Medicare Advantage Plans in Albuquerque for 2025

If you’re seeking the most fitting Medicare Advantage plans in Albuquerque, you will likely want transparent comparisons and details on the potential benefits.

Our guide walks you through some of the local options with direct insights on the potential coverage details, helping to clear any confusion as you weigh which Medicare Advantage plans in Albuquerque suit you best.


Key Takeaways


  • Top-rated Medicare Advantage Plans in Albuquerque boast high CMS ratings and could offer a range of possible benefits, with providers such as Humana and AARP potentially offering plans that will likely meet diverse needs and preferences, including travel coverage and potential cost efficiency.



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Medicare Advantage Plans in Albuquerque: An Overview


Medicare Advantage Plans Albuquerque 2025, Medicare Advantage Plans in Albuquerque: An Overview


A promising horizon of Medicare Advantage Plans, each will likely be tailored to your diverse health needs, may emerge as you navigate the healthcare landscape in Albuquerque. Some of these plans, which may be offered through Medicare-approved private insurance companies, could potentially provide the sturdy foundation of Original Medicare’s Part A and Part B coverage, with some potential benefits of amenities that Original Medicare might not cover.

From essential dental, vision, and hearing services to the often-critical prescription drug coverage, these plans could be designed to potentially offer a more comprehensive health package, which may ensure you’re well-equipped for the road ahead. Additionally, Medicare Supplement Insurance Plans could help fill some of the gaps in coverage that may arise with Original Medicare.

A potential factor that could distinguish some of the Medicare Advantage Plans in Albuquerque could be the personalized touch they may infuse into your healthcare experience. Unlike the one-size-fits-all approach of Original Medicare, some plans may come with tailored options that could cater to individual preferences and health requirements.

This level of customization in certain Medicare Advantage Plans may allow you to align your health coverage with your unique life journey, potentially providing peace of mind that your well-being may be handled with the care it deserves.


Types of Medicare Advantage Plans in Albuquerque

In the heart of New Mexico’s vibrant culture could be a diverse array of Mexico Medicare Advantage Plans, each will likely boast its appeal and benefits. With various plans in New Mexico, Albuquerque residents may choose from four main types of Medicare Advantage plans:

  • Health Maintenance Organizations (HMOs)



  • Private Fee-For-Service (PFFS) plans


  • Special Needs Plans (SNPs)


For those who cherish flexibility, PPOs offer the convenience of no referrals needed when seeing specialists. Meanwhile, HMOs, including innovative HMO-POS options like Presbyterian UltraFlex, blend features to provide out-of-network benefits, routine acupuncture, and chiropractic care coverage.

The allure of HMO-POS plans doesn’t end there; they offer comprehensive dental options, free fitness memberships, hearing aid coverage, and additional perks such as a flex card for over-the-counter medications.

These plans are not just health coverage; they’re a commitment to your holistic well-being, offering a spectrum of services to ensure your health journey in Albuquerque is not just covered, but truly cared for.


Potential Additional Benefits That May Be Offered by Albuquerque Medicare Advantage Plans

Medicare Advantage Plans Albuquerque 2025

Beyond the essential healthcare services, some of the Medicare Advantage Plans in Albuquerque might offer a range of additional benefits, including:

  • Dental services



  • Hearing services


The cherry on top for many beneficiaries will likely be the potential inclusion of Part D prescription drug coverage. This essential benefit could be a lifeline for those with regular medication needs, potentially offering peace of mind that your Medicare Advantage coverage could have your back when it comes to managing your prescriptions.

With these potential benefits, some of the Medicare Advantage Plans in Albuquerque may not just be about covering your healthcare needs; they could be about elevating your overall well-being.

Top-Rated Medicare Advantage Plans in Albuquerque


Medicare Advantage Plans Albuquerque 2025, Top-Rated Medicare Advantage Plans in Albuquerque for 2024


Some of the Medicare Advantage Plans in Albuquerque may be able to flaunt ratings that could testify to their exceptional quality and service. With a stellar 4.5-star rating leading the pack, some of these top-rated plans could set the benchmark for excellence in healthcare.

Take, for example, the Humana Gold Plus H0028-019 (HMO), a shining star among HMO plans, which may be celebrated for its comprehensive coverage and services that could resonate with subscribers’ specific needs.

For those who may prioritize cost efficiency without compromising on quality, the AARP Medicare Advantage Choice Plan 1 (PPO) might stand as a paragon of value among the best Medicare Advantage plans in New Mexico.

Some of the potential features could include:

  • Low maximum out-of-pocket expenses


  • Robust coverage


  • Providers such as Aetna Medicare, Anthem Blue Cross Blue Shield, and Blue Cross Medicare Advantage, which will likely be known for superior healthcare in New Mexico


These features could make the AARP Medicare Advantage Choice Plan 1 (PPO) a great option that will likely blend quality and affordability.


Criteria for Selecting the Best Plans

The Medicare Advantage Ratings System, a possible beacon provided by the Centers for Medicare & Medicaid Services (CMS), could guide you with star ratings reflecting participant satisfaction and preventive care.

Plans with a history of excellence, which could often have over a decade in the Medicare Advantage program, will likely shine brightly with 4 or more stars, suggesting a legacy of quality.

Other measures such as Transitions of Care could also be incorporated, while others like Controlling Blood Pressure will likely have gained more weight in the 2024 Star Ratings, highlighting the evolving standards of healthcare excellence. Plans that score 4 stars or higher are considered top-rated, with a notable subset achieving the 5-star accolade, indicating an elite level of service.

Non-profit organizations could potentially outperform their for-profit counterparts, possibly drawing more enrollees and possibly delivering higher quality care, signaling the potential impact of star ratings on both quality and financial incentives.


Featured Plans and Providers

When it comes to featured group Medicare Advantage plans and providers in Albuquerque, two names may stand out for their exemplary CMS ratings and their potential benefits to subscribers. Among some of these Medicare Advantage plans, the Humana Gold Plus H0028-019 (HMO) plan, with its high CMS rating, could show a steadfast commitment to catering to the specific healthcare needs of its members.

The AARP Medicare Advantage Choice 1 (PPO) plan, on the other hand, may offer a trifecta of possible benefits: comprehensive Part D drug coverage, a high CMS rating, and worldwide emergency benefits.

With leading providers like Health Care Service Corporation, Humana, Molina Healthcare, Presbyterian Health Plan, and UnitedHealthcare at the helm, some of these plans may not only offer health coverage but could also embody a pledge to deliver a superior healthcare experience.

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Enrollment Periods and Eligibility for Albuquerque Medicare Advantage Plans


Medicare Advantage Plans Albuquerque 2025, Enrollment Periods and Eligibility for Albuquerque Medicare Advantage Plans


For Albuquerque residents, specific times present the opening for Medicare Advantage Plans, possibly offering a chance to join or switch plans. Most notably, when you turn 65, you are welcomed into the world of Medicare Advantage, a milestone marking your eligibility for these plans.

Enrollment is also possible during the Annual Election Period and under certain circumstances that qualify for Special Enrollment Periods, such as moving to a new area.


When to Enroll in a Medicare Advantage Plan in Albuquerque

Your venture into Medicare Advantage commences with the Initial Enrollment Period, seven months enclosing three months before, the month of, and the three months after your 65th birthday.

Should this initial window slip by, the Annual Election Period, from October 15 to December 7, offers a second chance to make your healthcare elections.

Moreover, the Open Enrollment Period, from January 1 to March 31, provides an additional period to enroll in or reassess your Medicare Advantage Plan options. Life’s unpredictable turns, from job loss to relocation, can trigger Special Enrollment Periods, ensuring that your healthcare coverage can adapt with you.


Eligibility Requirements

To partake in the Medicare Advantage Plans of Albuquerque, a few keys to Medicare Advantage plan eligibility must align. Here are the requirements:

  • Enrollment in both Medicare Part A and Part B is the cornerstone of eligibility.


  • Opting for Medigap is a decision that requires forethought, as it excludes you from joining a Medicare Advantage Plan.


  • You must also cast your lot within the plan’s service area.


  • Continue to pay your Medicare Part B premium.


Individuals with disabilities find their gateway to eligibility after receiving 24 months of Social Security or Railroad Retirement Board (RRB) Disability Insurance payments.

Moreover, those grappling with End-Stage Renal Disease (ESRD) or amyotrophic lateral sclerosis (ALS) can also find solace in Medicare Advantage Plans tailored to their condition, For Albuquerque’s newcomers or those navigating disability, the Initial Coverage Election Period offers a 3-month enrollment window.

To enroll, call 1-833-641-4938 (TTY 711), Mon-Fri 8 am-9 pm EST. One of our licensed agents can provide comprehensive information, personalized guidance, and ongoing assistance to navigate the enrollment process for private insurance companies, making it easier for beneficiaries to make informed decisions about their healthcare.


How to Compare and Choose the Best Albuquerque Medicare Advantage Plan for You


Medicare Advantage Plans Albuquerque 2025, How to Compare and Choose the Best Albuquerque Medicare Advantage Plan for You


Embarking on the pursuit to identify the best Medicare Advantage Plan in Albuquerque will likely demand a set of considerations that could guide you to the best plan.

Assessing potential factors such as healthcare needs, possible plan benefits and costs, and provider networks may be able to ensure that each choice could bring you closer to your desired destination.


Assessing Your Healthcare Needs

The first step in your journey may be to chart your potential healthcare needs. Evaluating the possible coverage of prescription medications is crucial, as different plans may have varying formularies that could significantly impact your healthcare strategy.

The frequency of doctor and specialist visits may be another feature to consider; some plans may require higher copayments for these visits, which could influence your overall healthcare budget.


Evaluating Potential Plan Benefits and Costs

With your healthcare needs mapped out, the next phase may be to scrutinize the plan’s potential benefits and costs. This may include figuring out the details of possible out-of-pocket expenses such as:

  • copays


  • deductibles


  • prescription drug coverage



Plans that offer lower monthly premiums might be the most attractive, signifying less frequent healthcare use while potentially offering the safety net of adequate coverage.


Checking Provider Networks

The final leg of your plan comparison journey is to navigate the in-network providers. This step is vital, as it could ensure your trusted healthcare providers and pharmacies are in-network, thereby potentially avoiding unexpected detours in your healthcare plan.

Considering the potential impact of local or regional networks could be essential to maintain continuous and cost-effective care.

Local Resources for Medicare Advantage Plans in Albuquerque


Medicare Advantage Plans Albuquerque 2025, Local Resources for Medicare Advantage Plans in Albuquerque


As you navigate the terrain of Medicare Advantage Plans in Albuquerque, support will likely be available. Local resources such as the State Health Insurance Assistance Program (SHIP), the New Mexico Aging & Disability Resource Center (ADRC), and licensed insurance agents and brokers could stand ready to guide you through the process.


State Health Insurance Assistance Program (SHIP)

The SHIP program in New Mexico will likely offer:

  • Free, unbiased, and expert health insurance information and assistance


  • Help understand the potential nuances of Medicare Parts A & B, Medicare Advantage, Part D, or Medigap


  • Navigation through the options and assistance in making informed decisions


  • Resolution of any billing and claims issues that may arise


Engaging with SHIP through health fairs, informational workshops, or local offices could illuminate your path to the best Medicare Advantage Plan for your needs.


Licensed Insurance Agents and Brokers

Within the sphere of Medicare Advantage Plans, licensed insurance agents and brokers in Albuquerque may be able to serve as experienced guides, possibly aiding you in:

  • Comparing plan the potential  benefits and costs to ensure you may settle on a plan that aligns with your healthcare priorities


  • Understanding Medicare Advantage networks


  • Exploring the potential prescription drug plans


Their expertise could provide you with a comprehensive view of your options.

It will likely be pivotal to partner with an agent or broker who holds a valid New Mexico health insurance license and operates independently, which may guarantee unbiased advice that might be tailored to your individual needs.


Some of the Medicare Advantage Plans in Albuquerque may offer a tapestry of healthcare options, each could have the potential to cater to the unique contours of your life.

From the foundational coverage of Original Medicare to the potential benefits that might be able to enrich your overall well-being, some of these plans may stand as beacons of comprehensive care.

With the guidance of ratings, local resources, and a clear understanding of enrollment periods and eligibility, the journey to selecting the best plan becomes a well-informed adventure.


Frequently Asked Questions


→  What are the 4 types of Medicare Advantage plans?

The four types of Medicare Advantage plans are Health Maintenance Organization (HMO) Plan, Preferred Provider Organization (PPO) Plan, Private Fee-for-Service (PFFS) Plan, and Special Needs Plan (SNP). These plans cater to specific healthcare needs and preferences.


→  Does New Mexico have Medicare Advantage plans?

Yes, New Mexico will likely offer Medicare Advantage plans, with nearly 49% of Medicare beneficiaries in the state enrolled in these plans. The availability could range between 7 to more than 50 plans depending on the county.


  What are the advantages of a Medicare Advantage plan?

Some advantages of Medicare Advantage plans could include its broad range of networks and potential out-of-pocket costs. Be sure to carefully review the plan’s details before enrolling.


  What is the most highly rated Medicare Advantage plan?

Based on data from previous years, the most highly rated Medicare Advantage plans will likely include options from Humana, UnitedHealthcare, AARP/UnitedHealthcare, Blue Cross Blue Shield, Aetna, and Cigna. These plans could offer good coverage, affordable costs, a large network of providers, and a broad array of options.


 What is the difference between Original Medicare and Medicare Advantage Plans?

The main difference between Original Medicare and Medicare Advantage Plans will likely be that Original Medicare provides basic health coverage, while some Medicare Advantage Plans may include all Original Medicare coverage and might offer additional benefits like prescription drug coverage and dental, vision, and hearing services.

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Russell Noga
( Medicare Expert )

Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.