Health Action New Mexico

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I Need Coverage

Do you have questions about health coverage? This section gives you the information and tools that you need to find health coverage and learn how to use it once you have it.

1. Getting Covered

• Step 1: Find enrollment assistance

Finding health coverage that works for you and your family can be challenging.  Fortunately, New Mexicans across the state are trained to provide free enrollment assistance to consumers.  They can help you determine if you qualify for no-cost or low-cost health coverage and provide guidance on the options that are available.

Fill out my online form.

• Step 2: Choose your health coverage

If you are uninsured, there are two new ways you can get covered: the Medicaid Expansion and the New Mexico Health Insurance Exchange (NMHIX).  

Medicaid is a public health coverage program that provides cost-free coverage for low income Americans.  Individuals making less than $16,105 a year and families of four making less than $32,913 a year are eligible for Medicaid.  Medicaid is available throughout the year, unlike plans acquired on the exchange, which can only be purchased during the open enrollment period.  If you are 1) between the ages 19-64 and 2) are a U.S. citizen or lawfully present immigrant, and 3) meet household income requirements, you may be eligible for free health coverage. You can check with your Enrollment Counselor to see if you're eligible for Medicaid. In the meantime, use this calculator to see if you may be eligible.  You will need to provide your zip code, annual income, and the number of people in your family.

If you think you qualify for Medicaid but are denied by the state, don't give up!  You don't have to go through this alone. There are organizations in New Mexico that can help you through the process. These organizations can provide free help:

Law Access New Mexico – Bernallio: 505-998-4529 Statewide: 1-800-340-9771

Legal Aid New Mexico – Bernallio: 505-243-7871 (Click here to see phone numbers and office locations throughout the state).

NMHIX is a marketplace where you can comparison shop for private health coverage.  Financial help is available on NMHIX to make health coverage more affordable.  Talk to your Enrollment Counselor to see if you qualify for these benefits. In the meantime, use this calculator to get estimates on what type of discounts may be available for you.  You will need to provide your zip code, annual income, and the number of people in your family.

The major choice you need to consider when purchasing private coverage is the tradeoff between the cost of your monthly premium and the cost of your out-of-pocket expenses. The premium is what you pay each month to keep your health coverage active, with a setup similar to how many people pay their car insurance each month. Out-of-pocket expenses are what you pay when you visit the doctor. Plans with low premiums generally have higher out-of-pocket expenses and vice versa.  During the first few years of enrollment, consumers reported dissatisfaction with plans that had high out-of-pocket costs because many expenses weren't covered when they needed it.

There are four broad types of plans you can choose from: Bronze, Silver, Gold, and Platinum.  Each type of plan covers a certain percentage of your overall expenses.  Bronze plans cover about 60% of your expenses; Silver plans cover about 70% of your expenses; Gold plans cover about 80% of your expenses; and Platinum plans cover about 90% of your expenses.  However, Silver plans are equipped with cost-sharing subsidies that reduce out-of-pocket costs greatly.  If your household income is below 250% of the Federal Poverty Level (about $29,175 for an individual or $59,265 for a family of four), a Silver plan can cover up to 94% of your expenses.

Click here to learn more about the balance between premiums and out-of-pocket costs.

2. Using your coverage

• Step 3: Find a doctor in your network


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