healthreform

The New Mexico Health Insurance Exchange website, bewellNM.com, counts down to Oct. 1, when enrollment begins. State officials expect about 83,000 New Mexicans to buy insurance through the exchange.

The New Mexico Health Insurance Exchange provides a way for you to compare five private insurance companies’ health plans and buy health insurance. It is part of the federal health care reform, which requires most people to have insurance. If you shop on the exchange, you may qualify for a tax credit based on your income.

How you qualify

• You don’t have insurance offered by your employer or you can’t afford it.

• You are uninsured.

• You pay for private insurance and your policy is ending or you would like to find a better deal.

Cost

• It is free to use the exchange to sign up for insurance.

• There is no upper income limit to be able to buy insurance through the exchange. People who earn less than 138 percent of poverty level can apply for Medicaid.

• Five insurance companies will offer four levels of plans on the exchange. From lowest to highest price, the levels are categorized as bronze, silver, gold and platinum.

• The average premium for the lowest-cost silver plan in New Mexico is $275 without tax credits.

• The average premium for the lowest-cost bronze plan in New Mexico is $217 without tax credits.

• Premium rates are based on your age, location and whether you are a smoker or nonsmoker.

• Depending on your income, the most you will pay for insurance on the exchange is between 3 percent and 9.5 percent of your income, unless you opt for the most expensive gold and platinum plans.

Dates

• You can buy insurance on the exchange starting Oct. 1.

• Buy health insurance by Dec. 1 to be covered by Jan. 1, 2014.

• Sign up before March 31, 2014 (after that date you can only buy insurance on the exchange if you have a major life event such as a birth, marriage, adoption or change in legal status).

• Starting in 2015, the insurance enrollment period will be from Oct. 15 to Dec. 7.

Who is on the New Mexico Health Insurance Exchange

• Blue Cross Blue Shield — both individual and business

• Lovelace Health Systems — both individual and business

• Molina Health Care — individual

• New Mexico Health Connections — both individual and business

• Presbyterian Health Plan — both individual and business

How insurance will be different when coverage starts Jan. 1

• Insurance companies cannot deny you for having a pre-existing condition or charge you higher premiums based on your health condition.



• Insurance companies cannot drop coverage when you get sick.

• Costs for men and women must be the same.

• All plans must cover essential health benefits: outpatient care, emergency care, hospitalization, prescription drugs, maternity and newborn care, mental health and substance abuse treatment, laboratory services, chronic disease management, preventive and wellness services, and pediatric services that include dental and vision care.

• You don’t have to pay anything for preventive care (62 services including screenings, well women visits, contraception and vaccinations).

• No lifetime dollar caps on coverage or annual dollar limits on services.

• If you earn between 138 percent and 400 percent of the federal poverty level, you can get tax credits for buying insurance. Below 138 percent, you can qualify for Medicaid.

Special populations

American Indians

• You are not required to have health insurance, but it could provide you greater coverage and more services than Indian Health Services, which is a system, not insurance.

• If you earn less than 300 percent of the federal poverty level, you do not have to pay copays or deductibles for health insurance.

• You have the opportunity to buy insurance any month on the health insurance exchange, as opposed to only during open enrollment periods.

Immigrants

• If you are an immigrant who lives here legally, you can qualify for Medicaid if you earn less than 138 percent of the federal poverty level, or you can buy insurance on the health insurance exchange and get tax subsidies if you earn less than 400 percent of the poverty level.

Older adults

• The Affordable Care Act limits how much insurers can charge older adults. Insurers can only charge older adults a maximum of three times the premium rate for younger adults.

People younger than 65 who earn less than 138 percent of poverty level

• You may be eligible to receive Medicaid insurance through the expansion of the joint federal and state-funded program. You don’t have to have children to qualify.

Resources

www.bewellnm.com — New Mexico Health Insurance Exchange

www.SeguroQueSiNM.com — Spanish New Mexico Health Insurance Exchange

healthcare.gov — federal information on the health insurance exchange

Sources

• The U.S. Department of Health and Human Services

• New Mexico Health Insurance Exchange

• New Mexico Human Services Department

• Native American Parent Professional Resources Inc.

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