Do I Have to Take Health Insurance from My Job?

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  4. Do I Have to Take Health Insurance from My Job?

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. 

But buying 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-based plan is ‘affordable’? 

When it comes to monthly premiums, “affordable” is different for every family. The federal government says in 2024, a job-based health plan is affordable if your monthly premium in the lowest-cost plan is less than 8.39% of your household income.  

 

Example: Let’s say your household income is $55,000 a year. The guidelines say an affordable monthly premium should be $384.00 or less. 

A job-based plan should cover at least 60% of your family’s medical costs. It should also cover most of the cost of hospital and doctor services.

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 good options. You may qualify for Medicaid if you live in New Mexico and have a low or very low income AND meet one or more of these criteria: 

  • Pregnant 
  • Responsible for a child younger than 18 
  • Blind 
  • Disabled 
  • 65 or older  

Or you may choose a plan with an insurance carrier through beWellnm. Every carrier in our marketplace offers quality insurance to New Mexicans with a range of budgets and health needs. Shop for a plan. 

When you enroll in a beWellnm health plan, you might qualify for a special tax credit that can lower your monthly premiums. Here’s the catch: If your employer’s insurance plan meets the guidelines for “affordable” and “minimum value,” you won’t be eligible for this tax credit. A beWellnm Certified Assister will talk through your options to make the best choice. 

Related reading: Advance Premium Tax Credit     

How do I know if my prescriptions are covered? 

Through beWellnm, you can choose from new Clear Cost Health Insurance Plans that show exactly what you’ll get with your plan. Clear Cost Plans also have reduced out-of-pocket costs for New Mexicans who qualify.  

Before you enroll in a job-based or beWellnm plan, ask about your household’s medications. Most plans list the coverage by tiers, with generic and brand name medicines at different price points. If you choose a beWellnm plan, we’ll help you understand your Summary of Benefits Coverage—a statement that shows the specific details of your plan. 

Ready to start? 

Finding the best plan is a big decision. No worries if the answer is “not yet”! Before you make a decision, talk with a beWellnm 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.  

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.