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New Mexico Health Insurance

New Mexico Medical Insurance Overview
Residents living in the state of New Mexico are given many options for insurance coverage including group health plans for the working population, individual coverage for those who don’t otherwise have insurance and state-funded plans designed to offer medical services to low income individuals and families.  The programs on the market can vary depending on the person’s age, sex, medical condition and gender.

With the new health care legislation, many people in New Mexico, as well as across the country, will see improvements to the health of state residents.  It is estimated that within the next four years, the rate of people who are insured in the United States will see an increase by 30 million Americans.

Provided below is a range of data, statistics and information on the current climate of health insurance in the state of New Mexico.

New Mexico’s Health Care Issues
New Mexico’s population has been considered quite active, but they rank pretty low with regard to the health status of the people living in this state.  The United Health Foundation ranks the state of New Mexico at 37th place when compared to the rest of the country.  In 2012, the state was ranked in 32nd place, so the health status has dropped significantly since the implementation of the Affordable Care Act.  Below are some of the strengths and weaknesses in the state’s population:


  • Low levels of air pollution
  • Low rate of cancer-related deaths
  • Low prevalence for people who drink excessively


  • Low percentage of kids who graduate high school
  • High rate of violent crime
  • High percentage of deaths related to drugs

Understanding New Mexico’s Uninsured Population
In the state of New Mexico, there is a high rate of the population who does not have insurance coverage.  Currently, the state ranks 48th out of the entire country with regard to the high population of uninsured individuals.  The Kaiser Family Foundation reports that there are 12 percent of residents who are not insured in this state.  With such a high percentage, this makes the uninsured problem one of the state’s main worries.

It is believed that the Affordable Care Act will see many more residents who get insurance coverage in this state.  Politicians believe that the legislation will cause the numbers of uninsured residents to fall.

Group Health Plans
In the state of New Mexico, regulating insurance companies and Health Maintenance Organizations falls upon the shoulders of the state’s Department of Insurance.  Rules and regulations have put in place for employers to be able to easily provide insurance benefits to their pool of employees.  Even though these rules sometimes ease the burden of providing coverage, many small businesses still have issues with offering insurance coverage because of the costs that come along with insurance.  Even still, group health plans also require a certain portion of the premium contributions to be paid by the employee – which cause the coverage to be an expensive option.  However, despite the high costs of insurance through a group plan, this is almost always your best choice for getting insurance coverage.  It is less expensive than an individual plan and you have more options through a group plan.

Signing Up
Signing up for coverage under a group plan requires you to apply during an official enrollment period.  This time is usually predetermined by your employer and happens at the same time annually.  During the weeks of the enrollment period, you can apply for coverage under your employer’s group health plan.  In the event that you wait until after the designated enrollment period, you will be forced to wait until the next enrollment period to sign up for group coverage.

Before you join your company’s group insurance plan, you will want to do some independent research in order to weigh all of the options available to you.  In making the best decision on the plan options available, you will want to keep the following information in mind:

  • Coverage – Figure out the type of coverage that you and your family members will need.  There are usually several options available and they can all vary with regard to how comprehensive they are and how much they cost.
  • Future Medical Needs – It is important to consider whether or not you will expect any medical issues in the future.  This will aid your decision making process so that you can make sure anything you need medically is covered.
  • Dependents – Are you responsible for covering dependents or a spouse?  If so, you will want a plan that offers a lot of coverage.
  • Health Status – Are you or your family members suffering from pre-existing medical conditions?  If so, you will need to be sure that special coverage is available.

Pre-Existing Condition Exclusion Periods
If you have a pre-existing medical condition and have signed up for insurance coverage under a group plan provided by your employer, you may be subject to waiting through an exclusion period.  This length of time is typically 12 months long for employees under group plans and prohibits the use of your insurance coverage.  The only upside is that during the exclusion period is that despite making your monthly premium payments, you can get medical care for issues unrelated to the pre-existing condition.  You should be aware of the following information with regard to pre-existing condition exclusion periods:

  • Dependents under 19 do not have to wait through exclusion periods
  • The look back period is 6 months for insurance companies to determine if you have a pre-existing condition
  • Having a predisposition to a medical condition is not the same as having a pre-existing condition and cannot be treated as such for insurance purposes

Affiliation or Waiting Periods
Waiting periods apply to everyone who uses employer-sponsored coverage that is covered through an HMO.  You are not required to pay premiums monthly during the waiting period and in the state of New Mexico, it can’t last longer than two months from the date you’ve enrolled into the benefits package.  Employees who enroll late might have to wait three months for their coverage to become active.  Pre-existing condition exclusion periods cannot be added to the end of the waiting period as they both occur at the same time.

Individual Health Plans
Individual health insurance plans are usually the more expensive option when considering health benefits for residents of New Mexico.  If you can’t get coverage at your workplace and earn too much to qualify for state-funded options, you can obtain an individual insurance policy for coverage.

Unfortunately for those who go this route, this is an expensive means of getting coverage.  It can be made even worse if you are in poor health, which can cause costs to skyrocket for coverage.  When signing up for coverage through an individual plan, you may be asked to get a physical and you might have to fill out a health questionnaire.  In the state of New Mexico, insurance providers are monitored by the Public Regulations Commission.

Continuation Coverage
COBRA coverage is a type of continuation coverage that exists to fill in the gaps of insurance if you should lose your benefits for any reason.  This type of coverage is available for a period of 18 to 36 months, depending on why your insurance coverage came to an end.  Unfortunately for those who need this type of plan, it isn’t a cost-effective option.  Purchasing COBRA coverage is cheaper than buying an individual plan, but is still costly because you won’t have a contribution from your employer.

Your employer has the responsibility of providing your information regarding COBRA benefits and you are given a full sixty days to determine whether or not you wish to go this route.  If you fail to sign up during the allotted time frame, you are not able to change your mind and purchase coverage at a later time.

New Mexico Health Benefit Exchange
New Mexico has created and implemented its health benefits exchange of which can be accessed at  For the uninsured population of New Mexico, it is a place for residents to get educated with regard to health insurance options, compare insurance plans and enroll into a policy.

It was decided in 2012 that the state itself would operate the benefits marketplace without the aid of the federal government.  The exchanged is governed by a board of 13 members with the end goal of providing benefits to all of the residents living in the state.  The mission of the exchange was set to improve the collective health of people residing in the state of New Mexico.

New Mexico State Insurance Programs
If you have financial difficulties and are unable to afford coverage through a group or individual health insurance plan, you have the option to apply for coverage under a state-funded program.  There are many program options available and some typically factor in your income, age, sex and health status before approving your enrollment.

Below is a list of information on each of the state-funded programs that exist in the state of New Mexico:

New Mexico Medical Insurance Pool (NMMIP)
For people who are permanent residents of New Mexico is the Medical Insurance Pool.  In order to apply, you have to be HIPAA eligible or have your insurance already voiced.  Covered under this program are office visits, surgery, medications, hospital stays and more.

Pre-Existing Condition Insurance Plan (PCIP)
Under this plan, applicants can get coverage for any pre-existing medical conditions they have.  Prescription medications, hospital stays and specialty care are all covered under this program.

New Mexico Health Insurance Alliance (NMHIA)
You need to be HIPAA eligible in order to qualify for this program and unable to be a participant in any other program.  Individuals who have NMHIA can also transfers to NMMIP.

The Medicaid Program in New Mexico is in place to help families and individuals with lower incomes who are in need of health care coverage. There are a number of different costs covered through this program, some of which include physician care and office visits, immunizations, and hospital care. Whether or not a family is eligible for this program is determined by the income level. In many cases the premium amount is small and even, sometimes, $0.

New Mexikids
For kids under the age of 19 whose family unit is comprised of low earners, the New Mexikids program offers help with hospital stays, doctor’s visits, health checks and more.

Women-Infant-Children (WIC)
The WIC program is a federally funded program that offers breastfeeding assistance to new mothers along with food supplements for infants and children under five.

Colorectal Cancer Program
Using the Colorectal Cancer Program you can receive colorectal cancer screenings and related diagnostic services.  It is available to uninsured residents of New Mexico who are over the age of 50-years-old and meet other necessary requirements.

Breast and Cervical Cancer Early Detection Program
To be eligible, you must be a woman over the age of 30 and be a resident of the state of New Mexico.  There are income requirements to be met and you can get coverage as long as you are uninsured.

Indian Health Services
If you are of Indian ethnicity, you can receive medical services under this plan.  For members of Indian tribes and women who are pregnant by an eligible Indian resident, coverage is available.  Services covered include emergency room visits, in-patient services, outpatient services and physical therapy.

Medicare and Medicare Prescription Drug Program
Medicare coverage is available to seniors over the age of 65, disabled individuals and those people battling end-stage renal disease.  In order to qualify, you must have worked in a job that was covered by Medicare for the span of at least ten years.

Health Coverage Tax Credit
This subsidy is available to people who are currently receiving Trade Adjustment Assistance.  Services provided include doctor’s visits, preventive care, medications, mental health care, in-patient care services and more.

The Health Insurance Portability and Accountability Act (HIPAA)
HIPAA was enacted in 1996 to offer protections to consumers with regard to their medical records.  Now, with the additional legislation provided under the Affordable Care Act, HIPAA also works to regulate health insurance companies.  Under HIPAA, many insurance providers are not able to deny coverage to individuals based on pre-existing conditions.  It also regulates how much insurance companies can charge for monthly premiums, how long waiting periods can last and how long you have to wait for exclusion periods.

Under HIPAA, there have been many positives that have come from the legislation, but it hasn’t yet made it mandatory for companies to provide their workers with insurance coverage.