We reviewed the top 18 Medicare Advantage Plans available in Guadalupe County, New Mexico for 2024. Here's what we learned:
- The average premium is $29.22 per month.
- The average out-of-pocket limit is $4,886 per year.
- The average drug plan deductible (for plans that include Part D) is $227.14 per year.
- The Centers for Medicare & Medicaid Services (CMS) rated 56% of all plans available in Guadalupe County 4 stars or higher.
- There are no 5-star plans available.
- There are 2 plan types to choose from, including PPO, HMO, and possibly SNP plans (see: Guadalupe County, NM Medicare Special Needs Plans.
Guadalupe County, New Mexico Medicare Advantage Plans
Guadalupe County, NM
Medicare Advantage Plan Information
In County, Guadalupe, Medicare Advantage (MA) plans offer a distinct option for people on Medicare. These plans, also referred to as Medicare Part C, are provided by private companies authorized by Medicare, adhering to stringent regulations. Presently, there are 18 MA plans available (not including Special Needs Plans). Many deliver supplementary benefits beyond what Original Medicare provides.
Prescription medication coverage is one of the most popular additional benefits. These plans are also known as Medicare Advantage Prescription Drug Plans (MAPDs). These Guadalupe County plans offer people on Medicare comprehensive coverage that can help them reduce their out-of-pocket costs.
Medicare Advantage plans in New Mexico with a star rating of 4.0 or higher are often the plans people consider first. See: medicarewire.com/medicare-advantage/new-mexico/
2 Plan Types to Choose in Guadalupe County
The Medicare Advantage program was created to give people on Medicare (beneficiaries) a choice. To that end, Medicare developed 7 different types of private health plans. In Guadalupe County, 2 of the 7 types of Medicare Advantage plans are available, as follows:
Health Maintenance Organization (HMO) members usually receive services through the plan's local network of providers. Referrals are typically required to see a specialist and other providers. However, plans allow out-of-network care for emergencies and out-of-area dialysis. Prescription drug coverage is often included in HMO plans, and many plans include some coverage for dental, vison, and hearing.
Preferred Provider Organization (PPO) members can usually use in-network and out-of-network providers for care, including hospitalization. However, visits to non-network providers could cost significantly more. PPO plans often include prescription drug coverage and other benefits, and referrals are typically not required for specialist visits.
Getting Enrolled in a Medicare Advantage Plan
Most people with Medicare in New Mexico qualify to join a Medicare Advantage plan. The availability of plans in your area that meet your needs may be the determining factor.
You can join or switch Medicare Advantage plans during a Medicare Election Period. For most people, the Annual Enrollment Period, which starts on October 15 and ends on December 7, is the time they update their plan choices.
There's also an Individual Election Period (IEP) that you can use once. Your IEP is a 7-month period of time around your 65th birthday. It begins three months before you turn 65 and ends three months later. If you have Social Security Disability Insurance (SSDI), your IEP begins on the 25th month.
Adding Prescription Drug Coverage
Some individuals may be eligible to join a standalone prescription drug plan. Otherwise known as a PDP or Part D plan, a standalone prescription drug plan adds prescription coverage to Original Medicare and Medicare Advantage plans that do not include coverage for prescriptions.
It’s important to note that health plans that include prescription drug coverage may disenroll members who sign up for a separate drug plan. You cannot be enrolled in plans with overlapping benefits.
An Option to Medicare Advantage
If you are worried that your Medicare Advantage plan options in Guadalupe County may not meet your needs, or that Medicare Advantage plans are bad, inconvenient, or will limit your services, there is another way to get more coverage. There are Medicare Supplements available in New Mexico, as well as Medicare prescription drug plans. These work hand-in-hand with your Original Medicare to give you more coverage and more flexibility.
A Medicare Supplement protects you from big medical bills and may help you lower the total annual cost of your healthcare. See our directory of supplemental plans to compare supplemental Medicare insurance available in your area. The good news is that all supplemental insurance is standardized, offering you the luxury to buy the coverage you need based on the lowest price.
TIP: Medicare Advantage and Medicare Supplements do not complement each other as insurance options. Medicare Supplements are designed to work with Original Medicare and cannot be purchased while you are actively enrolled in Medicare Advantage.
Special Needs Plans (SNP) in Guadalupe County
Many people on Medicare have unique health plan needs. This includes institutional care, care for chronic diseases, and access to both Medicare and Medicaid. Consider a Medicare Advantage Special Care Plan (SNP) if you or your loved one has one or more of these special needs.
We organize Medicare Special Needs Plans for Guadalupe County, New Mexico in a separate directory. Although SNP plans are Medicare Advantage plans, they are only available to qualifying individuals, including:
- Individuals in a nursing home or receiving skilled nursing care at home;
- Individuals with both Medicare and Medicaid benefits; and
- Individuals with certain chronic health conditions.
The MA and MAPD plans on this page are available to people on Medicare enrolled in both Medicare Part A and Part B living in Santa Rosa, and all other areas of Guadalupe County, New Mexico.
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna Healthcare, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, UnitedHealthcare(R), and Wellcare.
Citations & References
- CMS.gov, "2024 Medicare Part C Landscape Source Files", Last Accessed October 14, 2023
- CMS.gov, "2024 Part C and D Performance Data", Last Accessed October 14, 2023
- Medicare.gov, "Types of Medicare Advantage Plans", Last Accessed 17 May, 2022
- Medicare.gov, "Special Needs Plans (SNP)", Last Accessed 11 June, 2023
- Medicare.gov, "Learn How Medigap Works", Last Accessed 1 July, 2023
Data & Statistics
The data presented on this page is derived from the 2024 Landscape Source Files and the Part C and D Performance Data published by CMS.
The average premium, average out-of-pocket limit, and average drug plan deductible statistics for Guadalupe County, New Mexico are derived from the most recent Landscape Source Files, excluding employer, MMP and SNP plans. MedicareWire publishes Special Needs Plans here.
Star rating statistics are derived from the most recent Part C and D Performance Data, excluding employer, MMP, SNP, and plans that have not yet been rated by CMS.
Highest-Rated Medicare Advantage Plans
CMS publishes the Medicare Advantage and Medicare Part D Star Ratings each year to measure the quality of health and drug services received by people on Medicare in Guadalupe County. MedicareWire highlights plans rated 4.0 or better as "highest-rated" or "top-rated" because they received the overall highest summary rating from CMS. According to CMS, "The Star Ratings system helps Medicare consumers compare the quality of Medicare health and drug plans being offered so they are empowered to make the best health care decisions for them."