The short answer is no, you don’t have to enroll in your employer’s health insurance coverage. That said, if job-based health insurance is offered and affordable, it is usually a good option to cover your family’s medical needs.
Enrolling in your employer’s health insurance plan (or your spouse’s) can give you peace of mind. If can help save money on medical costs, like doctor visits, emergency care, and medications.
Job-based coverage doesn’t work for every family’s budget:
- What if the cost of premiums takes too big a bite out of your paycheck?
- What if your employer’s plan doesn’t cover your health condition?
- What if your spouse’s prescriptions aren’t covered?
There are so many “What ifs” to consider with health insurance, from your household income to your health needs and even your heritage. Let’s take a closer look at some of the most common questions New Mexicans ask about getting health insurance at work.
How do I know if my job’s plan is “affordable”?
When it comes to monthly health insurance premiums, “affordable” is different for every family. The federal government says in 2026, a job-based health plan is affordable if your monthly health insurance premium for coverage only for yourself in the lowest-cost plan is less than 9.96% of your household income.
Example: Let’s say your household income is $55,000 a year. The guidelines say an affordable monthly health insurance premium is $456.50 or less:
$55,000 × 9.96% = $5,478
$5,478 ÷ 12 = $456.50
A plan through your job should also meet the requirements for minimum essential coverage (MEC) and minimum value (MV), meaning it covers at least 60% of your family’s medical costs and should also cover most of the cost of hospital and doctor services. If your job-based coverage costs more than this, or if it does not meet MEC, you may be eligible for BeWell coverage and Advance Premium Tax Credits (APTC) to lower your monthly health insurance premium.
If you are enrolled in a health insurance plan through BeWell and have recently gotten an offer of affordable coverage through your job, you will no longer be eligible to receive APTC health insurance premium. If you choose to keep your health insurance plan through BeWell, you will have to pay the full health insurance premium cost.
What if my job doesn’t offer affordable health insurance?
If your employer doesn’t offer health coverage or if it’s too expensive, you still have options. You may qualify for Medicaid if you live in New Mexico, have a low income AND meet one or more of these criteria:
- Pregnant
- Responsible for a child younger than age 18
- Blind
- Disabled
If you don’t qualify for Medicaid, you may be eligible to enroll in a plan through BeWell. Every carrier on BeWell offers quality insurance to New Mexicans with a range of budgets and health needs. Shop for a plan.
Can I get financial assistance to enroll in a health insurance plan through BeWell?
When you enroll in a BeWell health plan, you might qualify for APTC to lower your monthly health insurance premium. But if your employer’s health insurance plan meets the guidelines for “affordable” and “minimum value,” you won’t be eligible for an APTC. A BeWell certified assister can talk through your options to help you make the best choice.
How do I find out if I am eligible for a plan through BeWell?
You can submit an application to BeWell and find out whether you’re eligible for a plan and for financial assistance to help cover the cost of health insurance.
With your application, you will need to send proof you don’t have minimum essential coverage. These documents may include:
- Document from an employer with this information:
- Statement the employer does not currently offer you (or your family members) coverage
- Statement showing the cost of your share of the health insurance premium for the lowest-cost self-only plan, if offered
- Health insurance letter that confirms health coverage and expiration dates for coverage outside of BeWell.
Do not drop existing job-based coverage before submitting an application to BeWell. You must also pay your first month’s health insurance premium for your coverage to start the 1st of the next month.
Check with your job’s human resources office about when to drop employer coverage.
Related reading: How Obamacare and BeWell Help You Find Affordable Health Insurance Alternatives
How do I know if my prescriptions are covered?
Through BeWell, you can check to see if a health plan you’re interested in covers your prescription medications. You’ll also see Clear Cost Plans, which offer an apple-to-apple comparison of coverage, costs and more. Clear Cost Plans also have reduced out-of-pocket costs for New Mexicans who qualify. Clear Cost Plans also have reduced out-of-pocket costs for New Mexicans who qualify.
What if I lose job-based health insurance?
If you lose your job-based health insurance, you have many options available to ensure you and your family stay covered.
Submit an application for health insurance coverage through BeWell
When you fill out an application for a plan through BeWell, you’ll find out if you qualify for discounts on your monthly health insurance premiums and out-of-pocket health care costs based on your income. It may be a different health insurance plan than you had through your employer. When you apply for coverage, you will need to confirm if your health care provider is in-network and whether your medications are covered.
Apply for Medicaid
New Mexico is a one-application state. That means if you are found eligible for Medicaid while filing out the BeWell application, BeWell will seamlessly transfer your application straight to the New Mexico Health Care Authority, which runs the state’s Medicaid program.
Sign up for COBRA coverage
When you lose job-based health insurance, you may be offered COBRA coverage. COBRA may let you pay to stay on the plan you had through your job for a limited time after your job ends (usually 18 months). You pay the full health insurance premium yourself, plus a small administrative fee.
If you decide not to take COBRA coverage, you may be eligible to enroll in a health insurance plan through BeWell within 60 days of losing coverage.
Losing job-based health insurance qualifies you for a Special Enrollment Period (SEP). This is a time when people who have a Qualifying Life Event (QLE)—such as losing a job—can enroll in a health insurance plan outside the annual Open Enrollment Period (OEP).
Ready to start?
Let us do the work for you, for free! Make an appointment with a BeWell certified assister. We can take the stress out of comparing health insurance options and help you sign up for the right plan for your household and your wallet.
Questions? Call 833-862-3935 or TTY 711, chat with us, or schedule a free appointment with a certified assister.
