• Assurant
• Blue Cross and Blue Shield
• Celtic

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• GoldenRule
• Lovelace Health Plan

• Supplemental Medigap Insurance
• Medicare Advantage Insurance
• Blue Cross and Blue Shield

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• Humana
• Lovelace Health Plan
• SecureHorizons by UnitedHealthcare
• WellCare

Getting Individual New Mexico Health Insurance

7. If you are looking for health insurance but can't get it through your job...

...you may have to look for an individual health insurance policy in the private market. Here are some tips to help you:

• Shop carefully before buying insurance on your own because coverage and costs vary from company to company. When shopping for insurance, keep the following terms in mind and ask questions like:
  • Covered Services: What medical services are covered?
  • Deductible: How much must I pay before the insurance starts to help pay for services?
  • Co-payments: After I reach my deductible, how much do I pay for services, and how much does the insurance company pay?
  • Out-of-Pocket Maximum: Does the policy limit the total you have to spend for covered services in a year? Check the maximum carefully; sometimes not all spending counts toward it (for example, the deductible or co-payments for care from doctors outside the plan's network).
  • Pre-existing Conditions: Does the plan cover health problems I already have? If it does not cover these problems right away, when would it begin covering them? (Also see "Your Rights under Federal Law".)
  • Provider Network: Are the doctors I want to see covered in this policy? If not, would I have to pay extra to see any of my doctors because they are not "in the network"? You may want to ask your doctor directly if they would accept this insurance for your care.
• Talk with a health insurance agent in your area to help you think about the right policy for the right price. (Agents are listed in the yellow pages.) As you weigh your options, remember that you buy health insurance in case you get sick, not in case you stay healthy. Bare-bones policies that may seem adequate when you are healthy might leave you with high unpaid medical bills if you get seriously sick or injured.
• Be careful about plans that don't offer insurance coverage but offer only discounts on the cost of health care services. Generally, these plans are not a good buy, and many insurance regulators warn against buying them.
• Be sure to find out if the insurance company you are thinking about buying coverage from has been licensed in New Mexico and if there have been complaints about the company. This is especially important to do if you are thinking about buying health insurance through an association. For this information, contact the New Mexico Insurance Division at 1.800.947.4722.
• Know your rights. Because you may run into problems shopping for an individual policy, you should be aware of your rights and protections under federal and state law. One resource for learning more about these federal and state protections can be found at www.healthinsuranceinfo.net. This Web site has a separate guide for each state.

Your Rights under Federal Law

HIPAA (the Health Insurance Portability and Accountability Act) is a federal law that may give you the right to buy coverage. It prohibits insurance companies from refusing to cover a health problem you already have ("pre-existing condition").

To be eligible for these protections, you must have:

1. had at least 18 months of prior coverage, ending with coverage through a job;
2. used up any COBRA or state continuation coverage rights (see #1 and #2); and
3. had no gaps in coverage longer than 63 days, so you must act quickly.

If you qualify for HIPAA protection, in New Mexico you generally have a right to coverage through the New Mexico Medical Insurance Pool, the state's high-risk pool. See Section #6 for more information about high-risk pools. In addition, you have a right to buy coverage through the Health Insurance Alliance (1.800.204.4700).

Your Rights under New Mexico Law

Your state also has laws that control whether an insurance company must offer you a policy, what conditions must be covered and how high the premiums can be for a policy. Because these rules are complex, call the New Mexico Insurance Division at 1.800.947.4722 to understand your rights to insurance coverage in the individual market.