By Jesse Jones, with research assistance from Noah Gollin – About 75,000 New Mexicans who buy coverage through the state’s health insurance exchange will see health insurance rates increase between 35% and 52% starting in January, though state subsidies could help mitigate those increases for lower income families.
Earlier this year, the State’s Superintendent of Insurance warned consumers to prepare for “significant increases” after President Trump’s “Big Beautiful Bill” passed by Republicans in Congress without an extension of federal subsidies used by most New Mexicans to subsidize insurance plan costs.
On top of that, most insurance providers lost money in 2024 in New Mexico as rising costs for patient-related care exceeded premiums they collected, data released by the superintendent’s office shows.
The steepest increase will be felt by the highest earners — families of four making above $128,600 with individual plans from UnitedHealthcare — whose rates will increase 52%, according to plan documents filed over the summer. The average increase across all plans for all customers is 35.7%, says OSI.
Premiums are rising nationwide and New Mexico is no exception. But state lawmakers and the governor have stepped in with state-funded subsidies to cushion the blow from the loss of those federal subsidies.
“While it appears that Congress will allow enhanced federal Premium Tax Credits to expire, New Mexico’s Health Care Affordability Fund (HCAF) will cover the loss of the enhanced premium tax credits for households with income under 400% of the Federal Poverty Level (or $128,600 for a family of four),” OSI explained in August as cuts requried by President Trump’s “Big Beautiful Bill” were being implemented.
Democrats in Congress have insisted on a renewal of those federal subsidies in order to end the current federal government shutdown.
Most customers buying through the BeWell exchange – 88%, or about 66,000 customers – qualify for some premium assistance, OSI says.
“State insurance regulators across the country are grappling with rising health insurance costs,” said Superintendent of Insurance Alice Kane. “The OSI team rigorously reviewed rate requests to ensure they were fair and actuarially justified. These rate increases are consistent with the national trends of increased medical and prescription drug costs as well as high use of health care services. Fortunately, New Mexico had the foresight to prepare for the loss of federal premium support by providing state funds to shield most consumers.”
For example, a 43-year-old individual in Albuquerque can now expect to pay between $730 to $776 per month for a mid-level Silver plan from United Healthcare without subsidies, up from $499 to $533 per month that same customer pays today. State income-based subsidies could help to lower the cost of that plan and other plans with fewer services and higher premiums are available.
Customers can choose from plans in different service and price tiers (Gold, Silver, Bronze and Turquoise) on the exchange. The exchange still offers dozens of Turquoise-level plans for about $10 per month available for most New Mexicans.
Individual plans see the biggest increase
UnitedHealthcare of New Mexico sought a 52.2% increase next year, after reporting a medical loss ratio of 124.6% in 2024 – meaning the company paid out $124.60 in claims for every $100 collected in premiums. UnitedHealthcare projects the rate increase will bring its expected federal MLR to 85.80% in 2026 – still below the maximum 20% margin allowed by state regulators.
BlueCross BlueShield of New Mexico sought a 38.6% increase after paying out $232.9 million in claims in 2024 while collecting $216.3 million in premiums, resulting in losses of $16.6 million. Even with the increase, BCBS projects it will continue operating at a loss, paying out $1.05 in claims for every $1 in premiums.
Presbyterian sought a 29.3% increase after paying out $120 million in claims while collecting only $113 million in premiums. The company projects the increase will reverse that imbalance.
Molina, which sought a 15.3% increase next year after paying out $42 million in claims while collecting $64 million in premiums in 2024.
Small Business plans see smaller increases
Presbyterian’s PPO plans for small groups were approved for a 1.8% rate increase next year, while its HMO plans will increase 11.2%. UnitedHealthcare Insurance Company’s PPO plans for small groups will increase 13.1% and its HMO plans will increase 12.8%. BlueCross BlueShield of New Mexico’s small group plans will increase by an average of 21.2%.
Please do a story covering how much money is transferred from the federal and state governments directly to United Healthcare per year.
While it is fun to write stories about the rate payers and call out the “Big Beautiful Bill”, that isn’t the root of the issue.
How you say… “corporate welfare”?