With most of the Affordable Care Act’s major provisions now in effect, the nation’s health insurance marketplace has undergone a significant transformation. Obamacare impacts individuals, families and small business owners alike. Most Americans are required to have minimum essential coverage unless they qualify for an exemption; however, the law is designed to make health insurance more accessible and affordable with income-based financial assistance and one-stop shopping via state-based and federally facilitated exchanges. Meanwhile, the private marketplace remains a place to shop for quality, affordable health insurance plans that meet ACA requirements.
The following guide offers a glimpse at the various types of ACA-compliant health insurance in New Mexico, including individual and family healthcare plans, small group health plans, coverage for high-risk applicants, mini-COBRA continuation coverage, Medicaid, and CHIP.
Health and healthcare in New Mexico
New Mexico placed 33rd in United Health Foundation’s 2014 America’s Health Rankings.1 Its strengths include low levels of air pollution, a low prevalence of binge drinking, and a low prevalence of obesity. The state’s challenges include a high rate of drug deaths, a low rate of high school graduation, and a high percentage of children in poverty. However, in the past year, high school graduation increased by 10 percent from 67.3 percent to 74 percent of incoming ninth graders.
New Mexico individual and family health insurance
New Mexico’s health insurance exchange began as a state-federal partnership on Oct. 1, 2013. The state offers plan management and provides consumer information and assistance through Be Well NM. Residents must then shop and apply for health insurance coverage using the federal Health Insurance Marketplace website. They may also find qualified health plans away from the Obamacare exchanges in the private marketplace on websites such as HealthCare.com.
The U.S. Department of Health and Human Services reported that 32,062 individuals in New Mexico selected a marketplace plan through the exchange from Oct. 1, 2013, through April 19, 2014.2 In 2015, the number of individuals in New Mexico enrolled in a marketplace plan increased to 52,358 during the open enrollment period.3
|New Mexico’s health insurance exchange:||healthcare.gov|
|New Mexico department of insurance:||osi.state.nm.us|
New Mexico small group health insurance plans
Small business owners who live in New Mexico and have 50 or fewer employees may offer them access to coverage through the Be Well NM health insurance exchange, as well as in the private marketplace. Small businesses that use SHOP and have 25 or fewer employees may qualify for a Small Business Healthcare Tax Credit.
Self-employed individuals with no employees must apply for an individual health insurance plan on or away from New Mexico’s partnership exchange.
New Mexico state COBRA variations for small groups
The Consolidated Omnibus Reconciliation Act (COBRA) allows those employed by businesses with 20 or more employees to continue their group health insurance plan for a limited time should they lose coverage due to qualifying events such as termination of employment due to reasons other than gross misconduct, a reduction in work hours, divorce or legal separation, and loss of dependency status. To learn more about the federal COBRA program, visit dol.gov/ebsa/cobra.html.
In some states, those who work for a small business and lose health insurance coverage due to a qualifying event may be eligible for health insurance continuation through mini-COBRA or a similar state continuation program. In a few states, these programs may also be extended to those who work for larger companies and exhaust their federal COBRA continuation coverage limit. Mini-COBRA generally works like the federal COBRA continuation coverage, but its terms may vary.
New Mexico’s small group COBRA continuation variations are as follows4:
|Eligible group sizes||All employer group plans|
|Maximum continuation period – standard||6 months|
|Maximum premium Increase||102 percent|
|State legislation reference||N.M. Stat. Ann. § 59A-18-16|
New Mexico high-risk pools
It used to be that health insurance companies could deny applicants or charge them more based on health history and preexisting conditions. When the Affordable Care Act was passed in 2010, many states created federally funded preexisting condition insurance programs or accepted federal funding to assist with similar high-risk pool programs they already operated.5
The Affordable Care Act prohibits this practice for health insurance plans considered minimum essential coverage with effective dates beginning Jan. 1, 2014, and later. As such, the PCIPs and state high-risk pools created to provide health insurance for those once considered uninsurable are being phased out.
New Mexico Medicaid
Medicaid is a state health insurance program for low-income individuals under age 65, pregnant women, children, disabled individuals, and seniors over age 65; it is partially funded by the federal government. In 2014, states were given the option to accept additional federal funding and expand their Medicaid program eligibility to those who make up to 133 percent of the federal poverty level (effectively 138 percent due to how it is calculated, according to HealthCare.gov).6
New Mexico is among the states that expanded Medicaid in 2014.7 Medicaid/CHIP open enrollment takes place year-round.
The information below is specific to Colorado’s Medicaid program:
|Governing agency||Centers for Medicare & Medicaid|
|Administrator||New Mexico Human Services Department|
|How to apply||yes.state.nm.us / healthcare.gov|
|Additional application options||hsd.state.nm.us/LookingForAssistance/apply-for-benefits.aspx|
|Open-enrollment period||Year-round in all states|
New Mexico CHIP
The Children’s Health Insurance Program is a partnership between the states and federal government. CHIP provides health insurance to uninsured children who meet certain eligibility guidelines.
The information below is specific to New Mexico’s health insurance program for low-income children:
|Where to apply||yes.state.nm.us|
|Eligibility||Based on family size and income|
1 United Health Foundation. 2014 America’s Health Rankings Annual Edition. “Annual State Health Rankings.” http://www.americashealthrankings.org
2 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2014/.
3 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2015/.
4 N.M. Stat. Ann. § 59A-18-16. Justia U.S. Law. http://law.justia.com/codes/new-mexico/2006/nmrc/jd_59a-18-16-14b59.html.
5 National Conference of State Legislators. Coverage of Uninsurable Pre-Existing Conditions: State and Federal High-Risk Pools. Updated April 2014. http://www.ncsl.org/research/health/high-risk-pools-for-health-coverage.aspx.
6 Centers for Medicare & Medicaid Services. “Medicaid Expansion & What It Means for You.” HealthCare.gov. N.D. https://www.healthcare.gov/what-if-my-state-is-not-expanding-medicaid/.
7 Centers for Medicare & Medicaid Services. “New Mexico.” http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-State/new-mexico.html.