Insurance Basics Frequently Asked Questions

If you purchase a health plan for yourself or your family. You have an Individual and Family plan. This means you don’t have coverage through an employer, Medicare or Medicaid.

Individual and Family plans are plans you enroll in on your own during the Open Enrollment Period, or during a Special Enrollment Period if you have a qualifying event. These plans cover a wide range of services and:  

• Last a year or longer 
• Can usually be renewed  
• Meet the essential requirements set by the Affordable Care Act (ACA), including:
  • Emergency services, hospitalization and preventive care
  • Maternity, newborn and pediatric care 
  • Mental health care and substance use treatment  
  • Lab services, prescription drugs, and disease management 
  • Rehabilitative services and devices 

If you enroll in an Individual and Family plan, you may be able to get help paying for it with a premium tax credit, known as a subsidy. Learn more about getting financial help to lower your monthly bill.

Medicare is coverage for people 65 and older and people under 65 with certain disabilities and illnesses. You can enroll in individual Medicare or get Medicare as a retiree through your employer.

Original Medicare includes Part A (hospital) and Part B (medical). You can beef it up with additional coverage, including:

• Part C – Medicare Advantage Plans offer all-in-one coverage, some with built-in prescription drug coverage.
• Part D – Prescription drug coverage pays for approved drugs not covered by Original Medicare Parts A and B.
• Medicare Supplement Insurance Plans – Help pay for health care costs not covered by Original Medicare.

Need more information? Attend an event with us.

Medicaid is a joint federally and state-funded program that provides health care coverage mainly for people with a low annual income. CHIP is a program that offers health care coverage for the children of families who qualify. Some states have their own Medicaid programs, but New Mexico participates in the federal Medicaid and CHIP programs.

Medicaid and CHIP are types of low- or no-cost health insurance offered by the government. Eligibility is based on household size and income. You can apply any time of year. If you qualify, coverage can start right away.

• For Medicaid,  visit Medicaid.gov.
• For CHIP,  visit Medicaid.gov/chip  or call  1-877-543-7669.

If you get your coverage through your employer, an association or other organization, you have a group insurance plan. Group plans are sometimes called employer-sponsored plans.

Many plans cover health, dental, vision and more. But some only cover health. You may need a separate policy for dental and vision coverage.

Dental and vision insurance plans help cover dental and vision costs for you and your family. These types of plans can:

• Cover a wide range of dental and vision services, including routine care like annual visits. 
• Be bought as part of your Individual and Family health plan or as stand-alone plans. 

An HMO is a type of health plan that provides health care coverage to its members at a lower cost because you have one doctor, a primary care provider (PCP), coordinating your care. You’ll have lower copays and other out-of-pocket costs when you work with your PCP to schedule appointments with other health care providers. 

Learn more about HMOs.

If you like having the flexibility to choose the doctors, hospitals and other health care providers you use for care and you can afford to pay more, PPO insurance may be the right plan for you and your family.

PPO plans offer more flexibility in choosing where you go for care. You don’t need a referral from a PCP or to stay within a certain medical group. You aren’t limited to certain providers in your plan's network, though you will likely end up paying more out of pocket if you get your care outside your PPO network. PPO’s often have higher monthly premiums and out-of-pocket costs like copays, coinsurance and deductibles. With BCBSNM, there are different PPO plans to help meet your budget and health needs.

Learn more about PPOs.

A CDHP is a health plan with a health savings account (HSA) or other tax-advantaged account like a flexible spending account (FSA). These plans give members more control of health care expenses.

Learn more about HSAs and FSAs.

An HSA is an account that you can use to pay for qualified medical expenses, including dental and vision services. 

Things to know about an HSA:

• Pre-tax contributions: If you are eligible for an HSA, you and your employer can make tax-free contributions (up to the annual limit) to your HSA.
• Tax-free withdrawals: As long as you are paying for a qualified medical expense, withdrawals from your HSA are tax-free. 
• Portability: Take your HSA account with you, even if you change jobs or health plans.

Learn more about HSAs.

An FSA is an account that lets you deposit and save pre-tax dollars to pay for qualified expenses. There are different types of FSAs. The most common type is used for medical expenses. Sometimes it’s called a Health Care Flexible Spending Account (HCFSA).

You can choose to have an FSA if your employer offers it. You set aside a part of your earnings for the account. An FSA can be used along with any traditional health insurance plan.

Your employer owns your FSA. You can’t take your FSA account with you if you change jobs or retire.

Learn more about FSAs.

Supplemental health insurance offers extra policies you can enroll in to “add to,” or supplement, your medical health insurance plan. It helps you pay medical bills and living costs when you get sick or hurt. Our Supplemental Health products include Accident, Critical Illness and Hospital Indemnity insurance.