New Mexico Health Insurance

Last Updated on September 22, 2020 by Andrew Lee

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The health care sector of New Mexico has a lot to improve upon, particularly health ratings and access to insurance. It did see some updates that helped bring down its shockingly high uninsured rating. This guide covers some of the most crucial changes to health insurance in the state, details you should be aware of to help you make a wise decision when hunting for coverage.

Area of improvement: Health ratings

If New Mexico tried harder when it comes to overall health, 188,356 more of its residents can become insured, as the 2015 Commonwealth Fund’s Scorecard on State Health System Performance advised. In the study, it ranked 33rd of 51, after performing poorly in areas such as Access as well as Prevention & Treatment, where it received a scorecard quintile of 4. Below are some of the findings regarding the state’s health and lifestyle performance:

  • Mortality amenable to healthcare: 79 out of 100,000 people
  • Breast cancer fatalities: 17.3 out of 100,000 women
  • Colorectal cancer fatalities: 14.5 out of 100,000 people
  • Percentage of adult smokers: 18%
  • Adult obesity: 30%
  • Obesity in children aged 10-17: 33%

In terms of health insurance access, the study provided the following statistical comparisons:

  • 21% of adults (19 to 64 years old) don’t have insurance, compared with the national average of 15%
  • 8% of children (infants to 18 years old) are uninsured, as opposed to the countrywide average of 6%
  • 17% of the adult population chose not to obtain insurance due to the high costs associated with it
  • 16% of adults had expensive out-of-pocket medical bills

State-exchange metal tiers and reimbursements they provide

Those who enrolled in the state-exchange during the 2017 open enrolment noticed one less option in the tiers available. The remaining ones are all metal tiers. Each plan provides a set percentage of insurer-covered medical and hospital costs as follows:

Bronze – 60%

Silver – 70%

Gold – 80%

Platinum – 90%

Again, the cost of coverage depends on many different variables, and not just the ones discussed above. However, you can use these premium average projections that the United States Department of Health & Human Services charted in a report to gauge what your premiums will look like this year:

  • Average lowest-cost, monthly premium within metal level: $344
  • Average net premium for lowest cost plan within metal tier: $135
  • Second-lowest silver before advance premium tax credit (for a 27-year old with a $25,000 household income): $224
  • Second-lowest silver after advance premium tax credit (for a 27-year old with a $25,000 household income): $142
  • Second-lowest silver before advance premium tax credit (for a family of four with a $60,000 household income): $813
  • Second-lowest silver after advance premium tax credit (for a 27-year old with a $25,000 household income): $405

Effect of the downward trend in its uninsured rating

Rates are based on a myriad of factors, and not just on you, as a person. Insurers look closely not just at where you live, but also the percentage of its population without insurance. In general, they associate a low uninsured rating to being low-risk. Put simply, the greater the number of insured individuals in a given area, the better the premiums.

This is one of the good things that happened to The Land of Enchantment. Within five years, its 19.6% uninsured rating in 2010 went down by 8.7%, the U.S. Department of Health & Human Services reported. By 2015, only 10.9% of its then population, estimated at 2,085,109 (2015, latest data), went on without insurance. The study reported an additional 178,000 people gaining insurance during the said year.

Base your decision not just on overall coverage cost

Always keep in mind that the costs of medical and hospital services continue to go up, and having no insurance (or insufficient coverage) to help you pay for them can be your financial downfall.