provider. The PPO provides coverage for prescription drugs, but you can also purchase drug coverage separately.


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Medicare Supplemental Insurance - Medigap Options in New Mexico

Private Fee-For-Service (PFFS)

Offered by State-licensed organizations that work under contract with the Center for Medicare & Medicaid Services, the PFFS healthcare plan also includes a recommended network of providers their users can choose from.

To become eligible, you do not require a specialty referral or a primary care provider. Drug coverage is included, and there are higher premiums for people who choose an out-of-network provider.

Special Needs Plan (SNP)

This SNP plan is only available for people diagnosed with certain medical conditions. This healthcare plan offers special treatments and medical services designed to meet the specific needs of people with chronic conditions.

For this program, you require a PCP and a specialty referral. Prescription drug coverage is included, and you can join this plan anytime if you meet the eligibility criteria.

Medicare Part D

Since Medicare Part A and Part B do not provide coverage for outpatient prescription medications. New Mexican Medicare beneficiaries can avoid out-of-pocket expenses by opting for Medicare Part D to get coverage for prescription medication.

The coverage plan specifically pays for prescription drugs, including a wide range of intravenous medications, chemotherapy medications, and other over-the-counter drugs.

Experienced Medicare insurance agents in New Mexico can educate you about the exceptions, which generally include over-the-counter options, weight loss, or weight gain medicines, to name a few. Do note that the budget isn’t unlimited; you only get coverage for the allocated budget.

Moreover, you can only avail of Part D once you’ve paid for the yearly deductible, as you won’t be covered for your purchases until the yearly deductible has been taken care of. Going above the threshold would mean you will have to pay for all the remaining out-of-pocket expenses.

If you think the limit is too little for your needs, there are ways to increase it. You also get some copay solutions with your Part D coverage. Get in touch with our Medicare insurance agents in New Mexico to learn more about your options.

Since the Original Medicare Part A and Part B only cover 80% of the medical expenses, New Mexicans can purchase the supplemental Medigap policy, which pays for the rest of the 20% out-of-pocket costs.

Medigap, also called Medicare Supplement, is a comprehensive healthcare plan that Medicare beneficiaries invest in to get coverage for whatever isn’t covered in the Original Medicare. This set of health insurance policies is labeled from A through N.

Private insurance companies that provide Medigap coverage must adhere to federal regulations since each state’s insurance commissioner governs Medigap plans. To qualify for Medigap, enrollees must already be enrolled in Original Medicare. They can sign up for the Medigap plans in the first month after applying for Medicare Part B. They must also be:

  • Diagnosed with amyotrophic lateral sclerosis (ALS)
  • 65 years of age or older
  • Diagnosed with ESRD (end-stage renal disease), had a renal failure, or a kidney transplant

If under 65, must be receiving disability benefits from Social Security or the Railroad Retirement Board

How Do Medigap Insurers Set Their Premiums In New Mexico?

Issue Age Rating

This premium depends on the enrollee’s age at the time they apply. Enrollment premiums cost less for people who are under 65 than for people over 80. The overall rates may be affected due to inflation and other reasons, but never because of the enrollee’s age.

Attained-age Rating

Most insurance companies prefer to use this approach to calculating premiums. The person’s premiums become higher as they get older. These premiums are also less expensive for younger buyers.

Community Rating

Unless mandated by the state, insurers typically avoid this method of calculating premiums. But generally, the premiums are not affected by the enrollee’s age.

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Comparing Medicare Plans in New Mexico: Factors to Consider

Amount of Coverage Required

It’s best to maintain a list of all the goals and requirements that you expect your insurance plan to meet when you set out to shop for health insurance in New Mexico. A list of all your specific needs will help you keep your goals in mind and choose a plan that fulfills them all. Contact one of our Medigap insurance brokers to compare the pricing on different plans in New Mexico.

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Provider Network

Many Medicare plans require the beneficiaries to only choose in-network healthcare facilities. You will be asked to pay a higher premium for an out-of-network provider. This is why you should research and find in-network healthcare providers to save money on medical expenses.

Plan Ratings

The Center for Medicare & Medicaid Services (CMS) releases Part C and Part D performance data annually that you can go through to compare ratings.

Monthly Premium

The Medicare Advantage and Medigap plans add a premium to your medical budget, and you will have to pay the Part B deductible whether or not you exercise your benefits. Sign for at least one non-premium plan with sufficient coverage to save yourself from the financial strain.

Drug Coverage

Prescription drugs are costly, which is why it’s best to ensure your plan has adequate drug coverage before you sign up for it. You can consult with the policy’s formulary to check whether the drugs you’re prescribed are listed on it. If not, you can ask your doctor for an alternate or generic version of the drug.

Coinsurance & Co-pays

Often referred to as cost-sharing, you’re responsible for these costs when you use your benefits. Find out how much your insurance covers for doctor’s appointments, treatments, services, and prescriptions.


This is the amount you must pay before the insurance plan starts to help cover costs. Medicare Advantage Plans have set deductibles that typically change every year.

Extra Benefits

Most Medicare Advantage Plans cover prescription medications, but some also include additional benefits that the Original Medicare doesn’t cover.

You might require hearing or vision benefits, dental services, transportation to doctor’s visits, discounted gym memberships, and other targeted services.

Medicare Advantage Plans often tailor the benefits to meet the particular needs of chronically ill beneficiaries. Think about the additional benefits that are crucial to your situation.

When applying for a health insurance plan, ensure you get comprehensive coverage with additional benefits at competitive rates. This is why many first-time Medicare enrollees find the process of enrolment a daunting experience.

You can rely on Medicare Hope to provide you with all the details you need about sturdy health insurance policies that meet your requirements and are within your budget.


Why Choose Medicare Hope Insurance Agents?

Medicare Hope is Integrity Now Insurance’s service for increasing the chances of people having access to quality healthcare across not just New Mexico but the entire US. 

Our Medicare insurance agents prioritize your health and safety and are committed to going above and beyond to ensure you have the protection you deserve. Our experts will properly guide you and help you make an informed decision when choosing a healthcare plan.

Get in touch with our AHIP-certified team of Medicare insurance agents today, who will help you compare quotes and fill you in with all the details that you require. We extend our services to senior citizens, youth with disabilities, and other individuals who require instant healthcare solutions. Give us a call to get started.  

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