A number of new state laws impact health insurance policies delivered, issued or renewed in New Mexico as of January 1, 2024.
The state only has the ability to oversee health insurance plans that aren’t federally regulated. So, not all insured New Mexicans will see the changes. The state regulates plans through the state exchange, fully-funded plans, and plans issued through the Health Care Purchasing Act to public employees and retirees. Still, some of the laws exclude certain plans.
For those the law applies to, diabetics must now have access to the basic care and supplies needed to manage their condition. Additionally, out-of-pocket costs for insulin are capped at $25 for a 30-day supply.
Cost sharing for other kinds of care has been eliminated altogether. That includes diagnostic breast exams as well as prevention and treatment for sexually transmitted infections (STIs).
Biomarker testing must now be covered, though the patient may have to pay a portion of the cost. If coverage is denied, the law also requires the insurer provide a “clear, accessible and convenient” appeal process. According to the American Cancer Association, biomarker testing can give people with cancer crucial information about their prognosis and treatment.
A few of the laws require more equitable access to certain care. Insurers in New Mexico can no longer restrict coverage for mental health and substance use disorders more than they do for other types of care. Also, Health Care Purchasing Act plans must cover prosthetics and custom orthotics at least to the extent Medicare does. The medical necessity of those devices and fair trade practices are required for other types plans, as well. Finally, commercial insurers that offer chiropractic coverage can’t charge more for it than they do for primary care.
If you’re unsure if these laws apply to your plan, you can contact your insurance company or human resources department to find out.
