Affordable Care Act Factsheet and Resources
The Health Insurance Marketplace (Exchange)
The Health Insurance Marketplace enables you to shop, compare, and enroll in a health insurance plan. You and your family can explore every qualified insurance plan in your area, along with any tax credits and free or low-cost insurance programs you may qualify for.
More information about the Marketplace is available here.
Benefits of the Affordable Care Act
- You can’t be denied coverage for pre-existing health conditions.
- Your child can stay on your health plan until age 26.
- Your health insurance company can’t cancel your health insurance just because you get sick.
- You may be eligible to receive financial assistance to help you pay for your coverage.
- You have a choice between different types of health plans with easy to use comparison tools.
- You are guaranteed the right to appeal your health insurance company’s payment denials.
- Women cannot be charged more than men for the same health coverage.
- Most health plans must offer a set of preventative care services at no cost to you.
- Health insurance companies must spend 80% of their premiums on beneficiaries; no more than 20% may go toward administration and profits.
- New Mexico has the some of the lowest health insurance rates.
- Much more!
The Individual Responsibility Requirement
The individual responsibility requirement is a provision of the Affordable Care Act that requires you, your children, and anyone else that you claim as a dependent on your taxes to have health insurance in 2014 or pay a penalty.
Certain individuals (and their dependents) may be exempt from the penalty. These individuals include those whose household income is less than the filing threshold for federal income taxes for the applicable tax year (filing threshold exemption), as well as those whose required contribution for self-only coverage for a calendar year exceeds 8% of household income (affordability exemption).
If you are already receiving coverage through eligible employer-sponsored insurance, eligible individual insurance, grandfathered health plans, and federal programs such as Medicare, Medicaid, VA Health Care, CHIP and others, you do not need to purchase new health insurance.
More information about the individual responsibility requirement is available here.
- October 1, 2013: Start shopping for and enrolling in health insurance
- December 15, 2013: Sign up for insurance by this date to guarantee coverage on January 1, 2014
- January 1, 2014: Health insurance coverage starts
- March 31, 2014: Open enrollment for health insurance ends. If you do not have insurance by this date, you may have to pay a penalty.
- New Mexico Health Insurance Exchange (NMHIX) — New Mexico chose to create its own insurance marketplace where individuals and business can shop for health insurance, apply for financial assistance, and receive help filling out forms and assessing options. You can also shop the marketplace by calling 1-855-99-NMHIX (1-855-996-6449). For this year, individuals in New Mexico can use Healthcare.gov to shop and sign up for health insurance.
- Find Local Help — To find enrollment assistance and understand your health insurance options, make an appointment with a Health Care Guide or a registered New Mexico Health Insurance Exchange agent or broker near you.
- Veterans and Military Health Care — If you are already enrolled in VA health care or TRICARE, you don’t need to take additional steps to meet the Affordable Care Act’s coverage standards. The health care law does not change VA health care of TRICARE benefits or out-of-pocket costs.
- Indian Health Care — The Affordable Care Act includes special provisions for American Indians.
- Small Businesses — The New Mexico Small business Health Options Program (SHOP) simplifies the process of buying insurance for small businesses and their employees.
- Medicare — If you have Medicare, you are considered covered and don’t need to do anything. However the Affordable Care Act expanded Medicare benefits, including free preventative services and, if you are in the prescription drug “donut hole”, discounts on brand-name prescription drugs.
- Medicaid — New Mexico will expand its Medicaid program in 2014 to cover households with incomes up to 133% of the federal poverty level. That works out to about $15,800 a year for 1 person or $32,500 for a family of 4. If you're eligible, you get free or low-cost care.
- Children’s Health Insurance Program — The Children’s Health Insurance Program (CHIP) provides health coverage to nearly 8 million children in families with incomes too high to qualify for Medicaid, but too low to afford private coverage. The Affordable Care Act strengthened CHIP by providing additional funding and maintaining CHIP’s eligibility standards.
- File complaints involving grievances with insurance companies at the New Mexico Office of Superintendent of Insurance.
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