Centennial Care is the official New Mexico Medicaid program that provides low-cost health insurance to eligible individuals and families.
State residents below a certain income threshold or who meet the age or disability requirements, can access New Mexico Medicaid coverage. These healthcare services cover areas like dental, vision, and mental health at little to no cost. As of 2023, 823,720 New Mexicans were enrolled in the Medicaid program.
Finding affordable healthcare coverage in New Mexico doesn't have to be difficult. Centennial Care makes the application process simple. This initiative could provide you with excellent benefits in all areas of healthcare.
You might also want to consider extending your coverage through third-party insurance, which grants you access to the state's best healthcare providers more affordably. Don't compromise your well-being because of what insurance coverage costs—there’s quality healthcare available in New Mexico if you know where to look. To prevent shouldering the debt of unexpected medical expenses, many Floridians extend their Medicaid coverage to include a more comprehensive range of benefits and services by way of private health insurance.
Below, this guide shares how New Mexicos’ state medical insurance program works, what it covers, and how you can apply if eligible.
What is Centennial Care coverage through New Mexico Medicaid? This state health insurance program provides various healthcare benefits to low-income individuals that meet certain eligibility criteria in terms of their age, condition, household income and more.
Centennial Care receives funding primarily from the federal government (roughly 15% of New Mexico's annual spending budget goes towards additional funding). Still, this Medicaid model is unique compared to other states because New Mexico holds contracts with three private insurers, also known as Managed Care Organizations, (MCO’s).
These three Managed Care Organizations currently partnering with Centennial Care are BlueCross BlueShield of New Mexico, Western Sky Community Care, and Presbyterian Healthcare Services. The state gives funding to these insurance groups, who then provide the benefits to plan holders. Despite this, enrolling in Centennial Care is free, and plan holders generally face no copays when receiving various healthcare services.
Certain individuals receive New Mexico Medicaid coverage under the state's Working and Disabled waiver. These members will likely have copays for prescription drugs, hospital stays, and so on.
Every New Mexico Medicaid card will have the member's name on it as well as a special number that represents the plan's coverage. You will receive this ID card upon enrolling in the program and will need to show it to any healthcare provider that accepts the New Mexico Medicaid benefits. Your Centennial Care card indicates that you are a member of the plan and eligible for no-cost coverage.
*The card shown above is only an example and may vary in appearance depending on which carrier you choose.
Would you like to apply for Medicaid? You must first meet New Mexico’s eligibility requirements.
New Mexico's Human Services Department oversees the Centennial Care program, and your application would go through them. You can visit any office of the department's Income Support Division to speak with a specialist and apply in person. The offices are open Monday through Friday, with locations in Grant, Guadalupe, Hidalgo, Roosevelt, and Valencia counties.
Before submitting the application, you’ll need to provide the right documentation. A few documents you may need include the following:
If you are unable to apply for benefits in person, you can also submit an application as follows:
To join the Centennial Care Medicaid program, you need to meet certain federal guidelines, including the following:
Every applicant will need to fall below certain income limits in order to be eligible for benefits. These limits on yearly income before taxes apply to all applicants who want to receive benefits from New Mexico’s Medicaid program, whether they come from a single-person household, a two-person household, or a family of four or more.
|Size of Household*
|Max Income Eligibility Limit
*For households with more than eight people, add $6,836 per additional person. Always check with the appropriate managing agency to ensure the most accurate guidelines.
Additional requirements call for applicants to fall into certain demographics surrounding their age, disability, and whether they are raising young children. In most cases, you would either need to be over the age of 65, pregnant, or responsible for children under the age of 18 to be eligible to apply. A disability like blindness or having a disabled person living in your household also makes you eligible to apply for Medicaid in New Mexico.
Once you submit your application online, through the mail, or via a representative at an Income Support Division office, the organization will approve your enrollment and send you a New Mexico Medicaid card. One of the easiest ways to apply and then check your enrollment status is through the Human Services Department's YesNM online portal.
You will also need to select a health plan as part of your application. Upon submission, the Managed Care Organization that you select on your application will process your information and send you a Centennial Care card in the mail. If you want to change your health plan, you may do so within the first 90 days of enrollment.
Do you need to renew your coverage or receive a new Centennial Care card? You can either submit a request through the online portal or call the Consolidated Customer Service Center at 1-800-238-4465. You may also reach out directly to your Managed Care Organization and request a new ID card.
Contact your insurer using the information below:
Are you wondering what Centennial Care covers? If you have healthcare insurance through New Mexico’s Medicaid, you can usually receive no-cost services for everything from preventative care appointments to picking up prescription drugs.
The Centennial Care program includes dental care coverage for members. Dental practices that accept New Mexico’s Medicaid insurance will be able to perform a range of oral healthcare services for you at little to no cost. For example, most dental coverage will include the following services:
In New Mexico, it’s also helpful to be aware that some providers cannot accept new patients with Medicaid. Be sure to check with a dental office before making an appointment for an exam or agreeing to undergo a dental procedure.
While the dental coverages are extensive through New Mexico’s Medicaid programs, they may not cover those who require serious treatments, investing in private dental plans in Florida is advisable.
New Mexico Medicaid does include coverage for prescription drugs, though plan holders will need to check the details with their chosen Managed Care Organization. The basic drug coverage under each of Centennial Care's Managed Care Organizations is as follows:
You can receive no-cost prescriptions and over-the-counter drugs, including cough and cold medicines. If your provider prescribes a drug that is not on New Mexico’s current coverage list, you can ask them to receive a drug that is on the list instead. Contact BlueCross BlueShield of New Mexico to request an exception to the coverage plan.
A wide range of drugs is available free of charge for Medicaid through the Presbyterian Health Plan. In New Mexico, these choices include contraceptives, beta-blockers, antihistamines, and medication for high blood pressure. Using their formulary navigator, you are able to search for your drug alphabetically, by brand or by therapeutic class.
The preferred drug list for Western Sky Community Care Medicaid patients includes various over-the-counter medicines and specialty drugs. It's worth noting that medication or devices without FDA approval do not get coverage. The same applies to drugs that target weight loss, fertility, and erectile dysfunction.
Did you know that Centennial Care coverage includes some areas of healthcare that standard insurance would not cover? These additional areas include family planning services and speech therapy.
Here are some examples of extended health care available through New Mexico Medicaid:
Since the Medicaid New Mexico eligibility requirements insist that you are a resident of the state, you cannot continue to enjoy coverage after a relocation to another state. In this case, you will need to apply for Medicaid coverage under the new state's plan. Your coverage under Centennial Care will become invalid.
Do you require urgent medical care while traveling? New Mexico Medicaid may not cover the costs. State insurance plans generally only provide out-of-state coverage if you're facing a life-threatening situation and are unable to return to your home state to receive urgent care.
However, in special instances, you may receive a pre-approved treatment in another state and have your insurance cover it at no cost. For example, you may live along the state border and visit a care facility in a bordering state. Still, it's best to confirm the coverage with both the Human Services Department and your Managed Care Organization beforehand to avoid unnecessary costs.
If you are traveling outside of Florida for leisure, invest in proper travelers insurance.
New Mexico's students and senior citizens can receive insurance through their state Medicaid plan as long as they meet the eligibility requirements. Students only receive coverage if they fall below the household income requirements and either have children or are living with a disability. For seniors over the age of 65, coverage depends on meeting the state's income and citizenship requirements.
Understandably, coverage for New Mexico’s seniors is a bit more extensive since these residents often need long-term care. New Mexico seniors may be eligible for one of three long-term care programs through Centennial Care as follows:
New Mexico’s Centennial Care provides special coverage for certain subgroups beyond senior citizens and eligible students. The State also provides benefits for Aboriginals.
Native Americans living on indigenous lands in New Mexico may receive healthcare coverage through the state’s Medicaid program. It works closely with the Indian Health Service and Tribal Health Clinics to keep the Native population healthy. New Mexico’s Native Americans have the choice of selecting a Managed Care Organization through Centennial Care or enrolling in Fee-for-Service Medicaid.
Although Centennial Care provides coverage for a lot of healthcare services, plan holders generally won't receive benefits for the following services or medications (depending on their Managed Care Organization):
It’s also important to note New Mexico Medicaid will only put forth $200-$600 towards the cost of a funeral. Considering the rising cost of burial and related fees, ensure that your family is secured with comprehensive funeral insurance.
Figuring out exactly what medical procedures Centennial Care covers gets easier as you navigate the system and get to know your Managed Care Organization’s policies. Here’s a quick breakdown of the most common practices and procedures your plan may cover in New Mexico:
|X-Rays and Exams
|Visit any New Mexico dentist that accepts Medicaid, and you can have a routine exam or cleaning done at no cost. Coverage also includes corrective procedures like tooth extractions, fillings, and X-ray images that check the health of your teeth down to the root.
|Yes, two times a year.
|Yes, two times a year.
|Yes, once every five years.
|Stainless Steel Crowns
|Yes, with authorization.
|Yes, with authorization.
|Yes, with authorization.
|Yes, with authorization.
|Braces and retainers often receive dental coverage, but require prior authorization.
|Surgical extractions, such as wisdom teeth removal, are among the dental benefits covered by New Mexico Medicaid. The coverage may also extend to the general anesthesia and nitrous oxide used during the procedure.
|The Centennial Care plan allows members under the age of 21 to have one routine eye exam every 12 months. Adults aged 22 and older can receive a no-cost eye exam once every 36 months. Members of any age can receive a free exam every 12 months as part of treatment for a medical condition, such as glaucoma or cataracts.
|Plan holders can receive new frames or corrective lenses that follow the same timeline and age requirements for vision exams. The coverage also includes minor eyewear repair.
|Laser Eye Surgery
|Medically necessary treatments for vision problems generally fall under New Mexico's state plan coverage. If a doctor deems laser eye surgery necessary to correct a condition, Centennial Care will usually cover the cost.
|A nose job falls under the category of cosmetic plastic surgery. While this procedure can correct misshapen noses and help people struggling with a deviated septum, it's primarily an elective cosmetic procedure, which New Mexico’s Medicaid program will not cover. Your doctor will need to authorize rhinoplasty as a necessary treatment, such as to improve breathing problems caused by a nasal deformity.
|As this is another form of plastic surgery, you typically won’t be able to use your Centennial Care benefits to cover a breast reduction for cosmetic purposes. Your doctor may recommend this procedure if you have severe back pain or other issues due to large breasts. Only when it's deemed medically necessary can you expect breast reduction surgery to come at no cost under Medicaid in New Mexico.
|The Centennial Care plan covers all hospital stays and services in New Mexico. The coverage includes one-time visits to the emergency room, required hospitalizations from your primary care doctor, and even outpatient physical therapy services. Any type of hospital service, from X-rays to lab work, will be free for eligible members.
|As a Centennial Care member, you can receive transportation to the hospital free of charge. New Mexico Medicaid will approve ground and air ambulances in most life-threatening situations.
|A hospital stay where an expectant mother gives birth will form part of the typical Centennial Care coverage in New Mexico. Pregnant women also have the option to plan a home birth with a licensed midwife who partners with the Human Services Department's Medical Assistance Division.
|Women can receive full coverage when visiting a gynecologist who accepts Medicaid in New Mexico. These visits cover routine wellness exams and pregnancy-related checkups. Common procedures like pap smears or mammograms also fall under your state insurance coverage.
|Eligible men who experience issues with erectile dysfunction may be able to treat the issues with specific drugs on the approved drug formularies.
|Medicaid will generally cover contraceptives with FDA approval, such as birth control pills, patches, and intrauterine devices. Plan holders can pick up these prescriptions without a copay. They can also receive contraceptives like condoms through covered family planning services.
|Along the list of non-covered benefits are various fertility treatments, including specialty drugs plus procedures like in-vitro fertilization and artificial insemination.
|Your primary care doctor in New Mexico may refer you to a dermatologist for skin conditions like eczema, burns, or suspicious moles. Visits to this specialist generally come without a copay for Medicaid patients as long as they're seeking treatment for a medical condition. Cosmetic-based visits, like Botox injections, will not be free of charge.
|Chronic pain patients or those who suffer from physical injuries can heal and strengthen their muscles with a physiotherapist. Centennial Care includes this service to help patients get back on their feet.
|Medicaid members cannot expect to receive coverage for a recreational massage, and it is not part of the accepted Centennial Care benefits. If a doctor prescribes a massage for an injury, this may be an exception to the rule.
|Podiatry and Foot Care
|New Mexico’s Medicaid will typically cover visits to a podiatrist with some limitations. You can see a foot and ankle specialist without a charge if you're receiving routine foot care for a circulatory condition, surgical or non-surgical treatment to correct your foot's structure, wart removal from the feet, or infected toenail treatments.
|The state insurance plan in New Mexico will often cover testing for various allergies. However, you will need prior authorization before moving forward with this procedure to receive the maximum insurance benefits.
|Sleep Physician Services and CPAP Machines
|Do you have issues with sleep apnea? New Mexico’s Centennial Care program covers the cost of all durable medical equipment, such as CPAP machines, to monitor your breathing while you sleep.
New Mexico’s Centennial Care offers plenty of healthcare benefits for eligible residents. But what if you don't meet the requirements or you find yourself needing more comprehensive cover? It's still possible to receive affordable quality healthcare through a third-party insurer. A provider such as Insurdinary can even help you secure life insurance, which can help pay for outstanding medical costs, debts and many other important fees in the event of your passing.
Why not extend your coverage beyond what New Mexico Medicaid has to offer? Insurdinary helps people find the lowest insurance rates for healthcare plans, life insurance policies, and much more. Submit a simple online request form to receive insurance quotes from Insurdinary today.
Insurdinary, and its network of partners offer many different types of insurance. In addition to health, dental, disability, life, funeral and travel insurance as discussed on this page, you may also be interested to explore the following: