En español | Most New Mexico residents can buy health insurance through the New Mexico Health Insurance Exchange (or beWellnm), the state’s Affordable Care Act (ACA) marketplace, during open enrollment from Nov. 1, 2022 through Jan. 15, 2023. New Mexico shifted from a Healthcare.gov marketplace plan to a state-specific marketplace in 2022.
If you experience a qualifying life event — such as the birth of a child, a move, a marriage, a divorce or the loss of your employer-provided health insurance — you may be able to enroll or change your coverage outside of open enrollment.
Most people already enrolled in ACA marketplace plans have seen their premiums go down because the 2021 American Rescue Plan Act (ARPA) increased tax credits for insurance premiums and expanded the number of households who qualify for them. Every household that pays more than 8.5 percent of their household income now qualifies for federal tax credits to help them afford health insurance. These enhanced subsidies are now available until 2025.
Prior to the 2021 law, such tax credits were only available to people earning less than a certain salary ($54,360 for one person). Most Americans with a marketplace plan can save an average of about $800 per year, according to the federal government.
Who is eligible?
- Most New Mexico residents can buy health insurance through beWellnm, regardless of whether they are currently insured. Some non-U.S. citizens may also be eligible for coverage, and the state offers specific resources for Native American individuals and families seeking coverage.
- Low-income individuals and families may also qualify for free or low-cost health insurance through Medicaid. To enroll or to see if you’re eligible, create an account with YesNM, which also handles assistance programs like SNAP and TANF.
- The Children’s Health Insurance Program offers health insurance for children and teens in families with incomes too high to qualify for Medicaid but who still may struggle to find affordable coverage. To enroll or to see if you’re eligible, create an account with YesNM.
When can I enroll?
- BeWellnm’s open enrollment began on Nov. 1, 2022, and runs through Jan. 15, 2023.
- You can enroll outside of open enrollment if you experience a qualifying life event but you have only 60 days from that event to enroll. Qualifying events include births and adoptions, loss of employer-provided coverage, marriage, divorce, moving and other special circumstances.
- You can enroll anytime if you qualify for Medicaid or if your children qualify for CHIP.
- You also can enroll anytime if you don’t qualify for Medicaid or CHIP, but your household income is below 200 percent of the federal poverty level. For example, a three-person family who earned less than $3,839 per month would qualify to enroll at any point.
How do I sign up?
First, use beWellnm’s plan comparison tool to estimate costs and see what sorts of plans you may qualify for — or enter personal information like your name, phone number and zip code and set up a time to speak with a certified enrollment assister or insurance broker. Or call beWellnm’s customer engagement center at 833-862-3935 toll-free.
Once you’re approved for a plan, you’ll need to pay your first monthly premium for your coverage to begin. Your first payment is due by the 23rd of the month before your coverage kicks in, so by Dec. 23 for coverage that begins Jan. 1.
To apply and enroll:
- Online: Go to beWellnm’s website and click Sign Up Now!
- If you’re a new customer, you’ll need to create an account and provide personal information like your name, date of birth and email address.
- If you already have coverage through Healthcare.gov and are enrolling for coverage in 2022, you should have received a letter or email from beWellnm with a link to set up a beWellnm account. If you haven’t received a letter or email, call the customer engagement center at 833-862-3935 toll-free for assistance.
- By phone: Call the customer engagement center at 833-862-3935.
- Through an assister or broker: Both offer free help with creating an account and selecting a plan, but only brokers can recommend specific plans and help you apply for other types of coverage and insurance. BeWellnm’s website lets you search for assisters and brokers by zip code. You may be able to meet with an expert in person or virtually.
What is covered, and how much will it cost?
Coverage and cost depend on where you live, the type of plan you choose, your estimated household income, and the age and disability status of you and your family.
If you qualify for Medicaid, you will be able to get free or low-cost coverage and may not need to worry about premiums or copays, depending on your level of income.
All beWellnm plans cover 10 “essential” benefits, including:
- Emergency services and hospitalization
- Maternity and newborn care
- Mental health services (including counseling)
- Chronic disease management and preventative care
- Prescription drugs
Insurance companies cannot deny coverage because of preexisting conditions. When you apply, you can identify your medical needs and choose a plan that makes financial sense for you and your family.
Most beWellnm plans cover basic dental services for children, including cleanings and exams. But adults who want dental coverage, or parents who want more substantial coverage for their kids, must add it to their policy.
Deductibles and out-of-pocket costs vary between plans.
What about federal assistance for premiums?
Every eligible household that pays insurance premiums that exceed 8.5 percent of annual income qualifies for federal tax credits for insurance premiums through 2025.
According to Megan O’Reilly, AARP vice president of government affairs for health and family, subsidy recipients ages 50 to 64 have already seen average annual savings of over $950.
Is there any other financial assistance available?
Yes. If you qualify for a premium tax credit, you may also qualify for a cost-sharing reduction that would help you pay for such out-of-pocket expenses as deductibles and copays. You must enroll in a Silver-level plan to get this assistance.
What plans are available?
BeWellnm plans are organized into four categories:
- Bronze plans have the lowest monthly premiums and the highest deductibles and copays, and cover roughly 60 percent of care costs. They’re designed to help you in case of serious illness or injury.
- Silver plans have moderate monthly premiums, deductibles and copays. They cover roughly 70 percent of costs. They’re the only plans eligible for cost-sharing subsidies.
- Gold plans have higher monthly premiums and lower deductibles and copays, and cover roughly 80 percent of care costs.
- Platinum plans have the highest monthly premiums and the lowest deductibles and copays, and cover roughly 90 percent of care costs. These are for people who have significant health care needs and are willing to pay the highest premiums.
The beWellnm plan comparison tool helps you estimate costs and benefits of various plans and check whether you might qualify for financial assistance. New Mexico residents younger than 30 can also apply for a catastrophic plan offering low premiums but with high deductibles.
What if I already have health insurance?
If you already have coverage through your employer or directly through an insurance provider but are eligible for lower premiums, you can switch to beWellnm. But you may not qualify for tax credits if you opt out of your employer’s plan — unless those premiums exceed a certain portion of your household income. The premiums would need to be more than 9.12 percent of your household income for individual coverage to qualify for the tax credits.
If you lose coverage through the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), you may be able to sign up for a beWellnm plan during a 60-day special enrollment window. Try to apply and select your plan before your COBRA coverage ends to make sure there's no gap in coverage. If you’re not sure about whether making this switch makes sense for you, you can ask for free advice from a certified insurance broker or assister.
Will I need to get a new doctor?
That depends. Major insurance providers, including Blue Cross Blue Shield of New Mexico, True Health and Molina, offer beWellnm plans, but not all doctors accept them. You can talk to your primary care physician to see whether he or she accepts a particular marketplace plan.
Will my family members qualify for the same health plan that I do?
It depends. You can enroll as a family. But in some cases, some family members may also be eligible for subsidies or other programs such as Medicare, Medicaid or CHIP, depending on age, income and disability or caregiver status. Such families may choose to enroll separately. They may still be able to see the same doctor or go to the same medical practice, depending on the types of insurance plans accepted.
This guide was updated on Nov. 3 with information about open enrollment.