Medicare Advantage in NM

Medicare Advantage (Part C) plans are private health insurance plans approved by Medicare that provide an alternative to Original Medicare. These plans must cover everything Original Medicare covers, and most include additional benefits like dental, vision, hearing, and prescription drug coverage. Medicare Advantage plan availability varies by county across New Mexico.

How Medicare Advantage Works in New Mexico

When you enroll in a Medicare Advantage plan, you still have Medicare (and continue to pay your Part B premium), but you receive your Part A and Part B benefits through the private plan. Many plans charge a $0 additional monthly premium beyond what you pay for Part B.

Medicare Advantage plans use provider networks, so it is critical to verify that your preferred doctors, specialists, and hospitals in New Mexico participate in the plan you are considering. Compare Medicare Advantage plans in your county.

Types of Medicare Advantage Plans

• HMO (Health Maintenance Organization): Requires you to use in-network providers and get referrals for specialists. Often has lower premiums and copays.
• PPO (Preferred Provider Organization): Allows out-of-network care at higher costs. More flexibility but usually higher premiums.
• PFFS (Private Fee-for-Service): Determines how much it will pay providers and how much you pay. Providers must accept the plan's terms.
• SNP (Special Needs Plan): Designed for beneficiaries with specific diseases, limited incomes, or dual eligibility (Medicare and Medicaid).
• MSA (Medical Savings Account): High-deductible plan with a bank account that Medicare deposits money into for healthcare expenses.

Extra Benefits in NM Medicare Advantage Plans

Many Medicare Advantage plans in New Mexico include benefits not covered by Original Medicare:

• Routine dental care (cleanings, fillings, dentures)
• Routine vision care (eye exams, eyeglasses, contacts)
• Hearing aids and hearing exams
• Fitness and wellness programs (gym memberships)
• Over-the-counter (OTC) allowances
• Transportation to medical appointments
• Meal delivery after hospital discharge
• Telehealth and virtual visits

When to Enroll in Medicare Advantage

• Initial Enrollment Period: 7-month window around your 65th birthday
• Annual Enrollment Period: October 15 – December 7 to switch plans or join for the first time
• Medicare Advantage Open Enrollment: January 1 – March 31 to switch Advantage plans or return to Original Medicare
• Special Enrollment Periods: Triggered by qualifying events like moving to a new county