New Mexico Health Insurance Alliance
New Mexico Health Insurance Alliance, State-Sponsored Program
The NMHIA looks to provide affordable health insurance to working and unemployed individuals and families that have no other options. It is not a high-risk pool, but the NHMIA does not require medical screenings. In most circumstances, your entire family can get coverage.
The eligibility requirements are fairly straight-forward:
- You must be a legal resident of New Mexico
- You must have been covered under a group, government, or church health plan for the previous 18 months
- You must not have any other insurance options available to you (COBRA, Medicaid, etc.)
- Less than 63 days must have elapsed since you became eligible
How It Works
There are two types of plan: HMO and PPO. HMOs require participants to stay within a network of physicians, and you will pay a copay each time your receive service. With PPOs, you have more choice of provider but there is a deductible that you must meet before your provider will start paying for care. These deductibles are higher for physicians outside of the provider network.
Any health insurance provider that covers State employees is required to offer a plan option. That means that you can get a plan from some of New Mexico’s largest health insurers:
- Lovelace
- Mutual of Omaha
- CIGNA
- Blue Cross Blue Shield of NM
- Guardian
- United Health Care
- Principal Financial Group
- Presbyterian
To enroll, simply contact any insurance agent that is Alliance Certified. These agents are required to provide service at no cost. To find an agent in your area, click here.
Benefits
The details of yoru coverage vary depending upon whether you select the HMO or PPO option. In general, you can expect:
- Physician visits
- Inpatient and outpatient hostpital visits
- Preventative care
- Emergency services
- Maternity
- Mental health
- Prescription drugs
For complete details on the different plan options, click here.
Cost
Your premiums are set at the average rate paid by an individual in your age group who is covered by small-group health insurance. This cost varies from month to month. However, keep in mind that group insurance is typically cheaper than individual plans. This means that NMHIA will likely be a cost-effective option if you qualify.
For PPOs, deductibles range from $1,000 to $10,000 for individuals. For families, you can triple that. At the higher end of that range, your provider covers 100% of expenses once your deductible is met. At the lower range, they cover 50%.
For HMOs, copays range from $35-50 per visit. The maximum amount that you can pay (for copays, not including your monthly premiums) in a year is $3,500 for an individual and $7,000 for a family.
For a more detailed description of fees and costs, click select a plan here.
An Insider’s Tip
This can all get extremely confusing. To help you sort through it, we recommend that you contact an Alliance Certified agent. These people are required to help you for free and are experts on the ins-and-outs of selecting an HMO vs. a PPO and deciding which plan option is best for you. If you already have an agent that is certified, just ask them! If not, click here to find one in your area.
