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SANTA FE, N.M. (AP) — For a state that's long struggled with one of the nation's highest uninsured rates, New Mexico has a lot at stake with a new health insurance marketplace that starts enrolling customers on Tuesday.
Individuals and small businesses — those with 50 or fewer workers — can begin to shop for insurance through a health insurance exchange that's intended as a one-stop shopping center for health coverage offered by private insurers. Coverage would begin in January.
Enrollment can be done online by going to the state exchange's website (http://www.bewellnm.com/ ), by telephone or in person at about 160 locations across the state, mainly medical clinics and hospitals.
Nearly a fourth of New Mexico's population lacks health insurance. Only five states had a higher rate last year, according to the Census Bureau.
Although the uninsured are the primary target of the exchange, it's available to others as well.
Individuals who buy their own insurance or obtain it through an employer can go to the exchange to compare costs and purchase coverage if they a find plan that's more affordable or better suited to their health care needs. Immigrants living in the country illegally are barred from buying through the exchange, however.
Exchange officials estimate more than 80,000 New Mexicans may enroll in an insurance plan through the exchange in its first year and more than 200,000 by 2020.
Some uninsured — potentially 90,000 next year and perhaps 170,000 over several years — will end up obtaining medical care through Medicaid, which the state is expanding starting in January to cover more low-income adults. When people seek coverage through the exchange, they'll be directed to Medicaid if they're eligible for the program.
"I am really hopefully that we'll cut our uninsured rate in half this first year and as word gets out and as more and more people avail themselves of these programs we'll really see a dramatic drop in the uninsured rate to something much more like what it should have been all along," said Sen. Gerald Ortiz y Pino, an Albuquerque Democrat who sponsored legislation this year to create the exchange.
Initially, New Mexico is operating a state-run exchange for small businesses to shop for coverage for their employees but will use a federally operated exchange to enroll individuals for the next year.
The insurance plans available to individuals, however, will be specifically tailored to New Mexico. Individuals can go to the state exchange website to begin to shop for plans and they will automatically be linked to the federal government's exchange to complete the application process.
One potential complication has arisen that could create problems in heavily Hispanic New Mexico. The federal website's Spanish-language version won't be ready for online enrollment for a few weeks.
But New Mexico's call center and in-person enrollment sites will offer help for Spanish speakers.
"I am hopeful that our infrastructure, both through the call center as well as the enrollment assisters, can help bridge that gap for the time being," said Jason Sandel of Farmington, vice chairman of the exchange's 13-member governing board.
But Sandel is bracing for glitches in the early days of the exchange.
"Is it going to be seamless? Is it going to be perfect? Absolutely not. The only way we are going to be able to overcome those challenge is for folks to give us feedback so that we can improve," said Sandel.
SANTA FE, N.M. (AP) — New Mexicans can start shopping Tuesday for health insurance through a new marketplace called a health insurance exchange. Here are a few questions and answers:
WHAT IS THE EXCHANGE?
It's a one-stop shopping center to buy health insurance from private insurers, with the package of benefits tailored to New Mexico. The exchange allows individuals and small businesses — those with 50 or fewer employees — to compare a range of plans offered by several companies.
HOW DO I USE IT?
Enrollment is possible online at the New Mexico exchange website (http://www.bewellnm.com ), through a toll-free telephone number or it can be done in person at about 160 health clinics and other sites across the state. The exchange is to publicly release the call center phone number Monday. Assistance by phone and at in-person sites will be available in English and Spanish. There will be health care "guides" at some locations that speak Native American languages, such as Navajo. New Mexico initially is using a federal government website to enroll individuals. New Mexicans can go to the state's website and will automatically be connected to the federal exchange. There will be paper applications on the federal website available in English and Spanish.
WHAT ARE MY INSURANCE OPTIONS?
Five insurance companies will offer a range of plans for individuals, and four companies will provide coverage for small businesses. Consumers will be able to pick from insurance plans with a range of coverage called bronze, silver, gold and platinum. The least costly, or bronze, plans will require people to pay more out-of-pocket expenses. The cost sharing of medical expenses is less with other plans, but premiums will be higher. Bronze plans are to cover about 60 percent of health care costs on average, with 70 percent coverage for silver plans.
HOW MUCH WILL IT COST?
Costs will vary depending on a person's age and within different regions of a state. Premiums typically will be lower in Albuquerque because it has more health care providers and greater competition. Premiums generally will be higher in rural areas and in smaller communities.
Individuals in New Mexico will pay an average of $282 a month for a mid-range insurance plan considered a benchmark by the federal government, according to a recent government report. That's lower than the national average of $328.
Those costs are before tax credits that individuals and businesses may be eligible to receive. The credits will be available to individuals with incomes up to nearly $46,000 a year and $94,000 for a family of four. Individuals with "affordable" coverage through their employer aren't eligible for subsidies, however.
The tax credits employers get will vary based on the average wage of their employees.
WHEN WILL THE COVERAGE START?
In January for people who enroll soon. Employers can start selecting a type of coverage they want to offer their workers, such as a silver plan. Then in November, the employees can pick from the range of silver plans offered by different companies. It's possible that workers for the same company will get insurance from different insurers.
Enrollment is open for individuals from Oct. 1 through March 31, 2014. There will be another open enrollment for individuals starting next October. There's no similar enrollment deadline for employers in New Mexico.
WHAT HAPPENS IF I DON'T ENROLL IN AN INSURANCE PLAN?
There's a penalty next year of $95 per adult and $47.50 per child, or 1 percent of annual income, whichever is higher. A family would pay a penalty of no more than $285 next year. The penalties increase every year. People will need to prove they have insurance or pay the fine when they complete their 2014 federal income tax returns, which are due in early 2015. American Indians and some others are exempt from the penalties.
Follow Barry Massey on Twitter at https://twitter.com/bmasseyAP