For Individuals & Families

You still have options for getting coverage even though the 2014 enrollment deadline has passed.What are your options?

1. Did you have a qualifying life event?

There are many life events which enter you into a special enrollment period. If you think you might qualify or just aren’t sure, use the NMHIX Qualifying Tool.

Find Out If I Qualify

Fill out a short form and we can help you determine your status.

Changes in your household, including: marriage, civil union, divorce, annulment or legal separation; birth; adoption; fostering or becoming a legal guardian; death of a spouse or dependent; leaving incarceration, gaining citizenship.

Loss of health coverage due to: change in you or your spouse’s work status; divorce; aging out of your parent’s coverage after your 26th birthday; change in status of dependent’s eligibility; COBRA coverage ends, loss of Medicaid or CHIP eligibility.

Voluntarily ending coverage doesn’t qualify you for a special enrollment period.

Gaining status as a member of an Indian tribe – Members of federally recognized Indian tribes can sign up or change plans once per month throughout the year. Learn more about how to sign up as a Native American here.

Important: You have 60 days from the date of a life changing event to qualify and enroll in a Special Enrollment Period.

2. Apply for Medicaid and CHIP

You can apply for Medicaid and the Children’s Health Insurance Program at any time, all year long – there is no limited enrollment period for either program. If you qualify, you can enroll immediately.

New Mexico is expanding its Medicaid program to cover households with incomes up to 138% of the federal poverty level. That works out to $16,105 a year for 1 person or $32,913 for a family of 4. You can find out whether you qualify for Medicaid in New Mexico 2 ways: By filling out an application with this exchange or through the state Medicaid Office.

3. File for an exemption

Most people are required to have Minimum Essential Coverage, or face a penalty when they submit their income tax return. These are some situations where an exemption to this requirement may be granted. For the 2014 plan year, individuals can submit an exemption request with the Federally Facilitated Exchange.

Information on submitting an exemption request can be found here.

4. Appeal a decision

If you believe any decisions about your eligibility or the costs you pay are incorrect, you can file an appeal.

I have a qualifying life event.

Great, make sure you have these items before applying.

  • Information about your qualifying change
  • Social Security Numbers (or document numbers for legal immigrants)
  • Employer and income information for every member of your household who needs coverage. (pay stubs or W-2)
  • Policy numbers for any current health insurance plans covering members of your household.
  • A completed Employer Coverage form for every job-based plan you or someone in your household is eligible for. Download this form

Apply Now


You can also apply by phone
1-800-318-2596
TTY: 1-855-889-4325

Be sure to tell the representative that you believe you qualify for a special enrollment period

More FAQ's

  • What happens to people on UNM Care?

    Many individuals on UNM Care will be eligible for Medicaid expansion.  Others may be eligible for premium tax credits on the NMHIX.  The NMHIX is working with UNM to develop a coordinated system to ensure that those individuals understand their options and how to enroll.

  • How will client eligibility for income and subsidies be verified?

    Pursuant to the information from the federal government, the exchanges “will always use data from tax filings and Social Security data to verify household income information provided on an application, and in many cases, will also use current wage information that is available electronically”. If verification cannot be accomplished using IRS and SSA data, exchanges are to check wage information from employers provided by Equifax. In a final rule issued this past July, CMS provided exchanges “with temporarily expanded discretion to accept an attestation of projected annual household income without further verification” under certain circumstances and for 2014 only.

  • How will individuals who are on SSI/SSDI be impacted?

    No impact is anticipated from the NMHIX.  Anyone currently receiving either Medicaid or Medicare will not be eligible to enroll in the NMHIX.

  • When SCI ends, are working individuals obligated to assume their employer’s insurance plan?

    Employees who have access to coverage from their employers will need to use that option.  There are exceptions, for employees for whom their employer coverage is not “affordable.” Any employee wishing to explore his or her exemption status should contact a Health Care Guide for additional assistance in reviewing the guidelines.

  • How does a person appeal a decision of the NMHIX?

    If an individual believes that he or she should be eligible for a subsidy or for cost sharing and has been told that he or she is not eligible, the NMHIX will have an appeal protocol available.

  • What is the definition of a family?

    A head of household and all who are on the tax return with the head of household.

  • Where can a consumer learn about the Affordable Care Act?

    The federal government has an extensive website at www.healthcare.govAdditionally, the Kaiser Family Foundation has information at www.kff.org.

  • As a retiree under the age of 65, will I be subjected to the $2 million lifetime limit under my current policy? Does ACA differentiate between retirees and active employees?

    The $2 million lifetime limit ends for all except grandfathered plans at the end of 2013.  Grandfathered plans who did not have limits before 2014 may not impose new limits.

    In general, all individuals who are not exempt must have coverage. Retiree coverage is not considered employer coverage for the employer coverage rules. However, retirees who have retiree employer coverage do meet the coverage requirements for individuals.

  • What is the difference between a Health Care Guide, an assister, a navigator and a broker?

    Health Care Guide is a general term used by NMHIX to refer to both assisters and navigators who will provide assistance to individuals seeking health insurance coverage. The Health Care Guides provide information in a neutral and unbiased manner.  Health Care Guides are not allowed to receive any compensation from an insurance carrier.  Agents/brokers act on behalf of the consumer and may receive compensation from an insurance carrier.

  • Up to what income level is a single parent with three children able to make and still receive premium tax credits?

    A family of four can receive tax credits with an income up to 400% FPL (Federal Poverty Level), $94,200/year.

  • I bought health insurance which is too expensive for me as I live on a low fixed income. Can I change from this individual plan to participate in the exchange here in New Mexico?

    Yes—you may see explore options for affordable coverage on the NMHIX and you may also see if you are eligible for Medicaid expansion. A Health Care Guide can help you determine the options that are available.

  • I am uninsured and have pre-existing conditions. Will I be able to use NMHIX to purchase an insurance plan? I do not need or seek a subsidy. What documentation will I have to supply?

    Beginning in 2014, any health insurance plan you buy, on or off the exchange, will not be able to consider pre-existing conditions. Documentation required for the NMHIX will be proof of income, residency, and citizenship (or legal status).

  • If someone is a citizen and has no income and no children what are they eligible for?

    It is likely that they would be eligible for Medicaid expansion coverage; for further information contact the Human Services Department at 1-888-997-2583 and www.centennialcare.net Additionally, the online application website goes live in October, 2013 www.yes.state.nm.us.

  • What if I can’t afford the premiums?

    The New Mexico Health Insurance Exchange offers people with certain incomes subsidies so they can afford health insurance.  Cost sharing subsidies are available to help pay for copayments and deductibles and are based on income level.

  • If you buy health insurance on the NMHIX, do you have to pay the full monthly premium for that insurance and receive the tax credit annually as a tax refund?

    You have options.  When consumers apply for a plan on the health insurance marketplace they’ll be asked to provide income information to determine whether they’re eligible for a premium tax credit. If they qualify, consumers can opt to receive the tax credits in advance, and the exchange will send the money directly to the insurer every month. This subsidy will reduce how much people owe up front. Consumers can also choose to receive their credit when they file their taxes the following year.  It’s important to estimate your income as accurately as possible and contact the exchange during the year if you find you’re making more or less than expected. That’s because when completing your 2014 taxes, your estimate will be reconciled with what you actually earned. If you’ve received more than you were due, you could have to repay those amounts. Likewise, if you earned less than expected, you’ll get money back.

  • How much are the subsidies?

    The amount of the subsidy you’re eligible for will depend on your family size and income. Here are some examples. (These are examples, your actual subsidy will depend on a number of factors):

    • Joe is 25 and single and makes $7.62 per hour.  He picks a plan that costs $250 per month—but he gets a subsidy to help him afford the NMHIX insurance and only pays $43 per month for his premium.
    • Mary is 40 and has one child that is covered already by Medicaid.  Mary makes $11.20 per hour.  She picks a plan that costs $300 per month—but she gets a subsidy to help her afford the NMHIX insurance and only pays $78 per month for her premium.
  • How can I calculate my subsidy eligibility and amount?

    The BeWellNM website is designed to assist you with this calculation! To use the calculator feature, you will need the following:

    • The amount of your annual household income
    • Whether insurance is available through your employer
    • Number of family members
    • Number of adults in the family (21 and older)
    • Number of children (younger than 21 years old
    • You’ll also need to answer whether you smoke or not
  • What type of family income calculation is used to determine my subsidy eligibility?

    Your Modified Adjusted Gross Income (MAGI) will be used to determine your income eligibility for the NMHIX as well as for Medicaid.  This number is taken from your federal tax return.

  • My spouse does not work and I receive benefits through my job. Can my spouse apply for coverage and receive a subsidy?

    If an individual has access to employer-sponsored coverage that is affordable and meets the minimum value standard or is enrolled in employer-sponsored coverage, regardless of whether it is affordable and meets the minimum value standard, he or she or his or her dependents will not be determined eligible for subsidies.

  • If I have other coverage options, but haven’t enrolled yet, can I qualify for subsidies on the NMHIX?

    Depending on what types of coverage you are eligible for, you may still be able to apply and receive subsidies through the NMHIX.  You can still qualify for premium subsidies if you are eligible for, but not enrolled in these types of health insurance: (1) Retiree health coverage offered by a former employer (2) COBRA or (3) Student health plan coverage.

    If your job offers you health insurance and the premium cost for one person under that plan is less than 9.5% of your household income then you are not eligible for a premium subsidy.

    If you are eligible for Medicaid or Medicare you are not eligible for coverage on the NMHIX.

  • What if my children live in another state, but I am legally responsible for providing them with health care?

    Which state your children reside in for most of the year will determine the state where they should apply for health insurance. For example, if your former spouse has custody of the children and lives in a different state than New Mexico, your former spouse will have to apply for health insurance coverage in the state where he or she resides. You can still pay the children’s premiums.

  • How do I determine my family income when I have several types of family members living in my household?

    Anyone you include as a personal exemption on the federal tax form counts as a member of your household. This includes: yourself, your spouse and dependents. Dependents must (1) be US Citizens or residents of US, Mexico or Canada, (2) live with you for more than half the year, (3) under 19 or age 24 if a full time student and is away from home due to education, illness, business, vacation or military service and (4) doesn’t provide more than 50% of their own support. In-laws, or full time members of your household may also qualify as dependents if they: (1) are US citizens or residents of US, Mexico or Canada, (2) receive more than 50% of their support from you, (3) are related to you or live in your home all year and (4) Make less than $3,900 (in 2013) generally excluding Social Security.

  • How do I report my income if it is cash based?

    If your income qualifies you for Medicaid expansion as shown in the chart on the first page, the state already has a set protocol for dealing with cash income. It’s basically a written statement from whoever pays you in cash that this is the situation and the amount is specified. If your income is over the Medicaid level, and you are required to file a tax return, your income will be based on your tax return.

    If you have not been filing a tax return and are required to, you will need to start filing that return. The NMHIX can work with you in the meantime to help you get coverage based on your self-declared income. If you suddenly have an increase in your cash-based income between last year and this year and so haven’t had to file a return yet, the exchange may ask you for further documentation. Also, cash-based income individuals must file a tax return at the end of the year as part of the subsidy/cost sharing agreement.

  • Is it possible to buy insurance outside of the Open Enrollment Period?

    You can have a special enrollment opportunity (60 days from the date of a life event) to sign up for coverage during the year other than the Open Enrollment Period if you have a qualifying life event. These life events are:

    • Loss of eligibility for other coverage (for example if you quit your job or were laid off or if your hours were reduced, or if you lose student health coverage when you graduate) Note that loss of eligibility for other coverage because you didn’t pay premiums does not trigger a special enrollment opportunity.
    • Gaining a dependent (for example, if you get married or give birth to or adopt a child). Note that pregnancy does NOT trigger a special enrollment opportunity.
    • Divorce or legal separation.
    • Loss of dependent status (for example, “aging off” a parents’ plan when you turn 26).
    • Moving to another state or within a state if you move outside of your health plan service area.
    • Exhaustion of COBRA coverage.
    • Losing eligibility for Medicaid or the Children’s Health Insurance Program.
    • For people enrolled in a NMHIX plan, income increases or decreases enough to change your eligibility for subsidies.
    • Change in immigration status.
    • Enrollment or eligibility error made by the exchange or another government agency or somebody, such as a Health Care Guide, acting on your behalf.

    You can also buy health insurance on the open market outside of the NMHIX anytime. However, subsidies are only available for NMHIX customers.

  • What if I don’t have a checking account?

    NMHIX provides a variety of payment methods. Insurance carriers that offer health insurance through NMHIX accept paper checks, cashier’s checks, money orders, and all general-purpose pre-paid debit cards, as well as electronic fund transfers. These methods are available to you for both the initial premium payment (at enrollment) and ongoing payments.

  • What happens if I’m late making a monthly payment?

    If you have an advanced premium tax credit and miss a payment, your health plan will provide you with a 90 day grace period to bring your payments to date. This applies when an individual has paid at least one month’s premium. If no payment is received after 90 days, coverage can be terminated by the insurer. People not receiving advanced premium tax credits are expected to get a 31-day grace period.

  • Are immigrants eligible to shop and purchase health care on the New Mexico Health Insurance Exchange?

    If you are a non-citizen who has permission to live and/or work in the U.S., you are eligible to buy a plan on the Exchange; this includes those who are in the waiting period for Medicaid. Undocumented immigrants and deferred action childhood arrivals may not use the NMHIX to purchase coverage for themselves.

  • Can immigrants get help paying premiums and/or cost sharing for health insurance in the NMHIX?

    Lawfully present immigrants can get tax credits to help pay premiums and cost-sharing for health insurance through the NMHIX, depending on their income, just like citizens.

  • What if my family has members of mixed immigration status?

    Citizens and lawfully present family members can get health insurance through Medicaid, CHIP, and NMHIX even if other family members are not lawfully present. Family members who are not lawfully present, including undocumented immigrants, may complete the application for health insurance on behalf of citizens and lawfully present family members. For example, an undocumented immigrant parent may apply for health insurance for their citizen child. This is because when that parent applies for health insurance, they are only obligated to provide citizenship and immigration status for those family members applying for coverage (their children).

  • How is individual citizenship and immigration status verified in the NMHIX?

    Citizenship and immigration status for those applying for health insurance will be checked electronically with several systems. These systems include: the Social Security Administration, the Department of Homeland Security, and SAVE (Systematic Alien Verification for Entitlements).

  • If I have a complex family immigration issue, who can I contact?

    The National Immigration Law Center is a good resource. You can visit them at www.nilc.org You can also talk to one of our Health Care Guides. You can find the closest Health Care Guide location at http://bewellnm.com/were-here-to-help/

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