Original Medicare (Parts A and B) does not include prescription drug coverage in New Mexico (or the rest of the United States). For that, you need Medicare Part D. On this page, we explain your Medicare Part D options in New Mexico as well as when you can sign up and why you should.

How do you get Medicare Part D in New Mexico?

As in the rest of the country, you have two options to get Medicare Part D in New Mexico:

  • A standalone Medicare Part D prescription drug plan (PDP)
  • A Medicare Advantage Prescription Drug plan (MA-PD)

These policies are sold by private insurance companies who contract with Medicare to provide these benefits.

Medicare Advantage plans must provide the same benefits you get with Original Medicare. However, most – over 90% – offer additional coverage as well. MA-PD plans are sometimes called all-in-one plans, because they offer the same benefits as Original Medicare plus a Part D plan.

Please note that not all all MA plans include prescription benefits. In this case, you may add a standalone PDP to your Advantage plan.

When can you get Medicare Part D in New Mexico?

You qualify for Medicare Part D in New Mexico as soon as you're enrolled in Medicare Part A and/or Part B. To join a specific plan, you must also live in that plan's service area.

Most people become eligible for Medicare when they turn 65. If you begin receiving Social Security benefits at least 4 months before your 65th birthday, Medicare Parts A and B enrollment is automatic. Everyone else needs to sign up for Medicare. Your Initial Enrollment Period (IEP) begins 3 months before your birthday and lasts for 7 months. So, if you turn 65 in May, your IEP opens on February 1 and closes on August 31.

If you qualify for Medicare due to a disability, you're automatically enrolled in Parts A and B on your 25th month. Your Initial Enrollment Period begins 3 months before that, starting on your 22nd month and ending after your 28th month. So, if month 25 of disability benefits occurs in June, your IEP begins on March 1 and ends on September 30.

Medicare Part D enrollment is never automatic – you must always choose a prescription drug plan.

Additional Medicare Part D enrollment periods

In addition to your IEP, Medicare provides numerous enrollment periods throughout the year. They are:

  • General Enrollment Period (January 1 through March 31): Available to anyone who failed to sign up for Medicare during their IEP and does not qualify for a Special Enrollment Period (SEP). During General Enrollment, you may sign up for Part A and/or Part B. After that, you may join an MA-PD or Part D prescription drug plan from April 1 through June 30.
  • Annual Enrollment Period (October 15 through December 7): Current Medicare enrollees may change their Part D coverage at any time during Annual Enrollment.
  • Medicare Advantage Open Enrollment Period (January 1 through March 31): If you have a Medicare Advantage plan, you can use this period to either join a new MA plan or return to Original Medicare. You may only sign up for Medicare Part D if making one of those changes results in you losing your prescription drug coverage.
  • Special Enrollment Periods: There are dozens of special circumstances that may qualify you for a Special Enrollment Period. You can find the full list – plus guidelines for the particular SEP – on Medicare.gov here.

How to compare your Medicare Part D options

Coverage and costs vary according to which Part D option you choose, so compare plans carefully.

Start by looking at the plan's drug formulary, which is simply the list of covered prescription medications. If it doesn't include any of your medications, look for a Part D plan that does.

Next comes costs. You need to look beyond the monthly premium to understand the full cost of any Medicare plan. Your out-of-pocket costs under Medicare Part D include:

  • Annual deductible
  • Monthly premium
  • Copayments or coinsurance

You can gauge your copayment costs by looking at the drug tiers at the same time you review the formulary. All Part D plans place covered medications on tiers. The higher the tier, the more that drug will cost you.

Do you have limited resources or income? Extra Help is a program that helps beneficiaries pay for a variety of Part D costs. There are different levels of Extra Help available in New Mexico. Click here to see if you qualify.

Do you have to have prescription drug coverage in New Mexico?

Although nobody can force you to sign up for Medicare Part D, you do face significant late fees if you delay enrollment without having creditable coverage elsewhere. You pay this penalty for the entire time you're enrolled in Medicare Part D.

To be considered "creditable," your plan must offer the same level of benefits you get with Part D and at a comparable price.

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