A Medicare Advantage (MA) plan is a good option if you're looking for more robust coverage in a single plan. Increased benefits are one reason millions of Medicare beneficiaries have made the switch, with over half now enrolled in an Advantage plan. This page explains Medicare Advantage plans in New Mexico, describing how the program works and how to compare your options.
What is Medicare Advantage?
Also known as Medicare Part C, Medicare Advantage plans must provide same benefits as Original Medicare. This includes Medicare Part A, hospital insurance, and Medicare Part B, medical insurance. Prescription drug coverage is not included with Original Medicare. For that, you need Medicare Part D.
Advantage plans are not limited to the coverage provided by Original Medicare. In fact, around 90% offer additional benefits, such as prescription drug coverage and routine vision and dental care.
You are still responsible for paying the Medicare Part B premium, even if you join an Advantage plan.
New Mexico Medicare Advantage plans with prescription drug coverage
Medicare Advantage Prescription Drug plans (MA-PD) combine your Parts A, B, and D benefits into a single policy. Most MA plans include prescription drug coverage. If yours does not, you can get it with a standalone Medicare Part D plan.
Who is eligible for Medicare Advantage in New Mexico?
If you have Medicare Parts A and B, you are eligible for Medicare Advantage in New Mexico.
You become eligible for Medicare once you turn 65. Or, you may also qualify if you collect Railroad Retirement Board (RRB) or Social Security disability benefits for 24 months.
When can you sign up for a Medicare Advantage plan in New Mexico?
Medicare Advantage sign-up periods are:
- Initial Enrollment Period (IEP): Begins 3 months before your Medicare eligibility month and lasts for 7 full months. So, if your birthday or 25th month of disability is in June, your IEP lasts from March 1 through September 30.
- General Enrollment Period: From January 1 through March 31, anyone who did not sign up for Medicare Part A and/or Part B can do so. Then, from April 1 through June 30, you may join an Advantage plan.
- Medicare Annual Enrollment Period (AEP): From October 15 through December 7, current Medicare beneficiaries may make any desired change to their Medicare coverage, including joining a Part C plan.
- Medicare Advantage Open Enrollment Period (OEP): If you already have Medicare Advantage, you may participate in OEP from January 1 through March 31. Options are limited to switching to a new MA plan or returning to Original Medicare. If making that change causes you to lose your prescription drug coverage, you may also join a standalone Part D plan.
- Special Enrollment Periods (SEP): A variety of special circumstances may qualify you for an SEP. The full list is on Medicare.gov.
Types of Medicare Advantage plans in New Mexico
There are four main types of Medicare Advantage plans in New Mexico.
- Health maintenance organizations: HMO plans use a provider network and require members to choose a primary care doctor who provides specialist referrals.
- Preferred provider organizations: PPO plans also use a provider network, but they allow members to receive out-of-network services for a higher copay. You don't need a primary doctor or referrals to see a specialist with a PPO plan.
- Private fee-for-service: PFFS plans set price limits for covered services. Some PFFS plans have a provider network that accepts the plan's terms. Your copay is higher for out-of-network services.
- Special needs plans: SNPs limit membership to people who have certain chronic illnesses, qualify for both Medicare or Medicaid, or who live in a nursing home or require at-home care.
How to choose a Medicare Advantage plan in New Mexico
When comparing Medicare Advantage plans in New Mexico, look at the following metrics:
- Coverage (including the drug formulary if it's an MA-PD plan)
Our Find a Plan tool makes it easy to compare Medicare Advantage plans in New Mexico. Just enter your location information and estimated coverage start date to review Medicare plans in your area.
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