In Depth: New Mexico Health Insurance Exchange
New Mexicans can start shopping Tuesday for health insurance through a new marketplace called a health insurance exchange. Here are a few questions and answers:
WHAT IS THE EXCHANGE?
It's a one-stop shopping center to buy health insurance from private insurers, with the package of benefits tailored to New Mexico. The exchange allows individuals and small businesses — those with 50 or fewer employees — to compare a range of plans offered by several companies.
HOW DO I USE IT?
Enrollment is possible online at the New Mexico exchange website (http://www.bewellnm.com ), through a toll-free telephone number or it can be done in person at about 160 health clinics and other sites across the state. The exchange is to publicly release the call center phone number Monday. Assistance by phone and at in-person sites will be available in English and Spanish. There will be health care "guides" at some locations that speak Native American languages, such as Navajo. New Mexico initially is using a federal government website to enroll individuals. New Mexicans can go to the state's website and will automatically be connected to the federal exchange. There will be paper applications on the federal website available in English and Spanish.
WHAT ARE MY INSURANCE OPTIONS?
Five insurance companies will offer a range of plans for individuals, and four companies will provide coverage for small businesses. Consumers will be able to pick from insurance plans with a range of coverage called bronze, silver, gold and platinum. The least costly, or bronze, plans will require people to pay more out-of-pocket expenses. The cost sharing of medical expenses is less with other plans, but premiums will be higher. Bronze plans are to cover about 60 percent of health care costs on average, with 70 percent coverage for silver plans.
HOW MUCH WILL IT COST?
Costs will vary depending on a person's age and within different regions of a state. Premiums typically will be lower in Albuquerque because it has more health care providers and greater competition. Premiums generally will be higher in rural areas and in smaller communities.
Individuals in New Mexico will pay an average of $282 a month for a mid-range insurance plan considered a benchmark by the federal government, according to a recent government report. That's lower than the national average of $328.
Those costs are before tax credits that individuals and businesses may be eligible to receive. The credits will be available to individuals with incomes up to nearly $46,000 a year and $94,000 for a family of four. Individuals with "affordable" coverage through their employer aren't eligible for subsidies, however.
The tax credits employers get will vary based on the average wage of their employees.
WHEN WILL THE COVERAGE START?
In January for people who enroll soon. Employers can start selecting a type of coverage they want to offer their workers, such as a silver plan. Then in November, the employees can pick from the range of silver plans offered by different companies. It's possible that workers for the same company will get insurance from different insurers.
Enrollment is open for individuals from Oct. 1 through March 31, 2014. There will be another open enrollment for individuals starting next October. There's no similar enrollment deadline for employers in New Mexico.
WHAT HAPPENS IF I DON'T ENROLL IN AN INSURANCE PLAN?
There's a penalty next year of $95 per adult and $47.50 per child, or 1 percent of annual income, whichever is higher. A family would pay a penalty of no more than $285 next year. The penalties increase every year. People will need to prove they have insurance or pay the fine when they complete their 2014 federal income tax returns, which are due in early 2015. American Indians and some others are exempt from the penalties.
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