Over the past two years, since the passage of the Patient Protection and Affordable Care Act in 2010, state governments have been faced with implementing its provisions, a process that will not be complete until 2014. The most significant early changes in health care reform have involved children, who are not protected from insurance exclusion due to the presence of pre-existing conditions. Also, children may remain covered by their parents’ health insurance until they reach age 26, regardless of education or marital status.
High-risk insurance pools have been created at the state level on a temporary basis to help adults with pre-existing conditions, but will be replaced on January 1, 2014 by health care exchanges, which will be competitive marketplaces where consumers can buy coverage.
Health Care Exchanges
The State of New Mexico is continuing to study its options for establishing a health care exchange, with planning and research being led by the Office of Health Care Reform.
Pre-Existing Condition Insurance
The Pre-Existing Condition Insurance Plan program in the state is administered by the New Mexico Medical Insurance Pool and provides coverage in a monthly premium range of $128 to $679 with deductibles of $500 to $2000 for eligible participants. The coverage includes prescription drug benefits, hospitalization, and both primary and specialty care. Maximum annual out-of-pocket limits vary by plan, and range from $2450 to $3500.
Medicare eligibility is determined by percentages of income measured by the Federal Poverty Level, the same standard used to determine the payment of funds from the CHIP-funded Medicaid Expansions. In New Mexico, all children from birth to age 19 qualify for Medicaid at 185% FPL and for CHIP at 235%.
Pregnant women may draw Medicaid at 185% FPL, parents at 28%, adults at 200%, and non-elderly disabled Social Security recipients at 74%.
About 15 percent of the residents of New Mexico draw Medicare benefits with more than 296,000 receiving prescription drug coverage.
New Mexico offers two prescription assistance programs, NM SenioRx and NMRx, while the Benefits Counseling program within the State Health Insurance Program provides educational and counseling services to Medicare beneficiaries.