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  • NM
  • Male
  • 59 or younger
  • 1 Person
  • Income
  • Tribal Status
  • Insurance
  • Report

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How the Health Care Law Works for You

Private Individual Coverage

It is important to know what the health care law means for you and your family. There are new protections and coverage choices available to you—and you might even be able to get help with some of your costs.

Private individual insurance is health coverage you buy for yourself and your family. The health care law works to give you more options for coverage.

Did you know?

You can take a look at the range of insurance plans different companies offer, because shopping for coverage and comparing plans is now easier. Be sure to read Choosing a Health Care Plan before you make changes to your coverage.

You Have More Consumer Protections   

  • Your health plan can’t drop your coverage just because you get sick.
  • Your health plan can’t put dollar limits on how much it will pay for covered services you receive in a year (annual dollar limits) or over the life of the plan (lifetime dollar limits).
  • Your health plan can’t deny you coverage because of health problems you had before your insurance started (known as pre-existing conditions).
  • Your health plan can’t charge you more because of your gender or if you get very sick.
  • Health plans must justify rate increases of 10 percent or more.

Your Coverage Goes Further

  • Health plans will now offer four different tiers, known as “metal levels,” so it’s easier to make “apples-to-apples” comparisons among plans and to choose what plan works for you and your family.
  • You can keep your children on your family plan until they reach age 26—even if they don’t live at home, are married or attend school.
  • Your plan must spend at least 80 cents of every dollar on health care rather than on administrative costs (costs that are not related to your care).
  • There are limits on what your plan can make you pay for your deductible, copayments and coinsurance.

Your Coverage Has a Core Set of Benefits

  • Plans must cover certain important health care services, including:
    • Doctor’s office visits
    • Emergency room care
    • Hospital visits
    • Maternity and newborn care
    • Mental health and substance abuse treatment
    • Prescription drugs
    • Rehabilitative and habilitative services and devices
    • Laboratory services
    • Preventive and wellness services and chronic disease management
    • Pediatric services, including oral and vision care.
  • Your plan covers more preventive care. For example, health screenings and tests for colon cancer, diabetes and heart disease are now covered if they are recommended for you. See the full list of preventive services.

It is important to know that not all of these changes will apply to all health plans right away. Be sure to check with your plan to see what applies to you.

There Are New Ways to Shop for Coverage

If you will soon need new coverage or want to compare your options, you will now be able to do it through the Health Insurance Marketplace. Through the marketplace, you can shop online and get help by phone or in person to find the plan that works for you and your family. Visit the New Mexico Medicaid Program, sometimes referred to as New Mexico Medical Assistance or call (888) 997-2583 to learn more.

Get More Information

If you have more questions about your coverage and the health care law, or if you want to look at what other plans offer, check out these resources to learn more.

Find Local Help in Your State

Resources

These are your responses:

  • State: New Mexico
  • Gender: Male
  • Age: 59 or younger
  • Household: 1 Person
  • Income: Above $47,000
  • Tribal Status: No
  • Insurance: Private Individual Coverage