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Medicare Part D Plans in New Mexico


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Medicare Part D in New Mexico is considered optional coverage, but if you don’t have creditable prescription drug coverage from another source, you’d be wise to sign up as soon as you’re eligible. If you don’t, you could pay a late-enrollment penalty with your premium each month as long as you have coverage.

Here’s what you need to know about enrolling in Medicare Part D in New Mexico.

What is Medicare Part D in New Mexico?

Medicare Part D is a prescription drug insurance program authorized by Congress in 2003 as part of the Medicare Modernization Act. Unlike Original Medicare (Part A and Part B), which is administered by the federal government, Part D plans are offered and administered by private insurance companies regulated by Medicare. Although each company offering Medicare Part D in New Mexico must provide a minimum level of coverage required by the Centers for Medicare and Medicaid Services (CMS), they are free to set their own benefits and exclusions.

For you as a consumer, this means that plan premiums, deductibles, copayments, and coinsurance amounts may differ from plan to plan. There may also be other rules and regulations specific to each plan.

If you are shopping for Medicare Part D in New Mexico, be sure to get all the details so you know what your costs and benefits will be, since they may vary significantly by insurance company.

What does Medicare Part D in New Mexico cover?

All Medicare plans with prescription drug benefits use a formulary, which is a list of prescription drugs covered by the plan and the benefits available for each one. Formularies may change at any time but you will be given notice when necessary. By law, the formularies must include at least two different medications in each class of drugs defined by Medicare, although most plans cover more than two. They must also cover essentially all medications in the following classes:

  • HIV/AIDS medications
  • Antidepressants
  • Antipsychotics
  • Anti-seizure drugs
  • Immunosuppressants
  • Anti-cancer drugs

Medicare Part D in New Mexico also covers all commercially available vaccines that aren’t covered by Medicare Part B.

Medicare plans with prescription drug benefits generally cover a broad range of generic and brand-name medications, but if you take prescription drugs on a regular basis, it’s a good idea to check with each particular plan you are considering to be sure your medication is on the formulary.

Keep in mind, depending on the plan, you may have to follow special rules to get certain medications. These might include prior authorization, quantity restrictions limiting the amount of doses you can buy at one time, or step therapy, in which your doctor prescribes a lower-cost medication first to gauge your response to treatment before prescribing more expensive alternatives.

How do I enroll in Medicare Part D in New Mexico?

Your initial enrollment period for Medicare Part D is the same as other Medicare coverage: The seven-month period beginning three months before you turn 65, your birth month, and the three months after. You can also change plans during Medicare open enrollment between October 15th and December 7th each year.

You can get stand-alone Part D prescription drug coverage as a complement to Original Medicare or you can sign up for an all-in-one Medicare Advantage plan that includes Part D coverage for prescription drugs. Most Medicare Advantage plans include Part D coverage.

Once you find a plan you like, simply follow the enrollment instructions with the insurance company you choose.

It’s important to keep in mind that if you enroll in a Medicare Advantage plan with Part D, and then enroll in a stand-alone Medicare Part D Prescription Drug Plan, you will be automatically unenrolled from your Medicare Advantage plan and returned to Original Medicare. You can only have one type of Part D prescription drug coverage at a time.

What else should I know about Medicare Part D in New Mexico?

There are currently 30 Medicare Advantage plans and 24 stand-alone Medicare Part D plans in New Mexico according to the Centers for Medicare and Medicaid Services (CMS). Over 90% of enrollees have access to Medicare Part D in New Mexico with a low premium than they had the year before. The lowest plan premium for Medicare Part D prescription drug plan in New Mexico was just $17.40 monthly. Thirty-eight percent of Medicare beneficiaries in New Mexico qualify for the Extra Help program, which covers some of the costs associated with Part D prescription drug coverage.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply.

Benefits, premiums and/or copayments/co-insurance may change on January 1 of each year.

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