Acknowledging the high costs of healthcare and private insurance, the federal government funds Medicare, which offers health insurance coverage to persons over the age of 65. Workers with certain disabilities may also qualify for New Mexico Medicare insurance.
While Medicare is federally supported, the state government of New Mexico also offers several programs designed to assist Medicare beneficiaries living in the state. These programs provide various degrees of financial assistance, as well as free counselling regarding Medicare issues.
At the heart of Medicare is Original Medicare, which may be obtained from the Medicare agency itself. It is made up of Medicare Part A and Part B, which covers different healthcare services.
Part A doesn’t normally require a premium, and it covers various hospital services including inpatient care and care in skilled nursing facilities. Medicare Part B deals with medically necessary treatments including outpatient care, durable medical supplies, and preventive screenings. Medicare Part B requires most beneficiaries to pay a premium, but the amount will depend on the annual income of the beneficiary. Those who earn less than $85,000 a year typically pay $134 a month for the Part B premium. This is much more affordable than the average cost of premiums in New Mexico, which is $494 a month.
Both Part A and Part B will come with out-of-pocket expenses. These will include copays, deductibles, and coinsurance costs.
Some Medicare beneficiaries wish to add more benefits to the coverage of Original Medicare, and such benefits can be obtained from Medicare Supplemental Plans. These are plans that can be purchased from Medicare-approved private health insurance carriers in New Mexico.
The benefits of the supplemental plans can be tailored to fit the needs of the Medicare beneficiary. The most common type of plan offers coverage for Medicare prescription drugs, as these can be extremely expensive for elderly Medicare beneficiaries. This type of plan is often called Medicare Part D.
Other types of supplemental plans can cover healthcare services that are not covered by either Medicare Part A or Part B. The supplemental plan can even cover the costs of deductibles and other out-of-pocket expenses.
These plans will also require a premium, which will have to be paid in addition to the premium for Medicare Part B.
A significant number of New Mexico residents find it difficult to afford Medicare expenses. This is not surprising as the state has one of the highest poverty rates in the country at 21.3% and its median household income is ranked 43rd among all states. It is also no surprise that New Mexico has among the highest enrolment rates for their Medicare Savings Programs (MSP) at 71%. The national average is 51%.
The most helpful of the MSPs is the program for Qualified Medicare Beneficiaries (QMB), which helps pay for the premiums of Medicare Part A and Part B, plus the deductibles, copayments, and coinsurance. To qualify for this QMB program, an individual cannot earn more than $1,032 a month while a married couple is limited to a combined monthly income of $1,392.
The program for Specified Low-Income Medicare Beneficiaries (SLMB) pays for only the Part B premium, which still saves the beneficiary more than $1,600 a year. To be eligible, an individual’s income cannot exceed $1,234 a month, while the limit for married couples is $1,666.
The program for Qualified Individuals (QI) also pays for the Part B premium, though its income limits are more generous. This is due to the limited funding for the program, which may keep eligible applicants from receiving benefits. To qualify, the QI must earn less than $1,386 a month while a married couple is limited to $1,872 a month.
These programs also have an asset limit of $7,560 for an individual and $11,340 for a married couple. The values of the applicant’s home and first car are not factored among the countable assets.
These three programs also may qualify beneficiaries for the Extra Help program, which is also called the Low-Income Subsidy program. This covers payment for Medicare Part D premiums.
Another program is for Qualified Disabled and Working Individuals, which covers the premiums for Medicare Part A. The monthly income limit for individuals is $4,132 while assets cannot exceed $4,000. For married couples, the income limit is $5,572 with assets limited to $6,000.
New Mexico has anticipated that numerous Medicare beneficiaries will ask for counselling and information regarding Medicare. The state thus runs a State Health Insurance Program (SHIP) called the New Mexico State Health Insurance Counseling and Assistance Program. The staff of the organization will provide free and unbiased counselling for Medicare beneficiaries in New Mexico.
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