Neighbors Help Each Other: A Certified Assister’s Story of Connecting New Mexicans with Health Insurance
Miranda Tso, Native American Liaison Manager, became a beWellnm Certified Assister in 2016. A lifelong New Mexican, she has a passion for helping her neighbors get high-quality health insurance—a passion that starts with getting to know her neighbors throughout the state.
“Being a Certified Assister takes passion for providing education and helping people get what they need,” said Tso. “It brings me joy to see someone walk confidently out the door after an enrollment session, when I know they understand their plan and what they need to do to use it.”
Tso says a lot of people think the Certified Assisters only help during Open Enrollment, the time of year when anyone can make changes to their health insurance coverage. But that’s simply not true.
“We are here all year long to help people in three ways,” Tso said.
Those three ways include:
- Personalized guidance: Getting to know people on a personal level to understand how best to serve their needs.
- Month-to-month updates: Answering questions and updating information to maximize your benefits.
- Year-end tax planning: Helping you sort out your health plan-related tax information to avoid paying unexpected penalties.
Personal Help: What Do You Need in Your Coverage?
Getting to know people is Tso’s favorite part of her job. She serves as a Tribal Liaison Manager for beWellnm. meeting with Native American tribal leadership, communities, programs, customers and health centers to help more Native Americans voice their health needs and connect with health insurance.
Tso and her fellow Certified Assisters organize and lead community outreach and customer education events to help New Mexicans understand and enroll in high-quality health insurance—a challenge that requires personalization and really understanding her neighbors.
“Over the years, I’ve seen people who feel worried about getting health insurance. Maybe they had a bad experience in the past, or maybe they’re worried they can’t afford it,” she acknowledged. “As a Certified Assister, my role is to get to the root of those concerns. We’ll help you avoid surprises and replace bad feelings with confidence!”
When you meet one-on-on with a Certified Assister, they will ask questions about your:
- Health needs, like prescription drug coverage
- Job—seasonal, part-time, full-time, or unemployed
- Income—above or below the federal poverty level (FPL)
- Household size and needs
Using that information, we will help you sort through the many available health insurance plans from top New Mexico carriers the find the plan that best meets your needs and budget. Then, we’ll give you information to think through your options or help you enroll on the spot!
Related reading: Enrolled… Now What?
Help from your Certified Assister doesn’t end after you enroll, said Tso. “We’re here year-round to make sure you understand what your insurance covers, how to use it and what you can expect to pay.”
Tso emphasizes that keeping your information up to date with beWellnm is the best way to avoid unexpected costs. “If your income, household status or employment changes, call us with that update,” Tso said. “Getting accurate information can save you more money each month and avoid having to pay back benefits come tax time.”
We recommend that everyone, especially those who are self-employed, check in quarterly or mid-year with a beWellnm Certified Assister to make sure you are on track to avoid insurance financial assistance-related tax penalties at the end of the year.
Meet with a Certified Assister anytime throughout the year to get help with making updates to your information.
Helping you keep insurance costs affordable month-by-month is a big part of the Certified Assister’s job. Financial assistance is available for New Mexicans who qualify. For example, if any of these apply to you:
- Your income is 100%-400% above the federal poverty level
- Are Native American
- Can’t get health insurance at work
- Don’t qualify for Medicaid
- Can’t afford coverage for your household through an employer-sponsored plan
There are many ways to make health insurance affordable in New Mexico. A few of these include:
- Health Care Affordability fund: This is financial assistance that doesn’t have to be reported to the State of New Mexico on your taxes. We’ve seen situations where the fund helped cover the full cost of the monthly premium.
- Advance premium tax credits: If your income is above 400% of the federal poverty level, you may qualify for premium tax credits to lower your monthly health insurance premium for a beWellnm plan.
- Extra savings: If you do not qualify for Medicaid or employer-sponsored insurance, you may qualify for cost savings with a beWellnm plan.
- Subsidies: BeWellnm is the only place you can get subsidies to significantly reduce the cost of health insurance.
Through beWellnm, you don’t have to come all the way to Albuquerque to meet with a Certified Assister. We belong to a dedicated network of community partners who help us connect with New Mexicans throughout the state, where and when it is convenient for you.
Certified Assisters working at these locations hold education and outreach enrollment sessions where people can enroll in health insurance, make changes to their plan during open enrollment and check in to update their income throughout the year.
We are also working to embed Certified Assisters in insurance broker offices and within Native American communities throughout the state to get the word out about how we can help New Mexicans get health insurance.
Understanding Your Plan
Signing up for insurance for the first time—or the twentieth time—can be confusing, Tso admits. “Things change year to year with the rules for financial assistance. People change jobs, develop new health needs and grow their families. That’s why we are hear to help year round!”
New Clear Cost plans make it easier to see what each plan includes and what amount of money you’ll save. But not everything is so simple!
Call your Certified Assister anytime throughout the year to ask questions about your plan, how to use it and what you are responsible to pay. Common questions include:
- Can I stay on the same plan I had last year?
- Does another carrier offer a better plan for my needs?
- Does this plan cover my prescriptions?
- Is beWellnm the same as Obamacare?
- Can I still see my Tribal Healthcare Center provider?
- What hospital can I go to with this plan?
A Certified Assister will also help you understand confusing terms associated with your plan, such as:
- Deductible: The amount you must pay with your own money before insurance starts to pay for health care.
- Out-of-pocket max: The most you will pay in a year (January to December) for health care.
- Summary of Benefits and Coverage statement: The SBC is a document that uses simple terms to explain important details about your health insurance.
- Co-pay: The set amount you pay for covered services, such as when you visit the doctor for any reason.
- Co-insurance: The percentage you must pay for care, after your deductible.
Related reading: Wow, My Health Insurance Does That?
End of the year: Sorting out tax dollars
“If you’ve been on top of your updates throughout the year, preparing for tax time will be a breeze,” Tso urged. “If not, your Certified Assister has your back!”
Premium tax credit assistance must be reported on your taxes. When you enroll, you will estimate your income for the coming year to see how much financial help you can get to pay for health insurance. For example, if you estimate that you are going to make $50,000 in 2024 but you wind up making $60,000, you will likely have to pay back some money to the state for the extra support.
We’ll also help you fill out the employee coverage form 1095-C for your taxes. If you pay more than 9.12% of your income toward your health plan at work, you can get tax credits if you enroll with beWellnm. You can also apply for tax credits to cover the costs of dependents’ insurance through beWellnm if you take individual insurance through your job.
Certified Assisters can help you find a plan that works for you, and we are available year-round to answer questions and check in. Certified Assister services are at no cost to you. So, there’s no harm in asking questions and applying for benefits—you never know what subsidies you can get until you try.
Ready to get help from a Certified Assister, in person or online? Schedule an appointment with a Certified Assister near you.
Where do I begin?
With more than 56,000 uninsured New Mexicans who qualify for significant premium reductions, you may be one of them. Having the security of health insurance coverage may be more affordable than you think.