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New Mexico's Health Insurance Model Is Unique

By Kathleen Doheny
WebMD Health News

Reviewed by Lisa Zamosky

July 23, 2013 -- As efforts are ramped up to meet the deadlines of the Affordable Care Act, New Mexico's health insurance Marketplace (also called an Exchange) will take a hybrid approach, unlike most other states, officials said.

"We opted for a hybrid model, where New Mexico will stand up for the SHOP Exchange for small employers and rely on the feds for the individual Exchange," said Mike Nunez, CEO of the New Mexico Health Insurance Exchange. "We will implement this hybrid model for 2014 and move toward a full state-based exchange in 2015."

The state approved the hybrid model in May, Nunez said. Federal officials gave conditional approval on July 10.

Earlier this month the state launched a new web site for the New Mexico Health Insurance Exchange. Both individuals and small employers can use the web site to shop for insurance, Nunez says. "Behind the portal, New Mexico will administer the SHOP, and the feds will administer the individual Exchange."

Utah also will have a hybrid model, but the individual Marketplace and small business Marketplace will have separate web sites.

About 450,000 of New Mexico's nearly 2.1 million residents have no health insurance, Nunez said. Around 83,000 residents are expected to buy through the Marketplace, including 8,000 through small business and 75,000 as individuals, he said.

The Medicaid expansion is expected to extend coverage to 90,000 New Mexicans.

Five insurance companies have applied to sell through the Exchange. Their rates are pending review. The companies are:

  • Blue Cross and Blue Shield of New Mexico
  • Lovelace Health Plan CK ALL 5
  • Molina Healthcare of New Mexico
  • New Mexico Health Connections
  • Presbyterian Health Plan

SOURCES: Mike Nunez, CEO, Health Insurance Exchange, New Mexico. U.S. Census Bureau.

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