New Mexico Health Insurance Consumer Guide

To be eligible to enroll in private health coverage through beWellnm, you must:⁵

• Be lawfully present in the United States, and live in New Mexico
• Not be incarcerated
• Not be enrolled in Medicare⁶

So most New Mexico residents can enroll in a health plan through the exchange.⁷ But a more pressing question for most people is eligibility for financial assistance in the form of state and federal subsidies through beWellnm. 

To qualify for income-based federal Advance Premium Tax Credits (APTC), New Mexico Premium Assistance, federal cost-sharing reductions (CSR), or New Mexico’s State Out-of-Pocket Assistance (SOPA), you must:

• Not have access to an affordable plan offered by an employer. If you are eligible to sign up for an employer’s plan and aren’t sure whether it’s considered affordable, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies via beWellnm. 
• Not be eligible for New Mexico Centennial Care (Medicaid).
• Not be eligible for premium-free Medicare Part A.⁸
• Not be able to be claimed by someone else as a tax dependent.⁹
• If you’re married, you must file a joint tax return with your spouse.¹⁰ (with very limited exceptions)¹¹

In addition to those basic parameters, beWellnm subsidy eligibility will depend on your household’s income.

In New Mexico, the open enrollment period begins November 1 and continues through January 15.¹² 

(Note that for off-exchange plans — obtained outside of beWellnm — the enrollment period ends December 15 in New Mexico, and does not continue into January the way it does for on-exchange plans.¹³ This is fairly unique, as the open enrollment period in most states is the same for on-exchange and off-exchange plans.)

For 2024 coverage, beWellnm enrollments had to be completed by December 31, 2023 to have coverage effective January 1. Enrollments completed between January 1 and January 15 had coverage effective February 1.¹⁴ (These dates are potentially subject to change in future years, so be sure you’re looking at the current year’s enrollment rules.)

After the open enrollment period ends, you may still be able to enroll or make a plan change if you experience a qualifying life event, such as giving birth or losing other health coverage. 

New Mexico also has an Easy Enrollment Program that allows people to start the health insurance enrollment process via state tax returns.¹⁵

And some people can enroll year-round even without a specific qualifying life event. This includes the low-income special enrollment period, which is available to applicants with household income up to 200% of the federal poverty level in New Mexico.¹⁶ (The household income cutoff for this SEP is 150% in most states.) 

Enrollment in New Mexico Centennial Care (Medicaid) is available year-round.

To enroll in an ACA Marketplace/exchange plan in New Mexico, you can: 

• Visit beWellnm –  New Mexico’s health insurance exchange – to compare the health plans available in your area, determine whether you’re eligible for financial assistance (including federal and state subsidies), and enroll in coverage during open enrollment or during a special enrollment period. 
• Enroll in a beWellnm plan with the help of an insurance agent or broker, Navigator, or certified application counselor.
  
• Contact beWellnm by phone at 1-833-862-3935.

When you enroll in coverage through beWellnm, you may find that you’re eligible for financial assistance. And the assistance may be more robust than it is in many other states, as both federal and state subsidy programs are available in New Mexico. The state subsidies are once again being expanded for 2025 (details below).

As a result of the Affordable Care Act (ACA), federal premium subsidies (advance premium tax credits, or APTC) are available depending on your income. If you’re eligible for APTC, it will reduce the amount you pay for your health coverage each month, as long as you enroll in a metal-level plan through beWellnm.

Eighty-four percent of beWellnm enrollees were receiving APTC as of early 2024. These subsidies averaged $551 /month, reducing the average enrollee’s premium to $139/month.¹⁷

Applicants with household income up to 250% of the federal poverty level are also eligible for federal cost-sharing reductions (CSR), which will reduce the deductible and other out-of-pocket expenses for Silver-level plans. Twenty-seven percent of beWellnm enrollees were receiving CSR benefits as of 2024.¹⁸

And New Mexico is among the states where additional state-funded subsidies are available. As of 2023, New Mexico began offering state-funded premium subsidies (for applicants with income up to 400% of the federal poverty level, or FPL) and cost-sharing assistance (for applicants with income up to 300% of FPL), in addition to the federal premium subsidies and cost-sharing reductions.¹⁹

New Mexico’s cost-sharing reductions (state out-of-pocket assistance, or SOPA) were expanded for 2024, ensuring that people with household income up to 300% of FPL could get plans with 90% actuarial value (ie, platinum-level coverage).²⁰ And that’s being expanded again for 2025, so that applicants with household income up to 400% of FPL can get plans with 90% actuarial value.²¹

Plans with reduced cost-sharing, including federal CSR and SOPA benefits, are known as “Turquoise plans” in New Mexico, to make it easier for consumers to identify them. The 90% actuarial value plans are called “Turquoise 3.”

Starting in 2023, New Mexico no longer allows health insurers in the individual/family market to add a tobacco surcharge to smokers’ premiums (the state joined several others that had already imposed similar rules).

Starting with the 2024 plan year, New Mexico has standardized plans available at the Silver, Gold, and Turquoise level.²²

Source: CMS.gov²³

Depending on your income and circumstances, you may be able to enroll in free or low-cost health coverage through Centennial Care (New Mexico Medicaid). Learn more about whether you might be eligible for Medicaid in New Mexico.

As was the case in all states, Medicaid disenrollments resumed in New Mexico in mid-2023, after being paused for three years during the pandemic. But New Mexico took some fairly unique steps to help people transition from Medicaid to the Marketplace: For those with income up to 400% of the poverty level, the state covered their first month of after-subsidy premiums for the Marketplace plan, and beWellnm also offered retroactive effective dates (the first of the month during which the person applied) for the new Marketplace plans when a person transitioned away from Centennial Care Medicaid.²⁴

For 2024, five insurers offer exchange plans in New Mexico,²⁵ including UnitedHealthcare, which was new for 2024.²⁶

For 2025, there will be four participating insurers, as Ambetter/Western Sky will no longer offer coverage after the end of 2024.² Enrollees with 2024 Ambetter/Western Sky plans will need to select new coverage during the open enrollment period that begins November 1.

Unlike most states, all exchange carriers in New Mexico offer plans statewide, so consumers in all areas of the state have access to the same plans.²⁷

For several years, New Mexico had one of the few remaining ACA-created CO-OPs, but it closed at the end of 2020, leaving just three CO-OPs still operational (as of 2024, those three CO-OPs offer coverage in five states).

For 2025, the following average rate changes have been approved by the New Mexico Office of the Superintendent of Insurance (OSI), applicable to full-price (pre-subsidy) premiums:²⁸ 

Source: New Mexico Office of the Superintendent of Insurance²⁹ and New Mexico SERFF³⁰ 

The weighted average rate increase for 2025 is 10.2% in the individual market in New Mexico.³¹ But that’s for full-price premiums, and enrollees do not pay full price. Eighty-four percent of beWellnm enrollees were receiving federal premium subsidies in 2024.³²

And many beWellnm enrollees also receive additional state-funded premium subsidies. 

Despite the 10% average rate increase for full price plans in 2025, the New Mexico Office of the Superintendent of Insurance highlighted the fact that most subsidy-eligible enrollees “will see no changes in their insurance premiums.” And  many middle-income households will be able to enroll in very robust coverage for only about $25/month.³¹

For perspective, here’s an overview of how average full-price premiums have changed over the years in New Mexico’s individual/family market:

• 2015: Average decrease of 1.7%.³³
• 2016: Average increase of 4%.³⁴
• 2017: Average increase of 28.4%.³⁵
• 2018: Average increase of 30%.³⁶
• 2019: Average decrease of 1%.³⁷
• 2020: Average increase of 0.9%.³⁸
• 2021: Average decrease of 1.5%.³⁹
• 2022: Average increase of 15.5%.⁴⁰
• 2023: Average increase of 11.3%.⁴¹ (before Friday Health Plans, which had the largest increase, announced that they would exit the market).
• 2024: Average increase of 7%.⁴²

During the open enrollment period for 2024 coverage, 56,472 people selected private plans through beWellnm,⁴³ setting a new record high.

Source: 2014,⁴⁴ 2015,⁴⁵ 2016,⁴⁶ 2017,⁴⁷ 2018,⁴⁸ 2019,⁴⁹ 2020,⁵⁰ 2021,⁵¹ 2022,⁵² 2023,⁵³ 2024⁵⁴

beWellnmThe state’s exchange for small businesses, individuals, and families.

Health Action New MexicoA consumer advocacy organization working to improve healthcare access and affordability in New Mexico.

New Mexico Human Services Department
Administers Centennial Care (Medicaid) and various other social services programs in the state.

New Mexico Office of the Superintendent of Insurance
Licenses and regulates health insurance companies in New Mexico, as well as brokers and agents; can provide assistance and information to consumers who have questions or complaints about regulated entities.

New Mexico State Health Insurance Assistance Program
A resource for New Mexico Medicare beneficiaries and their caregivers.