Medicare in New Mexico
Key Takeaways
- Medicare in New Mexico is a federal program available to all legal U.S. residents aged 65 and older.
- Original Medicare’sOriginal Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). Parts A and B cover hospital and medical services. Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). in New Mexico is an alternative that often bundles Part DMedicare Part D is prescription drug coverage for people enrolled in Medicare. Part D is optional and is offered by private insurance companies. and other services.
- The pricing for Medicare plans in New Mexico is based on standard costs and personal details like your work history and income.
Red or green chile — it’s the fundamental question New Mexicans may answer several times a day. And let’s face it, it doesn’t matter what you decide, as long as it’s not “Christmas-style” or “mild.”
But there’s another critical decision to make if you’re close to 65 or older: how to receive your Medicare in New Mexico. Ask yourself some important questions: What are the different kinds of Medicare? How much does Medicare cost? Does Medicare Advantage in New Mexico make sense for me?
How Do I Apply for Medicare in New Mexico?
There are several ways you can enroll in Medicare in New Mexico, including:
- Online through the Social Security Administration
- In person at a local Social Security office.
- Over the phone at 1-800-772-1213 (TTY: 1-800-325-0778)
With Medicare, timing can be everything, so you’ll want to know more about your IEP and Medicare’s other enrollment periods.
Find the Medicare Plan that works for you.
What Is the Income Limit for Medicaid in New Mexico?
It’s important to know that Medicaid is not the same as Medicare in New Mexico. Medicaid is a state and federal program designed to help low-income adults, children and seniors. In New Mexico, this also applies to Native Americans living in tribal and non-tribal areas. There are several programs, and eligibility depends on your income and household size.
What Are the Standard Medicare Costs for 2025?
Medicare Part A
Premium:
- $0 if you or your spouse worked 10 or more years
- $285 a month if you worked between 7.5 and 10 years
- $518 a month if you worked fewer than 7.5 years
Deductible:
- $1,676 each plan period
Copayments & coinsurance:
- Hospital stays: $0 copay for Days 1-60 following deductible payment; daily charges for Days 61 and after
- Skilled nursing facility: $0 for Days 1-20 (each plan period); daily charges for Days 21 and after
Medicare Part B
Premium:
- $185 monthly and up
- Income-based
Deductible:
- $257
Copayments & coinsurance:
- None for most preventative services.
- 20% of the Medicare-approved costs for other services.
- 35% for outpatient health services.
Medicare Part D
Premium:
- Income-based; varies by plan
Deductible:
- Plan-based; not to exceed $590 in 2025
Copayments & coinsurance:
- Depends on plan specifics and drugs needed
Can I bundle multiple benefits into one plan?
What Is the Best Medicare Plan?
The answer to this question is completely based on you and your needs. Choosing between Medicare plans in New Mexico should start with understanding your options.
There are two main ways to receive Medicare in New Mexico: Original Medicare (Parts A and B) and Medicare Advantage (Part C). Here’s how they work:
Original Medicare (Parts A and B)
Original Medicare is made up of Parts A and B. They work separately and provide a base level of care.
- Part A: Helps cover stays at hospitals, nursing homes, skilled nursing facilities, hospice care, and some home health care.
- Part B: This portion helps cover medically necessary and preventive services from doctors and other providers
Medicare Advantage (Part C)
Medicare Advantage (Part C) substitutes for Original Medicare (Part A & B) and offers the same benefits. Part C plans usually bundle additional services like dental, hearing, vision, and prescription drug coverage.
New Mexicans on Original Medicare may also choose to enroll in a Medicare Prescription Drug Plan (Part D) and Medicare Supplement Insurance (Medigap).
Medicare Prescription Drug Plan (Part D)
Part D provides prescription drug coverage as a standalone plan purchased separately from Original Medicare. Medicare Advantage plans typically include Part D coverage.
Medicare Supplement Insurance (Medigap)
Medigap policies are sold separately by private insurance plans and help cover “gaps” in Original Medicare. These gaps refer to the range of high out-of-pocket costs that can come with Parts A and B, such as deductibles, coinsurance and copays. Like Part D, Original Medicare enrollees pay their Medigap premiums separately from Original Medicare.
What Are the Disadvantages of Medicare Advantage Plans?
The answer really depends on what you need out of your plan. It doesn’t matter whether you have Medicare Advantage or Original Medicare in New Mexico; what may be an advantage for someone in Las Cruces could be a downside for folks in Farmington. To help, here are some resources to figure out how the Medicare plans in New Mexico stack up for you:
- Enrollment Checklist: Assess your budget, coverage needs and enrollment timing
- Medicare Star Rating System: See what other enrollees think of their plans
- Pros and Cons: What to know about Original Medicare vs. Medicare Advantage in New Mexico
- Pro Tips: Little-known pointers you’ll want to know
- Contact GoHealth: Our licensed insurance agents are available to shop plans and explain the differences you need to know.
What Are the Top Medicare Advantage Plans?
There are several Medicare Advantage options to choose from in New Mexico. They may include the following plan types:
- A Health Maintenance Organization (HMO) uses primary care physicians and provider networks to manage your care.
- Preferred Provider Organizations (PPO) use primary care physicians but offer some out-of-network coverage
- Private Fee-For-Service (PFFS) plans pay your providers each time you receive a service.
- Special Needs Plans (SNP) help enrollees living with specific health conditions. D-SNP assists dual eligible individuals, and C-SNP is for people with chronic diseases.
Your Ideal Medicare Plan is out there.
Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 404,382 people are enrolled in Medicare Part A and B in New Mexico. The total number of beneficiaries enrolled in Medicare Advantage increased from 162,355 to 179,136 year over year. Medicare Advantage participation in New Mexico went from 41.33% to 44.30% year over year. If you’d like to dive deeper into how Medicare in New Mexico breaks down across the state, we provide a glance at who is using Medicare and how.
404,382 Beneficiaries with Part A & Part B
179,136 Medicare Advantage Beneficiaries
44.30% Medicare Advantage Participation Rate
52.58% Female
47.42% Male
61.70% Non-Hispanic White
1.54% African American
26.95% Hispanic
9.81% Other/Unknown
20.59% Eligible for Medicaid
0.89 Average HCC Score
$8,317.44 Actual Per Capita Costs
16.08% Hospital Readmission Rate
24.55% % of Beneficiaries with an Emergency Department Visit
162,355 Medicare Advantage Beneficiaries, Previous Year
Increased Medicare Advantage, Year over year
41.33% Medicare Advantage Participation Rate, Previous Year
Table reflects the latest Beneficiary Demographics Data: Medicare Geographic Variation – by National, State & County
Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.
New Mexico Aging & Long-Term Services Department
https://aging.nm.gov/
What should I know about the New Mexico Aging & Long-Term Services Department?
Connect with the Aging & Disability Resource Center for info on saving on your Part D.
Centennial Care (Medicaid)
https://www.hsd.state.nm.us/lookingforassistance/centennial-care-overview/
What should I know about Centennial Care?
Low-income New Mexicans and Native Americans may qualify for health, community and long-term benefits.
New Mexico Human Services Department
https://www.hsd.state.nm.us/
What should I know about the New Mexico Department of Health and Human Services?
Report fraud and stay current on local New Mexico health conditions.
New Mexico Department of Veterans Services
https://www.nmdvs.org/
What should I know about the New Mexico Department of Veterans Services?
The NMDVS can help you with housing, healthcare, and legal resources.
Nationwide Resources
Speak with a GoHealth insurance agent that is licensed in New Mexico about your Medicare questions.
Mon – Fri, 8 a.m. – 6 p.m. CT
Centers for Medicare and Medicaid Services
You can reach the Social Security Administration by phone for general questions. Not all questions can be answered over the phone.
Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online
1-800-722-1213
TTY 1-800-325-0778
Speak to SSA Representative, Monday – Friday, 8 AM – 7 PM ET
Medicare Learning Guides
Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement
Medicare Plans Guide
Costs, coverage and enrollment details for each Medicare plan
Medicare Beneficiary Guide
For those currently enrolled in Medicare
Low Income and Medicare Guide
For individuals with a qualifying income status
A Caregiver's Guide
For individuals with a qualifying income status
Sources
- Apply for Benefits. SSA.gov.
- Social Security Office Locator. SSA.gov.
- Income Eligibility (Federal Poverty Level Guidelines). HSD.state.NM.us
- Special Needs Plans (SNP). Medicare.gov.
This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.
Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.