Medicare Hope
New Mexico
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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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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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Supplemental Insurance - Medigap Options in Idaho

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. You can use our plan finder tool to compare the pricing on different plans in New Mexico.

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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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