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Guide to Medicare in New Mexico

October 9, 2023

Guide to Medicare in New Mexico

More than 20 percent of people who live in New Mexico use Medicare, with over 1.8 million people enrolled in a Medicare Advantage plan and almost 1.5 million people with a Prescription Drug plan. 

You should begin reviewing the various Medicare options several months prior to your 65th birthday. Since you can apply for Original Medicare three months prior to your 65th birthday, you will need to know whether you want a Medicare Advantage plan or Original Medicare.

Is Medicare Free in New Mexico?

Yes and no. Part A is premium free if you worked enough quarters in your career. Part B and Part D have premiums you must pay. Additionally, Parts A and B have deductibles. Part D most likely has a deductible, though it depends on the plan you choose under Part D.

The premium for Part A is $499 in 2022 if you worked less than 30 quarters. If you worked less than 30 to 39 quarters, the premium is $274 in 2022. The deductible for Part A is $1,556 in 2022. If you worked at least 40 quarters, Part A does not have a premium.

You also have to pay for Part B premiums. In 2022, the premium will be $170.10.

Additionally, Original Medicare has deductibles. When comparing Medicare Advantage plans with Original Medicare, do not forget to account for any deductibles in Original Medicare and in the Medicare Advantage plans. Medicare premiums and deductibles can be confusing, learn more in this guide to Medicare costs.

Help With Medicare Premiums

If you cannot afford Medicare premiums, you may be eligible for help. New Mexico and the federal government offer Medicare Savings Programs that may help you cover some of your costs.

You can choose from one of four Medicare Savings Programs to help with Medicare premiums:

  • Qualified Medicare Beneficiary Program: You must earn less than $1,094 if you are single and less than $1,472 if you are married. You cannot have resources worth more than $7,970 if you are single and $11,960 if you are married. The program covers premiums for Parts A and B, copayments, deductibles, and coinsurance for Medicare coverage.
  • Specified Low-Income Medicare Beneficiary Program: This program helps pay for Part B premiums if you have Part A and limited resources and income. To qualify, your income cannot be over $1,308 if you are single and $1,762 if you are married. You cannot have over $7,970 in resources if you are single, or $11,960 if you are married.
  • Qualifying Individual Program: This program helps with Part B premiums if you have Part A and limited income and resources. The applications are granted on a first-come, first-served basis. You have priority if you used the QI program the previous year. The income limits for the QI program are $1,469 for single people and $1,980 for married people. The resource limits are $7,970 for single people and $11,960 for married people.
  • Qualified Disabled and Working Individuals: If you have to pay Part A premiums, this program will help. You must have a disability, must be working, and lost Social Security and Part A premium-free because you started working. The program also has limits: $4,379 for single people and $5,892 for married people. You cannot have more than $4,000 in resources if you are single, or $6,000 if you are married.

How Old Do You Have to Be to Get Medicare in NM?

You must be 65 to apply for Medicare, but you may be able to get Medicare early if you have a qualifying disability or have ALS or end-stage renal disease. If you are disabled, you must be on disability for 24 months before you become eligible for Medicare. If your doctor diagnoses you with ALS or end-stage renal disease, you can apply for Medicare immediately after you receive your diagnosis.

You should apply for Medicare three months before you turn 65 because of the length of time it takes to process the application. You have three months after your 65th birthday to apply for Medicare. If you don’t apply in time, you must wait until open enrollment. It’s important to learn about the different Medicare enrolment periods to ensure you have coverage and to avoid any penalties for not signing up on time. 

Does New Mexico Have Medicare Advantage Plans?

New Mexico has several Medicare Advantage plans. These plans feature everything Original Medicare offers but have different out-of-pocket costs. Many Medicare Advantage plans also offer dental, vision and prescription coverage.

You should compare the Medicare Advantage plans available in your area to find the one that best fits your needs, and then compare it to Original Medicare to see which one is better for you. Learn more about the differences between Original Medicare and Medicare Advantage in this guide. 

Medicare Advantage plans have a variety of premium pricing, deductibles, and coverages. Some might cover certain prescriptions, while others might not. Always check the prescription coverage, especially if you have an expensive drug that you must have. Since you can only change plans on a  yearly basis, choosing a plan that does not cover a drug you need could cause you to pay for that drug out of pocket – and that could be expensive.

If you are on Original Medicare and want to switch to a Medicare Advantage plan, you can switch during Medicare's annual enrollment period (AEP) from October 15 through December 7. You can also add, remove, or change Medicare Part D plans for prescriptions.

If you have a Medicare Advantage plan and want to switch to Original Medicare or a different Medicare Advantage plan, you can do so from January 1 to March 31.

Contact Us to Learn More About Medicare in New Mexico

If you are looking for a Medicare Advantage plan in New Mexico that best fits your lifestyle and healthcare needs, you can compare available Medicare plans in your area. Once you enter your zip code, you can review available plans or contact us to speak to a licensed insurance agent.


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