New Mexico Health Connections wants to be your resource for understanding the changing landscape of health insurance.
The terms “Affordable Care Act” (ACA), “Obamacare,” and “healthcare reform” all refer to the same law that has been changing health insurance rules to benefit you. This section of our website has information critical to understanding the law, and provides some links to other websites in case you want to learn more.
- One term you may hear a lot is “Exchange.” The Health Insurance Exchange, also called the Health Insurance Marketplace, is a place where people that qualify for assistance will buy health insurance. The terms “Exchange” and “Marketplace” are interchangeable.
- The basic promise of the Affordable Care Act is to expand health insurance coverage by giving individuals, families, and small businesses new ways to get insurance. It was created to target people who don’t have health insurance, either because they couldn’t afford it or don’t qualify for public assistance programs like Medicaid.Now with the assistance of the ACA, uninsured New Mexicans may qualify for tax credits to assist with the purchase of health insurance coverage in the Marketplace, or they may qualify for Medicaid.
What the ACA Means to You
Under the Patient Protection and Affordable Care Act, all individual and small group plans have the following benefits:
- Outpatient services
- Emergency services
- Maternity and newborn care
- Mental and substance abuse
- Prescription drugs
- Rehabilitation services and devices
- Lab services
- Preventative and chronic disease management
- Pediatric dental and vision
- All state mandates
Keep in mind that:
- These benefits have no annual or lifetime maximums.
- There are no longer be pre-existing condition exclusions. This means you cannot be turned down for coverage based on your medical history. It also means that you will not have to pay extra for your health insurance premiums because of your medical history.
- Some individuals and their families may be eligible to receive an Advanced Premium Tax Credit (APTC or subsidy). This will be based on household income, and will help cover some of the cost for your insurance premiums.
- New Mexico has the highest uninsured population in the country. The Affordable Care Act is an important step toward ensuring more New Mexicans get health insurance.
- When you have health insurance, you and your family will have access to preventive care services (like annual physicals, mammograms, and well-child visits) without having to pay a copay.
- The ACA is also increasing financial support for community health centers and primary care practitioners. In New Mexico, 15 health centers operate 145 sites, providing preventive and primary care services.
For more information on health reform in New Mexico, check out the following sites:
Health Action New Mexico
Getting to Know the Exchange
The Health Insurance Marketplace (also called the Exchange), or healthcare.gov, is a virtual marketplace where individuals and families can shop for health insurance coverage.
Depending on your household Modified Adjusted Gross Income (MAGI), you may be eligible for assistance in paying your monthly health insurance premiums. You may also be eligible for reduced cost-sharing amounts when you access healthcare services. Households earning up to 400% of the annual Federal Poverty Level may be eligible for premium assistance, or subsidy. Households earning up to 250% of the annual Federal Poverty Level may be eligible for cost-sharing reductions.
If you believe you are eligible for a subsidy, you must apply for coverage through the federal Health Insurance Marketplace at www.healthcare.gov, or by calling 1-800-318-2596.