What's covered: All approved plans in the state must cover the same package of benefits, called essential health benefits. In New Mexico, the benefits include:
- Outpatient services, such as doctor visits or tests done outside a hospital
- Emergency services
- Hospital stays
- Pregnancy and baby care
- Mental health and substance abuse services, including behavioral health treatment
- Prescription drugs, including generic and certain brand-name drugs
- Rehab and habilitative services, those that help people recover from an accident or injury and those that help people with developmental issues. In New Mexico, this includes diagnosis and treatment of autism spectrum disorder and coverage for hearing aids for children, among others.
- Lab tests
- Preventive and wellness services, along with those that help people manage chronic conditions
- Services for children, including dental and eye care
Health Insurance Advisor: Check out Web MD’s Health Insurance Advisor to compare different kinds of plans based on your needs.
Financial Aid and Medicaid
You may be eligible for financial aid to help pay for insurance or for government sponsored insurance. Here’s what’s available:
Premium Subsidies (also known as Tax Credits): You may qualify for a subsidy -- money to help pay your health insurance premium each month. The subsidy may be sent directly to your health insurance company and is available only if you buy your insurance in the Marketplace. In general, you'll be eligible if you're single and make about $45,960 or less a year, or if you have a family of four and make about $94,200 or less a year. Subsidies are based on your estimated household income for 2014.
You also may be eligible for cost-sharing subsidies that will reduce your costs when you get medical care. Cost sharing subsidies are available only if you buy a silver-level plan.
Medicaid Expansion: Some states expanded their Medicaid program so more people can get health insurance coverage. Because New Mexico is one of them, you may be eligible if your yearly gross income is no more than about $15,856 for one person and $32,499 for a family of four.
CHIP: The Children’s Health Insurance Program provides coverage for children of some families who have a low income but are not eligible for Medicaid.
Check with Be Well New Mexico to see if you are eligible for these programs.
There are several ways you can get help with your insurance decisions:
- Web Site: Find information about New Mexico’s Marketplace at Be Well New Mexico. From that site, you will be able to create an account, find information about different plans, and buy insurance.
- Call Center: You can call the federal government’s help line, 800-318-2596, 24 hours a day, seven days a week for information, help, and to buy insurance.
- Navigators and assisters: They will teach you about the Marketplace and guide you through your insurance decisions. They are supposed to be fair and impartial helpers and cannot take any money from insurance companies.
- Local, state, and federal organizations: Many health and community organizations, public libraries, and hospitals are offering help. Some organizations will have volunteers who can answer questions for you. Other groups will have trained and certified helpers who can take you through the whole process by computer or by using a paper application. Certified helpers must complete required training. They also are supposed to protect your personal information.
You can find a list of organizations that are helping with enrollment at LocalHelp.HealthCare.gov.
- Insurance brokers and agents: People in the insurance business who take special training also can help you buy insurance through the Marketplace. They also may have policies that are not offered on the Marketplace. You can only get tax credits or subsidies if you buy through the Marketplace.