Choosing the right Medicare Advantage plan can make a significant difference in managing your healthcare. If you live in Albuquerque, New Mexico, you have access to a variety of plans with unique benefits, costs, and coverage options.
This guide breaks down the available plan types, out-of-pocket costs, and more to help you make an informed decision.
Overview of Medicare Advantage Plans in Albuquerque
In 2025, Albuquerque offers 38 Medicare Advantage plans from several top-rated insurance companies. These plans cater to diverse needs, providing options like low premiums, extra benefits, and specialized coverage for chronic conditions or dual-eligible beneficiaries.
Medicare Advantage Plans in Albuquerque
- Total Medicare Plans Available: 38
- Top Plan Types:
- PPO (Preferred Provider Organization): 18 plans
- HMO (Health Maintenance Organization): 12 plans
- SNPs (Special Needs Plans): 13 plans (including Chronic, Dual-Eligible, and Institutional)
- PFFS (Private Fee-for-Service): 1 plan
- These plans offer a mix of network flexibility and cost-saving opportunities, ensuring there is something for everyone.
Insurance Companies that Offer Medicare Advantage Plans in Albuquerque
There are 10 different insurance companies that offer the total 38 plans.
Each company brings unique benefits, such as $0 premium options, wellness programs, and broad provider networks.
Types of Medicare Advantage Plans Available
Medicare Advantage plans in Bernalillo County include various types to suit your individual preferences:
- Health Maintenance Organization (HMO): These plans require you to use in-network providers for most services.
- Preferred Provider Organization (PPO): Offers more flexibility to see out-of-network providers but may have higher maximum out-of-pocket costs.
- Special Needs Plans (SNPs): Tailored for individuals with specific conditions or eligibility requirements, such as dual-eligible for New Mexico Medicaid or those with chronic conditions.
- Private Fee-for-Service (PFFS): Allows you to see any provider that accepts the plan’s terms.
Maximum Out-of-Pocket Costs (MOOP)
Understanding MOOP is essential as it determines the most you’ll pay annually for your covered services with whatever plan you choose. Here’s what you can expect as a resident of Albuquerque:
- Average MOOP: $6,137
- Range of MOOP:
- Minimum: $2,800
- Maximum: $9,350
- Median: $5,400
- Distribution:
- $2,800: 3 plans
- $4,900: 6 plans
- $6,700: 3 plans
- $7,550 and higher: Several plans
These figures help you estimate your financial exposure under different plans.
How to Enroll in Medicare Advantage Plans
Enrolling in a Medicare Advantage plan in Albuquerque is straightforward.
As required by law, you must enroll using a health insurance agent who is both licensed with the State of New Mexico department of insurance as well as certified to sell the health insurance plan you’re interested in. Health insurance agents work both directly for insurance companies as well as local health insurance agencies like Medicare Health Benefits.
Health insurance agents with Medicare Health Benefits understand the Medicare Advantage plans in Albuquerque and can guide you to the best plan for your needs.
Frequently Asked Questions (FAQs)
- What is Medicare Advantage (Part C)?
Medicare Advantage combines Part A and Part B into one plan, often including additional benefits like prescription drugs, dental, and vision coverage. - How do I choose the best plan for me?
Consider your medical needs, prescription drugs, your preferred providers and specialists, budget, and the plan’s maximum out-of-pocket. Comparing plans on Medicare.gov or consulting a local agent can help. - What is the enrollment period for Medicare Advantage?
You can enroll during the Annual Enrollment Period (October 15 – December 7) or qualify for other enrollment periods under certain circumstances.
Glossary of Medicare Terms
- Medicare Advantage (Part C): An alternative to Original Medicare that includes Part A and Part B benefits, often with additional perks.
- HMO (Health Maintenance Organization): A plan with lower premiums requiring in-network care.
- PPO (Preferred Provider Organization): A more flexible plan with higher costs for out-of-network care.
- MOOP (Maximum Out-of-Pocket): The maximum amount you’ll pay annually for covered services.
Call our Albuquerque office today at (505) 355-5966 or contact us to schedule an appointment to come visit our office located at 1504 Wyoming NE.
