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Medicare Plans in New Mexico – Coverage and Benefits

The federal Medicare program, for anyone age 65 or older, is a convenient and cost-effective form of health care sponsored by the US government. The base plan, which is sometimes referred to as either Original or Traditional Medicare, consists of two parts: Part A, and Part B. Together, these two parts can cover the majority of your medical needs, whether they occur inside or outside of a hospital. But there are some unfortunate coverage gaps which, if you aren’t careful, could end up costing you a lot of money. We’ll talk about those later in this article.

But first, let’s discuss the base expenses you can expect when you enroll in Medicare. For some seniors, Part A might actually be free, but that largely depends on your history of employment. For those with a lengthy employment history, about 10 years or more (40 quarters can also qualify you), you will not have to pay anything for access to Part A benefits. Anything less than that, though, and you will be required to pay fees. There are required costs associated with Part B also. You can find out exact totals by clicking on this link.

Medicare Part A (Hospital Coverage)

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home health care
Medicare Part B (Medical Insurance)

  • Services from doctors and health providers
  • Outpatient care
  • Home health care
  • Durable medical equipment
  • Some preventive services
Medicare Part C (Medicare Advantage)

  • Includes all benefits and services covered under Part A and Part B
  • Usually includes Medicare prescription drug coverage (Part D) as part of the plan
  • Run by Medicare-approved private insurance companies
  • May include extra benefits and services for an extra cost
Medicare Part D (Drug Coverage)

  • Helps cover the cost of prescription drugs
  • Run by Medicare-approved private insurance companies
  • May help lower your prescription drug costs and help protect against higher costs in the future

Different Types of Medicare Plans in New Mexico

In total, there are about 329,994 New Mexico residents who are currently receiving Medicare Benefits. 58% of them, however, are either sticking with Traditional Medicare alone, or have an alternative form of extra coverage through some employer benefit. The remaining 42% who want to protect their savings from disastrous gaps in Medicare coverage are split into two groups: those who have replaced their Original Medicare with a Medicare Advantage policy ( 30%, or 98,998 people) and those who have supplemented their Medicare benefits with a Medigap insurance policy (12%, or 39,945 individuals).

Qualified seniors who are currently enrolled in Medicare can start shopping around for an affordable Medicare supplement policy now. If you are not enrolled, or unsure of whether you qualify, click the link above.

Should New Mexico Residents Worry About Supplemental Coverage?

For practical reasons, every retired senior citizen should give supplemental coverage some serious thought. Granted, there is no law saying that you have to purchase additional insurance; however, looking at the table below will give you an idea of some staggering costs you might be responsible for should you choose to avoid protecting yourself with extra coverage.

Medicare Part A Costs Medicare Part B Costs
  • $1,184 (as of 2014) Part A Annual Deductible for access to Basic Hospital Services
  • $296/day for an Inpatient hospital Stay between 61-90 days long
  • $147 Annual Deductible (as of 2014) for basic Part B Medical Coverage
  • 80/20 Coinsurance costs for all Medicare coverage; Medicare pays 80%, you pay 20% Out-of-Pocket

The older you get, the more likely a medical emergency might be lurking around the corner. It’s never too early to secure some additional protection in the event that one of these emergencies strikes you without warning. Below, we’ll go into more detail about the top supplemental coverage plans available right now.

Option 1: Medicare Supplement Plans

Medicare supplement plans, often referred to as “Medigap” policies, are a form of private supplemental insurance offered in addition to Traditional Medicare benefits. There are a grand total of ten plans: A, B, C, D, F, G, K, L, M, and N. We’ve included a chart below which explains what benefits each plan offers. The good thing about Medigap is that each company in each state offers identical plans – so your plan K in New Mexico won’t offer more or less than plan K in Texas. Basically, you only have to worry about finding a reputable insurance company and an affordable price on your policy.

[chart category=”supplement” name=”planTypes” state=”NM” zipcode=”87121″]

Option 2: Medicare Advantage Plans

You may have also heard these types of plans referred to as Medicare Part C. The tricky thing about Advantage plans is that they can be a bit confusing if you aren’t familiar with how they work. For all intents and purposes, purchasing a Medicare Advantage policy effectively replaces the Medicare benefits you are currently getting from the government. But the coverage you get from your Advantage policy is required by law to be identical, if not better. You may even have access to additional benefits, like dental, for a modest additional fee.

Keep in mind, though, that in areas where Medicare Advantage is competitively priced with other supplements, this is mostly in part due to their restricted provider networks. What does this mean for you? Well, if you are particularly attached to your current doctor, it could mean severing that relationship in favor of a physician in the approved Advantage network.

Approved Medicare Advantage networks come in one of two forms. You will receive your care through either a Health Maintenance Organization (HMO), or a Preferred Provider Organization (PPO).

[chart category=”advantage” name=”topHMOPlans” zipcode=”87121″ state=”NM”]

[chart category=”advantage” name=”topPPOPlans” zipcode=”87121″ state=”NM”]

Telling the Difference Between Medicare Advantage and Medigap

It can be hard to tell the difference between these two supplements. For this reason, we’ve organized the most important questions people like you have asked about each form of coverage, and organized the answers in this easy to read chart:

Questions Medicare Advantage Medicare Supplement
How are the plans funded? Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company. Your monthly premium takes care of the majority of your expenses.
Do I continue paying for Part B? Yes Yes
What does it cost me? Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly. While each plan does require a monthly premium, many of them are affordably priced.
What does the plan cover? Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be. All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.
Can I budget my health care expenses? It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket. Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.
Can my plan be cancelled? Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage. No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.
Are pre-approvals or pre-certifications required? Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care. No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.
Can I use any doctor or hospital? Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time. Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.
Can drug, vision, or dental coverage be included in the policy? Yes. No. These forms of coverage must be purchased separately.
Who is this plan type generally best suited for? If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you. If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.

Additional Resources for New Mexico Residents

It’s highly likely that you still have questions that even this informative article has not answered. If so, feel free to take advantage of our search able directory. It contains a plethora of contact information for local Medicare insurance offices and experts who can help you find the answers you need.

[chart category=”general” name=”usefulContacts”]

Important Medicare Terms

  • HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
  • Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
  • Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.

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