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Small Business Employee Benefits and HR Blog

New Mexico Health Insurance Exchange Guide

This guide provides an overview of the New Mexico Health Insurance Exchange including the history of the exchange, how the exchange will operate, and exchange information for New Mexico residents and small businesses.

New Mexico Health Insurance Exchange Introduction

Beginning in 2014, as part of the Affordable Care Act (ACA), health insurance coverage for individuals and small businesses will become available through new state health insurance exchanges (also called health insurance marketplaces).

Most importantly, the key tax credits (e.g. the small business healthcare tax credits) and tax subsidies (e.g. individual health insurance tax subsidies) will only be available for coverage purchased through a state health insurance exchanges.New Mexico Health Insurance Exchange, NM Health Insurance Exchange

All states have three options for setting up a state health insurance exchange for 2014:

  1. Build a state-based exchange
  2. Enter into a state-federal partnership exchange
  3. Default to a federally-facilitated exchange

New Mexico will enter into a unique state-federal partnership. Like Utah, New Mexico will run the small business "SHOP" exchange, and the federal government will run the individual health insurance exchange. The New Mexico Health Insurance Exchange will open October 1, 2013, with coverage beginning January 1, 2014. 

New Mexico Health Insurance Exchange - History

New Mexico planned to offer a state-based health insurance exchange for both the individual and small business SHOP Exchange. Final legislation was signed into state law in March 2013 that authorized New Mexico to establish and operate a state-based health insurance exchange.

However, with the deadline approaching to have exchange infrastructure in place, New Mexico did not have the proper technology up and running to operate the individual exchange. In May 2013, the governing board voted to partner with the federal government on the individual health insurance exchange. Even with the federal government operating the individual exchange, New Mexico will retain oversight of the all exchange plans, rates, and carriers. According to the New Mexico Health Insurance Alliance (NMHIA), the Exchange will aim to take over the individual exchange by 2015.

Click here for more information on NM's Health Insurance Exchange planning efforts.

New Mexico Health Insurance Exchange - What is it?

The New Mexico Health Insurance Exchange for individuals will be operated through a federally-run health insurance exchange, also referred to as the Health Insurance Marketplace. Starting in October 2013, New Mexico residents will be able to access information about all the plans available through the Exchange. Coverage from the Exchange starts in January 2014.

According to an estimate by healthcare.gov, 360,293 or 21% of New Mexico’s non-elderly residents are uninsured, of whom 334,339 (93%) may qualify for either tax credits to purchase coverage in the Exchange or for Medicaid if New Mexico participates in ACA Medicaid expansion. NMHIA estimates that 200,000 will purchase coverage through the New Mexico Health Insurance Exchange by 2020.

The New Mexico Health Insurance Exchange for small businesses will be state-operated and will be available to employers with up to 50 employees. 

New Mexico Health Insurance Exchange - What Plans Will be Available?

All plans offered through the New Mexico Health Insurance Exchange will meet the ACA definition of a Qualified Health Plan (QHP). The plans will be offered by level of coverage for essential health benefits (EHB), to allow consumers to compare plans on an "apples to apples" basis. The four "metal" levels are: Bronze (plan pays 60%), Silver (plan pays 70%), Gold (plan pays 80%) and Platinum (plan pays 90%).

At time of writing, specific carriers offering plans through the New Mexico Health Insurance Exchange were not available. Carriers had until April 30, 2013 to submit their intent to participate paperwork.

New Mexico Health Insurance Exchange - Role of Insurance Professionals & Navigators

The New Mexico Health Insurance Exchange will follow federal guidelines for insurance professionals selling policies through the individual Exchange, and state guidelines for insurance professionals selling policies on the small business SHOP Exchange. According to the New Mexico exchange blueprint, agents and brokers will be able to register with the exchange and receive any commissions or compensation directly from the carriers. Agents and brokers, including web brokers, who wish to sell Exchange products will be required to meet licensing requirements and take additional training on Exchange protocols.

The New Mexico Health Insurance Exchange navigator program will assist consumers in making choices about their health care options and accessing their new health care coverage, including access to premium tax credits for some consumers.