New Mexico residents from Bernalillo to Black Rock have many Medicare options.
There are 39 Medicare Advantage plans available in New Mexico, with many being premium-free or low-cost. We’ve put together a list of the top eight plans so you can get a look at some of your choices.
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When it comes to healthcare, the best plan is the one that meets your needs. With so many options, it’s easy to become overwhelmed. For some, low monthly premiums are essential; for others, it’s having affordable access to lifesaving medication. Determine what you need most from your Medicare Advantage plan, and it will be much easier to find the right one.
1. AARP Medicare Advantage Choice
2. HumanaChoice
3. Humana Gold Plus
4. Humana Value Plus
5. Blue Cross Medicare Advantage Basic
6. Blue Cross Medicare Advantage Choice Plus
7. Blue Cross Medicare Advantage Select
8. Humana Gold Choice
So, what determines a Medicare plan’s ranking? The star ratings are determined by various factors, including the price of monthly premiums, benefits offered, customer service, and the service area. Below is a brief look at the top eight MA plans in New Mexico.
Monthly Premium: $0
Deductible: $195
Out-of-Pocket Maximum: $3,900
If you’re looking for a premium-free plan with a low deductible and low out-of-pocket limit, this is a must-see! The prescription drug plan offers excellent prices, and Tier 2 drugs in the gap coverage phase are a $14 co-pay. All others cost the usual 25 percent coinsurance.
Other services with a $0 co-pay include diagnostic testing, lab tests, X-rays, hearing exams, preventive dental, and vision. Comprehensive dental is available for an additional monthly premium of $38.
Monthly Premium: $0
Deductible: $445
Out-of-Pocket Maximum: $6,700
Like the first, this plan is also premium-free, but both the deductible and out-of-pocket max are higher. Hospital stays are pretty expensive, coming in at $445 per day for the first three days. For days four and beyond, there is no charge.
Seeing your primary care physician costs $20, and specialists are $50. Lab services, diagnostic tests, and radiology range between $0 and $50 per item. This plan does not have dental, but there are two supplement packages you can add on for $28.50 or $29.90 to receive dental coverage.
Monthly Premium: $0
Deductible: $0
Out-of-Pocket Maximum: $4,000
This plan comes out on top when you consider monthly and out-of- pocket costs. With no premium and no deductible, savings will add up quickly.
Tier 1 and 2 drugs are under $10, and inpatient hospital stays are relatively inexpensive compared to other plans. For days one to six, you pay $195 per day. Day seven through 90 is fully covered. Dental exams, cleanings, and X-rays, eye exams, and transportation to medical facilities are $0.
Monthly Premium: $28.20
Deductible: $435
Out-of-Pocket Maximum: $7,550
This plan is unique because it charges inpatient hospital stays on a per-visit basis, $1,665 for each stay. Seeing your primary doctor or a specialist is a 20 percent co-payment.
Preventive dental and comprehensive dental are covered on this plan with $0 co-pays, whether you use an in-network or out-of-network care provider. Vision care is also free.
Monthly Premium: $10
Deductible: $250
Out-of-Pocket Maximum: $5,100
This three-and-a-half-star plan has a low $10 monthly premium that gives you prescription drug coverage. Medications in the Tier 1 formulary cost $0 when you reach gap phase coverage, not the typical 25 percent coinsurance.
Seeing your primary care doctor is free, as are hearing exams and vision exams. Unfortunately, nothing beyond the exams, like hearing aids or glasses, is insured with this plan.
Monthly Premium: $40
Deductible: $350
Out-of-Pocket Maximum: $6,700
Like the previous Blue Cross plan, this one also has Tier 1 preferred generic drugs for $0 when you reach gap coverage phase. Doctor visits are $20, and specialists are $40.
Both group and individual mental health therapy are $30 per session. There’s an optional package, for $24 per month, which gives you coverage for hearing aids, dental, and eyewear.
Monthly Premium: $0
Deductible: $150
Out-of-Pocket Maximum: $4,500
Like the first plan, this one features no monthly premiums, plus a low deductible and out-of-pocket max. The prescription drug plan offers affordably priced medications, with a $0 co-pay for Tier 1 preferred generics.
Mental health group and individual therapy cost $25, and vision exams are $0. For hearing exams, hearing aids, and preventive and comprehensive dental coverage, you can purchase a supplemental package for $23.70 per month.
Monthly Premium: $59
Deductible: $300
Out-of-Pocket Maximum: $6,700
Humana ’s plan is a private fee-for-service ( PFFS ) plan that gives you coverage without network restrictions. Doctor visits cost $15, and specialists cost $50. Preventive dental care is free.
There are optional supplemental packages that you can add to your plan to get vision, comprehensive dental, and wellness coverage. However, the price of all three plans plus your monthly premium will exceed $100.
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The average cost for a Medicare Advantage health plan in New Mexico is just over $13 per month, though this range will vary from person to person. Each plan has different pricing structures. The ones from UnitedHealthCare and BlueCross BlueShield have different premiums. Comparing costs and benefits is the best way to determine which one is right for you.
Your overall cost of Medicare will depend on the plan you choose and its premium, deductible, and out-of- pocket costs. The health services you use will also play a part in how much you spend on your healthcare. Finally, receiving benefits like Extra Help will lower your costs if you are eligible for the program.
Medicare Advantage, like Original Medicare, is one way for American seniors to receive their health insurance benefits. A Medicare Advantage prescription drug plan ( MA-PD ) gives Medicare beneficiaries hospital insurance, health insurance, and a prescription drug plan ( PDP ) in one convenient plan from private insurance companies.
Each plan offers Medicare coverage from approved healthcare providers and provides the same quality of care and coverage as those who opt for Original Medicare. They are not Medicare Supplement or Medigap plans, but a stand-alone plan that gives you the coverage you need.
There are five main types of Medicare Advantage plans available in New Mexico. The majority of these are either HMO or PPO plans. Here’s a look at the main features of each type of plan.
Health Maintenance Organization ( HMO ):
You must choose a primary care physician.
You must get care from within the plan’s network, except in an emergency
You must be referred to a specialist.
Preferred Provider Organization ( PPO ):
You do not need a primary care physician.
You can go out-of-network at a higher cost.
You do not need to be referred to a specialist.
Private Fee-for-Service ( PFFS ):
These offer flexibility to use any provider who accepts the plan’s payment terms.
Not all providers will agree to the payment terms.
Special Needs Plan ( SNP ):
Each plan is for people with particular healthcare conditions, such as end-stage renal disease, or situations, such as living in a nursing home.
Plans are tailored to the unique needs of the specific condition.
Medical Savings Account (MSA):
You use a high-deductible Medicare Advantage plan.
You pay for medical care out of a special tax-advantaged savings account.
You can join a Medicare Advantage plan when you complete your Medicare enrollment. This is generally during the three months before or after your 65th birthday. Typically, you will need an ID card, like your driver's license, to verify your date of birth and eligibility.
To learn about other requirements or for help with enrollment, you can contact your local Social Security office, visit Medicare.gov, or call the Centers for Medicare & Medicaid Services at 1 (800) 633-4227. TTY users can call 1 (877) 486-2048.
You can enroll in Medicare Advantage during the Open Enrollment Period, which runs from October 15 through December 7 each year.
No, you don’t. You can opt to use Original Medicare, which consists of Medicare Part A, Medicare Part B, and Medicare Part D prescription drug coverage. Medicare Advantage, also known as Medicare Part C, is an alternative to Original Medicare, which some people prefer because of the various coverage options.
Life is too busy to play phone tag with an insurance agent to sit down and talk about health insurance plans. Take control of the situation by doing your search online.
As you look for the right Medicare plan for you, remember to not go by price alone. Saving money is fine when you’re deciding on which apples to use in a pie, but not when it comes to your health.
Here are some questions to ask as you browse health insurance plans:
Can I keep my current doctor and hospital?
Is there adequate coverage for my current health conditions?
Are my medications covered in the formulary?
Do I want a plan with no deductible?
Does the monthly premium fit in my budget?
For most people, the plan that answers those questions positively will be a good option.
Don’t put this off; use the Insurify Medicare comparison tool to uncover Medicare Advantage plan options in your area at no cost to you. Try it today!
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