Alyssa Lane
Medicaid and Medicare are government-sponsored health insurance programs that provide coverage for a wide range of individuals. While Medicaid is designed for low-income individuals of all ages, Medicare primarily serves people aged 65 and over, as well as younger individuals with specific medical conditions or requirements. In New Mexico, Medicaid and Medicare programs are available to eligible residents, with options for supplemental coverage and short-term health plans. Understanding the specific insurance options and their eligibility criteria is essential for New Mexico residents to make informed choices regarding their healthcare coverage.
| Characteristics | Values |
|---|---|
| Medicaid eligibility in New Mexico | Low-income adults under 65, children and pregnant women with higher incomes, people over 65, blind or disabled people |
| Medicaid enrollment | Year-round with no open enrollment window |
| Application options | Online, by phone, by mail, or in person |
| Medicare in New Mexico | Original Medicare (Part A and Part B), Medicare Advantage, Medigap |
| Medigap coverage | Available to those without employer-sponsored supplemental coverage |
| Medicaid long-term care programs | Institutional/Nursing Home Medicaid, Medicaid Waivers/Home and Community-Based Services (HCBS), Program of All-Inclusive Care for the Elderly (PACE) |
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What You'll Learn
Medicaid eligibility in New Mexico
Medicaid is also available to those 65 and older, although there are income and asset limits for this population group. In addition, Medicaid eligibility in New Mexico extends to those who are blind or disabled, again with income and asset limits.
New Mexico's Medicaid program is called Centennial Care, and it is available to low-income adults under 65 as a result of the Affordable Care Act's (ACA) expansion of Medicaid. This program offers year-round enrolment, and applications can be made online, by phone, or by mail. There is also a paper application that can be completed and mailed to the Central ASPEN Scanning Area in Bernalillo, New Mexico. Alternatively, applicants can visit a New Mexico Human Services Department field office for in-person assistance.
Another aspect of Medicaid in New Mexico is the Turquoise Care program, which is the state's Medicaid Managed Care program. Under Turquoise Care, members receive additional services such as expanded care coordination, community benefits, and value-added benefits offered by Managed Care Organizations (MCOs). These MCOs are health plans that provide healthcare services to Medicaid members, and enrollees can choose their preferred health plan.
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Medicare eligibility in New Mexico
If you are not yet receiving Social Security benefits and therefore are not automatically enrolled when you turn 65, you can apply for Medicare in New Mexico via the Social Security Administration.
Medicare beneficiaries who also have Medicaid, a Medicare Savings Program, or Supplemental Security Income (SSI) will receive extra help. This program lowers Medicare Part D prescription drug costs. When beneficiaries apply for this program themselves, the income limit is $1,843 a month for singles and $2,485 a month for couples. The asset limit is $16,660 for individuals and $33,240 for spouses.
New Mexico is one of several states where private Medigap insurers are not required to offer plans to people under the age of 65. However, state high-risk pool coverage provides a backup option.
The New Mexico Aging and Long-Term Services Department (ALTSD) provides free volunteer Medicare counselling. The ALTSD can help beneficiaries enroll in Medicare, compare and change Medicare Advantage and Part D plans, and answer questions about state Medigap protections. Counselors can also provide advice about options for receiving long-term care.
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Medicaid and Medicare insurance options
In New Mexico, Medicaid is available to low-income adults under the age of 65, as well as children and pregnant women with higher incomes. Additionally, people aged 65 or older, blind, or disabled can also qualify for Medicaid, but there are income and asset limits for these groups.
Medicaid enrollment in New Mexico is open all year round, with no specific open enrollment window. Applications can be submitted online through the Centennial Care website, HealthCare.gov, or by phone. Paper applications can also be downloaded, completed, and mailed to the Central ASPEN Scanning Area.
For those seeking Medicare options in New Mexico, it's important to understand that eligibility and enrollment processes are consistent across the United States. Original Medicare, which includes Part A (hospital coverage) and Part B (physician/outpatient coverage), does not vary by state. Supplemental coverage, such as Medigap policies or Medicare Supplement insurance plans, can help with out-of-pocket costs that Original Medicare doesn't cover.
In New Mexico, over 462,000 residents are enrolled in Medicare, and the state offers a high-risk pool for beneficiaries under 65. Additionally, younger individuals can become eligible for Medicare if they have certain conditions, such as end-stage renal disease or amyotrophic lateral sclerosis.
For those who qualify for both Medicaid and Medicare, New Mexico offers the Program of All-Inclusive Care for the Elderly (PACE). This program combines the benefits of both programs into a single package, often including additional services like dental and eye care.
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Applying for Medicaid in New Mexico
Medicaid is available in New Mexico for low-income adults under the age of 65, as well as children and pregnant women with higher incomes. Those aged 65 and above, or who are blind or disabled, may also be eligible for Medicaid, but there are income and asset limits for this group.
Medicaid enrollment in New Mexico is open all year round, with no specific enrollment window. There are several ways to apply:
- Online: via the Centennial Care website, or at HealthCare.gov (this application will be reviewed for eligibility and then transferred to the state Centennial Care program for a final decision).
- By phone: call 1-800-318-2596, or 1-855-637-6574 (Spanish speakers available).
- In person: visit a New Mexico Human Services Department field office for assistance with your application.
- By mail: download a paper application, complete it, and mail it to Central ASPEN Scanning Area, PO Box 830, Bernalillo, NM, 87004.
If you are under 65 and do not have Medicare, you can also call 1-855-309-3766 for information.
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Medicaid and Medicare dental coverage
In New Mexico, Medicaid and Medicare dental coverage is available through various options. Firstly, New Mexico has a Medicaid expansion CHIP, which provides dental coverage to uninsured children and pregnant women with incomes above the eligibility limits for regular Medicaid. This expansion ensures that those who do not qualify for standard Medicaid can still access essential dental care.
Additionally, adults enrolled in Medicaid in New Mexico are eligible for extensive dental services through several health plans offered by the state Medicaid program. These plans may vary in their specific offerings, but they all aim to provide comprehensive dental coverage. One such example is DentaQuest, which offers a Medicaid (Turquoise Care) dental plan with benefits like an easy-to-use search tool to find a nearby dentist and flexible hours.
For those with Medicare, New Mexico uses a state-run exchange called BeWellNM, which allows individuals with Medicare to enrol in stand-alone dental plans. This is a unique feature, as not all states that use HealthCare.gov offer this option. BeWellNM also offers year-round enrolment, providing flexibility for those seeking dental coverage.
It is important to note that some dental providers in New Mexico may not be accepting new Medicaid patients, so it is advisable to confirm their participation when contacting dental providers. Indian Health Service dental providers, for instance, are restricted to Native American recipients. Overall, New Mexico offers a range of options for dental coverage through Medicaid and Medicare, ensuring that individuals can access the dental care they need.
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Frequently asked questions
Medicaid is a health care program for low-income individuals of all ages.
Original Medicare, which includes Medicare Part A (hospital coverage) and Medicare Part B (physician/outpatient coverage), is the same in every state.
Medicaid in New Mexico is available to low-income adults under the age of 65. Coverage is also available to children and pregnant women with higher incomes.
You can apply online through the Centennial Care website, HealthCare.gov, or by calling 1-800-318-2596. You can also download a paper application or visit a NM Human Services Department field office for in-person assistance.
Yes, Medigap policies, also known as Medicare Supplement insurance plans, are available in New Mexico. These plans will pay for some or all of the out-of-pocket costs that Original Medicare does not cover.
