Medicare Advantage (Part C) plans are private health insurance plans approved by Medicare that provide an alternative to Original Medicare. These plans must cover everything Original Medicare covers. Most also include prescription drug coverage, and some offer extra benefits such as dental, vision and hearing. Medicare Advantage plan availability varies by county across New Mexico.
How Medicare Advantage Works in New Mexico
When you enroll in a Medicare Advantage plan, you still have Medicare (and continue to pay your Part B premium), but you receive your Part A and Part B benefits through the private plan. Plans may charge their own monthly premium on top of your Part B premium, and premiums vary by plan and county.
Medicare Advantage plans use provider networks, so it is critical to verify that your preferred doctors, specialists, and hospitals in New Mexico participate in the plan you are considering. Compare Medicare Advantage plans in your county.
Types of Medicare Advantage Plans
- HMO (Health Maintenance Organization): Requires you to use in-network providers and get referrals for specialists. Often has lower premiums and copays.
- PPO (Preferred Provider Organization): Allows out-of-network care at higher costs. More flexibility but usually higher premiums.
- PFFS (Private Fee-for-Service): Determines how much it will pay providers and how much you pay. Providers must accept the plan's terms.
- SNP (Special Needs Plan): Designed for beneficiaries with specific diseases, limited incomes, or dual eligibility (Medicare and Medicaid).
- MSA (Medical Savings Account): High-deductible plan with a bank account that Medicare deposits money into for healthcare expenses.
Extra Benefits Some Medicare Advantage Plans Offer
Medicare Advantage plans may offer extra benefits that Original Medicare doesn't cover, such as:
- Dental care
- Vision care
- Hearing exams and hearing aids
- Fitness programs
- Transportation to medical appointments
- Telehealth visits
Extra benefits vary by plan and county, may have limits and costs, and not every plan offers them. Check a plan's Summary of Benefits or Evidence of Coverage.
Compare Medicare Advantage Plans in Your County
Because Medicare Advantage plan offerings, premiums, benefits, and provider networks differ by county, comparing your specific options is essential. What is available in Bernalillo County (Albuquerque) will differ from what is available in San Juan County (Farmington) or Dona Ana County (Las Cruces).
When to Enroll in Medicare Advantage
- Initial Enrollment Period: 7-month window around your 65th birthday
- Annual Enrollment Period: October 15 – December 7 to switch plans or join for the first time
- Medicare Advantage Open Enrollment: January 1 – March 31, for people already in a Medicare Advantage plan, to make one change: switch Advantage plans or return to Original Medicare
- Special Enrollment Periods: Triggered by qualifying events like moving to a new county