HEALTH INSURANCE FAQs

Premium subsidies are based on factors that may change every year. For instance, your income may change yearly. That’s why you need to update your information when you renew or apply for a health plan through the Marketplace.

You can use the beWellnm Subsidy Calculator to get a quick estimate of financial help. Before you start, you will need to know:

• The amount of your annual household income
• Number of family members who need insurance
• Age of each family member

Keep in mind that you’ll get the final decision on your subsidy amount when you apply for coverage.

No. The New Mexico Health Insurance Exchange is the only place where you can get a health plan with a premium subsidy.

Some New Mexicans qualify for reduced costs — or no costs — for health care visits. With cost-sharing reductions (CSR), you pay lower costs when you see a doctor, get treatment in the hospital or get medicine. If you qualify based on income, CSRs are only available with a silver level health plan through the Marketplace. Native Americans who qualify can get a break on costs with any health plan on the Marketplace. (You’re not limited to silver level plans.)

Yes, if you qualify based on income. Premium subsidies (also called advance premium tax credits) bring down the cost of health insurance. The lower your income, the bigger the credit. If you qualify, you may get a premium subsidy to help you pay for your health plan. The subsidy can be used right away so the monthly cost you pay is lower. Or, you can claim the credit when you file your taxes.

You pay two types of costs. The premium is the amount you pay each month for a health plan. You’ll also pay out-of-pocket costs when you receive health care. For instance, you might pay:

• A copay (a set dollar amount) for health visits or prescriptions
• A coinsurance (a percentage of the bill) for medical care
• A deductible (the amount you pay before the health plan starts paying for some of your costs)

Your out-of-pocket maximum is the most you may have to pay for covered services in a year. Once you hit this amount, services are covered at 100%.

The beWellnm website is available in English and Spanish. Use the Enrollment Counselor search tool to locate  an enrollment counselor near you who speaks your language.

Go to National Immigration Law Center to learn more. You can also talk to enrollment counselors who can help. Find an enrollment counselor near you.

Family members who are U.S. citizens or lawfully present immigrants can get health coverage. It doesn’t matter if other members of the household are not lawfully present. For example, parents who are undocumented immigrants may apply for health insurance for their children who are U.S. citizens. When the parent completes the application, he or she only has to provide documents for those family members who are applying for coverage.

Legal immigrants can get health insurance through the Exchange. Legal immigrants are those who have permission to live and/or work in the United States. Undocumented immigrants and deferred action childhood arrivals are not eligible for health insurance through the Exchange. Keep in mind: Undocumented immigrants can securely complete an application for coverage on behalf of a family member who is a U.S. citizen. In other words, a parent may apply for a child’s health insurance without entering information about the parent’s own immigration status. 

You may think you don’t need a health plan if you get health care through Indian Health Services (IHS), a Tribal Program or an Urban Indian Health Program. Even if you obtain care through Native American health care systems, there are good reasons to get a health plan through the Marketplace. You can keep using your doctors and services, but you have more options if needed. Plus, when you have health insurance, you’re supporting Native American health care systems because health insurance pays for your care. That means more money for your clinic to serve Native Americans. This helps you and your community. Read more about the benefits of health insurance for Native Americans.

Read more Native American FAQs

HealthCare.gov is the federal Health Insurance Marketplace website where New Mexicans can enroll in a plan or renew their plan. beWellnm helps you prepare so you’re ready to complete your application at HealthCare.gov. If you don’t want to enroll online, that’s OK! You have other options. (Read more about Ways to Enroll.) You can apply by phone or mail in an application if you wish. Or, beWellnm can connect you with free enrollment help in person. Find an agent or broker who can help you choose the right plan for you. Or, meet with an enrollment counselor who can help you apply. 

The Marketplace offers a range of health plans. These plans are from some of the top health insurance carriers in the state. Health plans all cover a set of essential health benefits, but the costs vary for each plan. Bronze and silver level plans generally have lower monthly premiums and higher costs when you go to the doctor or hospital. Gold and platinum level plans generally have higher premiums and lower costs when you go to the doctor or hospital. Use the Plan Finder to compare plans.

beWellnm is New Mexico’s Health Insurance Exchange for individuals and small business. The Exchange was created by state law in 2013 to help people get affordable health care coverage. We’re here to help you enroll in a health plan through the Exchange. It’s our goal to help more New Mexicans get quality, affordable health care when they need it. 

Health insurance helps you pay for health care. This protects you from paying the full cost of care when you go to the doctor or hospital. Learn more about health insurance and who can sign up.

BeWellnm for Small Business is designed to offer affordable coverage. Small businesses may choose from four levels of coverage and decide how much to contribute toward employees’ premiums. The cost to the business will depend on the metal level chosen and the amount paid toward premiums.

A tax credit lowers the amount of tax you pay. Employers with fewer than 25 employees may be eligible for a tax credit for a portion of their contribution to employee premiums. The maximum credit for small businesses is 50% of the amount paid toward employees’ premiums. The maximum credit for nonprofit employers is 35%. Small business tax credits are only available when coverage is purchased through beWellnm for Small Business. Learn more about premium tax credits for small business.

Small employers with fewer than 50 employees are not required to provide insurance and are not subject to penalties for not offering a health plan. Employers with 50 or more full-time employees (including full-time-equivalent employees) are subject to a penalty if they don’t provide affordable health insurance. Employers of any size are not required to provide insurance for dependents or for part-time employees (generally, those who work fewer than 30 hours a week).

beWellnm for Small Business offers health plans to New Mexico businesses and nonprofit organizations with 2-50 full-time-equivalent employees. 

No. You must have at least two employees to purchase a plan through beWellnm for Small Business. Sole proprietors may purchase individual insurance through HealthCare.gov. 

Employer coverage is considered affordable if the employee’s share of the annual premium for the lowest priced self-only plan is no greater than 9.56% of his or her annual household income.  

If you have 2-50 employees, there is no penalty. If you have 50 or more full-time employees and the coverage you offer meets minimum value requirements and is affordable, you aren’t subject to penalties if employees fail to enroll. Generally, a health plans meets standards if it pays at least 60% of the total cost of medical services for a standard population, and if its benefits include substantial coverage of inpatient hospital and physician services. Employees who are offered coverage that meets these requirements aren’t eligible for a premium tax credit on the individual Exchange.

For employers of 50 or more full-time-equivalent employees who do not meet the standards for providing health insurance, one of the following may apply :

$2,000 fine per employee (excluding the first 30 employees) per year for not offering coverage. This amount will be adjusted for inflation.

$3,000 fine per employee for each full-time employee receiving a tax credit when buying insurance on the individual Exchange, or the above penalty, whichever is less. This amount will be adjusted for inflation.

The four levels are bronze, silver, gold and platinum, also called metal levels. Bronze plans typically offer the lowest premiums, but generally have higher out-of-pocket costs, such as deductibles, copays, coinsurance and out-of-pocket maximums. Platinum plans generally have the highest premiums but lowest out-of-pocket costs. When choosing a plan, consider the needs of the employees in terms of paying for out-of-pocket costs as well as the premium costs. You should also consider the needs of the business or nonprofit organization, including finances and competition for employees.

Average coverage of health care costs:
$ Bronze: Health plan pays 60%. Employee pays 40%.
$$ Silver: Health plan pays 70%. Employee pays 30%.
$$$ Gold: Health plan pays 80%. Employee pays 20%.
$$$$ Platinum: Health plan pays 90%. Employee pays 10%.

 

No. The metal level has nothing to do with the quality of care provided by the plan. All plans offered through beWellnm for Small Business must provide coverage for essential health benefits and pre-existing conditions, as well as offer free preventive care. The metal level refers only to the premium costs and amount of coverage provided by the plan.
 

If you have 2-50 full-time employees, you are not required to offer coverage or pay a penalty. However, health insurance is an important benefit and can help you attract and keep valuable employees. Some employers increase wages to help offset the costs workers must pay to buy insurance on their own. However, any increase in wages is taxable income. Health insurance premiums are generally paid on a pre-tax basis.
 
If you have 2-50 or more full-time employees, you may face penalties for not offering affordable coverage. You should compare the cost of providing coverage against the cost of potential penalties.

For nonprofits and businesses with 50 or more full-time employees, there are rules about employer coverage affordability. Generally, if any of your employees qualifies for a premium subsidy through the individual marketplace, you may owe a penalty. A broker/agent can help you in determining if your coverage fits the affordability guidelines.

You can enroll in beWellnm for Small Business throughout the year. There is no open enrollment period for beWellnm for Small Business coverage, as there is for individual health insurance coverage.

If you have more questions, please call 1-800-204-4700 (TTY: 1-855-851-2018). or email [email protected].

BeWellnm for Small Business (formerly called SHOP) is New Mexico’s health insurance marketplace for small businesses and small nonprofit organizations with 2 to 50 full-time-equivalent employees. Sponsored by the New Mexico Health Insurance Exchange, beWellnm for Small Business offers competitively priced health plans that cover essential health benefits as well as preventive care, with no pre-existing condition restrictions. BeWellnm for Small Business is the only place where employers may qualify for a tax credit by providing coverage to their employees.

Yes. Many companies prefer to work with an agent or broker, since the services of these experts are free to small business owners. Agents and brokers understand the New Mexico health insurance market and can help business owners choose the plan that best meets their needs. Find an agent or broker who can help you enroll in group health insurance.

The number of full-time-equivalent (FTE) employees is used to determine eligibility for small business premium tax credits and applicability of employer penalties for not offering coverage. The IRS uses a full-time-equivalent calculation, which adds the number of full-time and part-time FTEs. Part-time employee hours are translated into an “equivalent” number of full-time employees. For more information, check out the FTE calculator in our Small Business Toolkit.