New Mexico seniors face fewer Medicare choices as open enrollment begins

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Medicare patients in New Mexico should prepare for an extra layer of complication during this year’s open enrollment period, which begins Thursday: Several major health insurers will discontinue certain Medicare Advantage plans for 2027.

Among the insurers discontinuing some or all Medicare Advantage plans are Presbyterian Health Plan, Christus Health Plan and Blue Cross Blue Shield of New Mexico.

Tens of thousands of New Mexico seniors are covered by those plans and face a Dec. 7 deadline to pick a new one, or their coverage will revert to original Medicare — which covers the cost of hospital stays and doctor’s visits but not prescription drugs.

It’s the local version of a nationwide phenomenon: Millions of Medicare Advantage enrollees across the U.S. are being forced to change their insurance coverage in 2027 as major insurers reduce the number of available plans, The New York Times reported earlier this month. Switching plans can bring higher costs — like steeper premiums, deductibles or copayments — for enrollees, a significant issue when half of New Mexico households headed by people 65 or older can’t afford basics like housing, healthcare, food and transportation.

New Mexico insurance companies and brokers pointed to rising healthcare costs, particularly for Medicare Advantage plans, as their reason for halting some of those options.

“Continuing in this market would limit our ability to invest in the care, workforce and access to serve New Mexicans where they need us most,” Presbyterian Health Plan said in a statement.

New Mexico Aging and Long-Term Services Secretary Emily Kaltenbach said in an interview this is the time for seniors to evaluate their coverage plan: “Is it still meeting your needs? We can help you walk through those important questions.”

She noted her agency operates the nationwide State Health Insurance Assistance Program, which provides assistance to Medicare patients and their families.

About Medicare

Most New Mexico residents have “two paths” toward Medicare coverage, Kaltenbach said.

Data from the health research and policy organization KFF shows about half of all enrollees choose “original Medicare,” a combination that covers inpatient hospital stays, hospice and skilled nursing care, as well as doctors’ visits, outpatient care, vaccines, screenings and medical equipment. Patients can also add prescription drug coverage assistance.

As health insurance premiums increase elsewhere — individual and small group plans through the federal Affordable Care Act are set to see increases of 24% and 19%, respectively — original Medicare premiums will see relatively small increases in 2027. The standard monthly premium is expected to increase by just $6.60, to $209.50, while the annual deductible — or the amount patients pay before Medicare kicks in — will increase from $283 to $292, according to the 2026 annual report from the Medicare Board of Trustees. Average premiums for prescription drug coverage are expected to rise by less than $1.

With open enrollment and midterm elections looming, President Donald Trump earlier this month promised $90 payments for the more than 20 million Americans on Medicare, to help them pay for their premiums. That proposal, which would require congressional approval, would offset less than half the cost of the standard monthly premium.

The other half of Medicare enrollees choose Medicare Advantage plans, also known as Medicare Part C. Managed by private insurance companies, these plans often bundle hospital, medical and prescription drug coverage into one. Some plans include ancillary benefits, like fitness programs or hearing, dental and vision coverage.

Medicare Advantage plans are expected to see big changes in 2027.

What’s changing?

Presbyterian Health Plan, the insurance arm of the umbrella organization Presbyterian Healthcare Services, in June announced plans to discontinue four of its five Medicare Advantage plans. The change is expected to affect some 30,000 patients, who will have to find new coverage for 2027.

Presbyterian’s choice to halt most of its Medicare Advantage programs came after the organization reported an annual operating loss of $568.2 million in a December financial disclosure.

“Presbyterian is focused on where we can make the greatest difference: delivering high-quality care, expanding access, and staying a strong, independent healthcare system for New Mexico,” the organization said in a statement. “To support that mission, we have made the difficult decision to no longer offer most of our Medicare Advantage plans in 2027.”

Christus Health Plan — the insurance arm of Christus Health, a Texas-based Catholic hospital firm that operates Christus St. Vincent Regional Medical Center in Santa Fe and clinics throughout New Mexico — will discontinue Medicare Advantage plans in New Mexico and Texas effective Dec. 31.

“This decision is limited to our Medicare Advantage product, impacting only a small percentage of customers,” Christus Health spokesperson C.C. Gonzalez-Kurz wrote in an email to The New Mexican. “It does not affect our other health insurance products or CHRISTUS Health’s broader care operations.”

Notably, the decision to halt Medicare Advantage plans doesn’t mean hospitals and clinics operated by Christus Health or Presbyterian Healthcare Services will stop accepting Medicare patients. The change will only apply to people who get their insurance through Presbyterian Health Plan or Christus Health Plan, rather than another insurance carrier.

Blue Cross Blue Shield of New Mexico’s website appears to indicate changes to its Medicare Advantage plans, too. As of Wednesday afternoon, the insurance company’s website listed two types of Medicare Advantage plans for 2026 — health maintenance organization and preferred provider organization plans — while it listed only a particular type of HMO plan for 2027.

Brady Hess, a Medicare broker and co-owner of the independent firm Vista Insurance Partners, said the company has issued a notice to insurance agents it will pull “all but one” of its Medicare Advantage plans from the state.

Spokesperson Amanda Douglas confirmed in an email Blue Cross Blue Shield of New Mexico offers a traditional Medicare Advantage prescription drug HMO plan in Bernalillo, Sandoval, Torrance and Valencia counties, but she stopped short of answering The New Mexican‘s questions about the number of plans the insurance giant will offer in 2027 compared to 2026.

Both Blue Cross Blue Shield and Presbyterian will continue to offer Dual Plus Special Needs Plans, which are Medicare Advantage plans specifically for low-income seniors eligible for both Medicare and Medicaid.

Carriers’ high costs

These kinds of disruptions — of insurance carriers changing their offerings or calling it quits on certain plans — are not new to New Mexico, said Hess, who has worked as an insurance broker in the state for more than a decade.

One big thing that has changed in recent years, however, is the cost of healthcare, he said.

At the height of the coronavirus pandemic, people weren’t going to the doctor as frequently, and their insurance companies weren’t being billed for the care. However, as people started going back to the doctor — to catch up on care they delayed or to manage new conditions — Hess said, “these insurance companies were a little inundated with having to cover these costs.”

Insurance companies also rushed to add extra perks to attract more patients, only to tighten their belts as the cost of those programs came due, said Tyler Hawks, another broker who co-owns Vista Insurance Partners with Hess.

“It was almost like a race to see who could provide more benefits on all these different plans. … And now it seems like it’s going the opposite direction — to ‘Oh, we actually need to cut back. Our expenses and everything are going up,’ ” he said.

Those rising costs aren’t unique to Medicare. New Mexico’s 2025 “claims experience” — which includes both the number and the dollar amount of claims — combined with inflated medical costs, more people receiving care and an increase in prescription drug costs resulted in the rate hikes for Affordable Care Act individual and small group plans.

“Some of these smaller plans — like Presbyterian — who aren’t nationwide, they’re getting hit the hardest. … They can’t absorb some of these losses like a national carrier can,” Hess said.

Whatever the Medicare situation, there is help available for customers who want to make informed insurance decisions. The State Health Insurance Assistance Program — also known as SHIP — answers Medicare questions without endorsing any particular plan, Kaltenbach said.

“We do an assessment, and we provide information so that there’s an improved consumer experience with Medicare. We don’t advocate for one plan over another,” she said.

It can be a helpful starting point for personalized advice to cut through the confusion, said State Health Insurance Assistance Program coordinator Angela Futch.

“My mom received a stack of information when she turned 65, and it was so complicated she didn’t know what to choose,” Futch said. “So us SHIP coordinators are there to help break that down for individuals and let them know what options are available.”

Margaret O’Hara reports on issues affecting healthy communities in New Mexico. Her work is funded by a grant from Anchorum Health Foundation. Anchorum will not have any role in editorial decisions. The New Mexican and its Public Service Journalism Fund retain full editorial control. Philanthropically funded stories by The New Mexican are made available to all readers without a paywall.

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