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Posted by on Sep 4, 2013 in New Mexico | 0 comments

New Mexico’s Health Insurance Exchange

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Doesn’t New Mexico already have an online health insurance marketplace?

The New Mexico Health Insurance Alliance was created by the State of New Mexico in 1994 to provide small employer groups and individuals who do not qualify for traditional health insurance plans access to health insurance. Carriers include Blue Cross Blue Shield, Presbyterian Health Plan, Lovelace Health Plan and UnitedHealthcare. Individuals and employees receiving coverage through the Alliance will be transitioned into the New Mexico Health Insurance Exchange.

Will there be separate online marketplaces for individuals and groups?

On March 28, 2013, Governor Susana Martinez signed legislation creating the New Mexico Health Insurance Exchange. Despite intentions to operate a fully state run health insurance exchange, New Mexico will partner with the federal government in the first year of operation. The Small Business Health Options Program, SHOP, Exchange will be run by the state of New Mexico and the individual health insurance exchange will be operated by the federal government. Both individual and group insurance can be purchased through the state’s website, NMHIX.

Will coverage and premiums be the same statewide?

The New Mexico Division of Insurance has the regulatory responsibility for setting guidelines and certifying Qualified Health Plans (QHPs). New Mexico requires that carriers offer at least one statewide plan at the metal level of any other plan submitted at a given metal level. So, if Carrier A has submitted a plan available at all the metal levels, then they need to provide at least one statewide plan at all the metal levels. If Carrier A has only submitted plans at the Silver and Gold levels, then they only need to submit statewide plans at the Silver and Gold Levels.  So, while options from each carrier will be available statewide, the same plan options won’t necessarily be available. The certification and submission guidelines for the 2014 plan year are described in the following document: New Mexico’s Qualified Health Plan Submission Guidelines.

The state of New Mexico is broken up into geographic rating areas, which are used to help determine health insurance premiums. In New Mexico, the United States Office of Management and Budget has set four metropolitan statistical areas (MSAs). MSAs are used to develop rating areas by using the number of MSAs and adding one more area for the rural regions of the state. In New Mexico, there are four MSAs. Four MSAs plus one rural regions, gives the state five geographic rating areas. Here is the breakdown:

AREA MSA COUNTIES
1 Albuquerque Bernalillo, Sandoval, Torrance, Valencia
2 Farmington San Juan
3 Las Cruces Dona Ana
4 Santa Fe Santa Fe
5 Rural Catron, Chaves, Cibola, Colfax, Curry, DeBaca, Eddy, Grant, Guadalupe, Harding, Hidalgo, Lea, Lincoln, Los Alamos, Luna, McKinley, Mora, Otero, Quay, Rio Arriba, Roosevelt, San Miguel, Sierra, Socorro, Taos, Union

Which companies applied to offer plans through the exchange?

Blue Cross Blue Shield of New Mexico, a division of Health Care Service Corporation, has submitted individual and small group plans to be offered statewide. Individual products include: Blue Community HMO, which will be offered at the gold, silver, and bronze metal levels; Blue PPO, which will be available at the gold, silver, and bronze metal levels; Blue Security PPO, a Catastrophic plan; and Blue PPO Multi-State Plan,  at the gold silver, and bronze metal levels. Small group products include: Blue HMO and Blue PPO, which will both be available at the gold, silver, and bronze metal levels.

New Mexico Health Connections , a new non-profit consumer oriented and operated health plan, has submitted individual and small group plans to be offered through the insurance exchange. Products include Care Connect, HMO and Choice Connect, PPO.

Lovelace Health Plan/Lovelace Health System has submitted individual and small group plans to be offered statewide at the platinum, gold, silver, and bronze metal levels. HMO plans will have access to a network with 2 tiers and no-out-of-network coverage. POS plans will have access to a network with 3 tiers; tier 3 includes access to out-of-network providers. The individual POS plan is available only at the platinum metal level.

Presbyterian Health Plan/Presbyterian Insurance Company has submitted individual and small group products to be offered statewide at the bronze, silver, and gold metal levels. Presbyterian Health Plan submitted filings for individual and small group HMO products and Presbyterian Insurance Company submitted plans for small group PPO products.

Molina Healthcare of New Mexico has submitted individual HMO Molina Marketplace Plans to be offered statewide at the gold, silver, and bronze metal levels.

New information is being released every day. Follow this blog to receive updates as new information is released in New Mexico.

Jillian Carlile
Research Analyst & Health Exchange know-it-all
Strenuus
jcarlile@strenuus.com

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