In New Mexico, medical underwriting is allowed without restriction. There is a 6 month look back and exclusionary period for preexisting conditions.
High Risk Pool
New Mexico offers a high risk pool called the New Mexico Medical Insurance Pool. You may be eligible for this pool due to your HIPAA rights or if you are a resident of New Mexico and you have been denied health coverage, have been accepted for coverage but at a higher rate than the high risk pool, received a reduction in services for at least 12 months, were involuntarily dropped from your current coverage, or you have been diagnosed with one of the conditions listed on the pool application.
Coverage under this high risk pool insurance plan includes Hospital room and board, medical-surgical services including both in-hospital and out-of-hospital, diagnostic services, anesthesia, consultation services, professional services for the treatment of illness or injury provided by a physician, prosthesis other than dental, ambulance Services, rental, or purchase, of durable medical equipment, diagnostic x-rays and laboratory tests, oral surgery for partially or completely unerupted impacted teeth and dental accident care, services of a licensed physical, occupational, or speech therapist, blood and blood plasma, inpatient and outpatient services for the treatment of mental illness, alcoholism, and substance abuse, hospice care, prescription drugs, skilled nursing facility services, home health care services, routine mammograms, pap tests and prostate examinations, radium and other radioactive materials, oxygen, diabetic patient education program, heart, lung, pancreas, kidney, liver, cornea and bone marrow transplants for specific condition listed in the NMMIP policy.
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Medicaid is a state/federal program that pays for medical and long-term care services for low-income pregnant women, children, certain people on Medicare, disabled individuals and nursing home residents. These individuals must meet certain income and other requirements.
Income requirements
Children
Children (ages 1-5)-235% of the Federal Poverty Level
Children (Ages 6-19)-235% of the Federal Poverty Level
Pregnant Women and Infants
Pregnant Women-185% of the Federal Poverty Level
Infants (ages 0-1)-235% of the Federal Poverty Level
Parents
Non-Working Parents-30% of the Federal Poverty Level
Working Parents-69% of the Federal Poverty Level
Other populations
Supplemental Security Income Recipients- 74% of the Federal
Poverty Level
Covered Services
Hospital outpatient, rural health clinic, federally qualified health centers, laboratory and x-ray, nursing home, physician services, dental, early periodic screening diagnosis and treatment, family planning, clinic services, prescription drugs, case management, medical transportation, nurse midwife, extended services for pregnant women, and ambulatory prenatal care.
Co-Payments
Co-payments vary. There are no co-payments if you are under 18, pregnant, living in a nursing home, or receiving family planning services.
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