Find Insurance by State
New Mexico Health Insurance
Health insurance is essential for the peace of your mind. Indeed, purchasing suitable health insurance coverage for your family is costly, but it also requires a good evaluation of all potential risks and its impact on your financial health. In the U.S., more than 47 million people are uninsured and working families constitute a major part of this uninsured population. With the rising health care costs, many of these families usually end up without having proper health coverage, unaware of the consequences of huge medical bills of an unforeseen event. For those families who are not covered under their employers’ group plan, many states provide low-cost health insurance programs to them.
In 2008, New Mexico was ranked as the 29th healthiest state to live in, climbing nine spots from its 2007 ranking, according to the United Health Foundation's Health Rankings. The state witnessed a remarkable improvement in its health score due to the decrease in the prevalence of binge drinking and in the percentage of children in poverty, and a strong public health funding. The state of New Mexico, having the population of more than one million citizens, has both private-market and public health insurance alternatives. The private-market health insurance comprises of numerous types of health plans including family, Medicare supplemental, short-term, student, group and dental. Additionally, the state and federal government sponsored programs provide inexpensive health coverage to the uninsurable residents of New Mexico who meet specific eligibility requirements such as age, income and tobacco consumption.
The Insurance Division of New Mexico Public Regulation Commission is responsible for regulating all types of insurance sold in the state of New Mexico including health insurance policies offered by private-market health insurers or public health coverage programs. However, approximately 22.8% of the population remains uninsured, which is, till date, the biggest health concern for the New Mexico government. According to the Censor Bureau’s 2007 and 2008 Current Population Survey, approximately 35.1% of New Mexico citizens continue to survive without any kind of health insurance and under the above 200% FPL category.
Choosing a health plan for your family requires a good amount research and review of all health insurance alternatives. Therefore, your best interests lie in consulting with a licensed health insurance agent/broker who can guide you in selecting a proper health insurance solution.
Individual/Family Health Insurance
Below is the guidelines for applying for and obtaining individual health insurance in the state of New Mexico. These regulations apply to all insurance companies offering individual or family health insurance in New Mexico:
| Medical Underwriting | Yes |
Pre-Existing Condition Exclusion Period | 6 months |
Look Back Period | 6 months |
Look Back Standard | Prudent person |
Mandatory Benefits | Cancer screening for women including screening of breast and cervical cancer, mastectomy stay of 48 hours, eating disorder parity, infertility treatment |
Market Rate Restrictions | Yes |
Guaranteed Issue Options | None |
Small Group Health Insurance
Below is the guidelines for small group health insurance in the state of New Mexico. These regulations apply to all insurance companies offering small group health insurance in New Mexico:
| Small Group Size | 2-50 |
Employee Qualifications | Two employees must work for at least 6 months out of the year, and work 20 hours per week |
Guaranteed Issue | Yes |
Premium Rating Factors | Rate Bands |
Rate Adjustment Factors | 20% |
Look-Back Period | 6 months |
Pre-existing condition exclusionary period | 6 months |
Mandatory Benefits | Same as individual |
State Cobra Variations for Small Groups
Below are the COBRA guidelines for small groups in the state of New Mexico. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:
| Mini-Cobra Option | Yes |
Eligible Group Sizes | 2-19 |
Extension of Benefits Period - Standard | 6 months |
Extension of Benefits Period - Disabled | 6 months |
Maximum Premium Increase | 100% |
State Legislation Reference | |
Additional Notes | You must have been covered under group health plan for at least 6 months to qualify for this continuation coverage. |
State Sponsored Health Insurance Programs
There are several state sponsored health insurance programs in the State of New Mexico to assist those without insurance in obtaining adequate coverage.
High-Risk Pools
Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. The guidelines for enrollment in these programs vary by state. The high-risk pool in the State of New Mexico is summarized in the chart below:
| Plan Name | New Mexico Medical Insurance Pool (NMMIP) |
Website | |
Phone Number | 505-424-7105, 866- 622-4711 |
HIPPA Eligibility Required? | Yes |
Available Carriers | Blue Cross Blue Shield of North Mexico |
Pre-Existing Condition Waiting Period | 6 months |
Enrollment Periods | Open to New Members |
Premium Limits | No more than 150% of the standard rate |
Lifetime Maximum Benefit | There is no overall maximum payment limit. However, there are specific maximums for certain benefits. |
Special Notes | To be eligible for coverage: |
Children’s Health Insurance Program
Through shared funding from the federal government, the State of New Mexico provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:
| Program Name | New Mexi Kids |
Website | |
Phone Number | 888-997-2583 |
Apply Online | Yes |
Age Limits | Under 19 |
Insurance Carrier | Blue Cross and Blue Shield of New Mexico, Lovelace Community Health Plan, Molina Healthcare, Presbyterian Health Plan |
Length of Coverage | Periodic Review for Income Eligibility |
Residency Requirements | New Mexico resident and U.S. citizen, legal immigrant |
Other Eligibility Requirements | Must be ineligible for no-cost Medicaid or employer-based coverage |
Pre-Existing Condition Exclusions | None |
Cost | $0 or minimal cost for coverage. Depending on the family income, small co-payments may be required. |
Medicaid
Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of New Mexico
| Governing Agency | New Mexico Human Services Department |
Website | |
Phone Number | 888-997-2583 |
Residency Requirements | New Mexico resident |
Federal Poverty Line Income Limits | Ages 0-19: up to 235% FPL |
Additional Resources
New Mexico Health Care Options Matrix™ Guide
Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines New Mexico’s public and private health care choices for individuals and groups with various demographic profiles.
Family Health Insurance Guide by HealthInsuranceFinders.com
The guide created by HealthInsuranceFinders.com provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.
New Mexico: At-A-Glance
Provides exclusive health data of New Mexico. Statehealthfacts.org, a project of the Henry J. Kaiser Family Foundation, provides free, up-to-date, and easy-to-use health data on all 50 states.
