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This glossary provides general information. It defines medical terms you may see. It’s not a complete list. Your health plan may define these terms in your plan documents. Look at your plan documents for details. Not sure where to look? Check your Summary of Benefits and Coverage to find out how to get a copy of your policy or plan document.
A user record on the BeWell portal. You access your account with your unique username and password.
The estimated percentage of total average costs for covered benefits a plan will cover. For example, if a plan has an actuarial value of 70%, on average, the plan pays 70% of cost of covered benefits and the consumer would be responsible for 30%.
Your total (gross) income for the tax year, minus certain adjustments you are allowed to take. Adjustments include deductions for conventional IRA contributions, student loan interest, and more. AGI appears on IRS Form 1040, line 11.
A federal tax credit to help pay for your monthly health insurance premium, when you take it in advance. You can wait and take the tax credit at the end of the year when you file your taxes if you prefer.
Learn more about APTC and if you qualify.
The comprehensive health care reform law enacted in March 2010 (ACA or commonly called “Obamacare”). BeWell operates New Mexico’s state-based marketplace in accordance with the ACA.
The law provides many benefits and protections, including:
The cost of the annual premium for the lowest-priced self-only plan must be less than 9.96% of annual household income in 2025 to be considered affordable. If the self-only coverage is affordable, the individual will not be eligible for financial assistance if they enroll in coverage through BeWell.
The cost of the annual premium for the lowest-priced family coverage plan must be less than 9.96% of annual household income in 2026 to be considered affordable. If the family coverage is affordable the family will not be eligible for financial assistance if they enroll in coverage through BeWell.
Provides health insurance information and assistance through the State Health Insurance Assistance Program (SHIP). Visit the ALTSDs website.
The maximum amount a plan will pay for a covered health care service. In a family plan with an aggregate deductible, this is an individual member’s deductible. Before medical bills can be covered, the entire amount of the deductible must be met. It can be met by one family member or by a combination of family members.
The allowed amount may also be called an eligible expense, a payment allowance or a negotiated rate. Under certain circumstances, if your provider is out-of-network and charges more than the health insurance plan’s allowed amount, you may have to pay the difference (see “balance billing”).
A federal civil rights law that prohibits discrimination against people with disabilities in everyday activities.
An individual who is a member of a federally recognized Native American Tribe or is an Eskimo, Aleut or other Alaska Native.
The total income for a household in a calendar year.
If you disagree with a BeWell assessment of eligibility for coverage or Premium Tax Credits (PTC), you can appeal the decision and ask for a redetermination. You will need to log in to your client portal and submit an appeal support request. Read more about the appeal process.
Note: Appeals of a decision by a health insurance carrier to deny payment for a claim should not be submitted to BeWell. Such appeals should be filed with your health insurance carrier.
The individual who is filling out a BeWell application and is seeking insurance coverage.
Collective term for assisters, agents, brokers, and enrollment counselors.
Integrated eligibility system used to determine Medicaid Programs.
When a provider bills you for the difference between what your health care provider charges and the allowed amount. For example, if the provider’s charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30.
The health care services covered under a health insurance plan. Covered benefits and excluded services are defined in the health insurance plan documents. The benefit start and end dates are when your coverage begins or ends:
The binder payment is the first month’s health insurance premium for your plan. You must make this payment with your health insurance carrier to complete enrollment. If you do not make this payment, you will not be enrolled in your health insurance plan.
A broker, also called an agent or a certified assister, can help you for free to apply for and enroll in a health insurance plan. They can make suggestions about which plan to enroll in based on your needs and budget. Brokers cannot endorse a specific plan and must represent all carriers equally. Make a free appointment with a certified assister.
The organization of your health care across several health care providers. Medical homes and Accountable Care Organizations are two common ways to coordinate care.
A health insurance company.
Part of the Centers for Medicare and Medicaid Services (CMS) that oversees health insurance marketplaces.
CMS is the federal agency that provides health coverage to more than 160 million people through Medicare, Medicaid and the Federally Facilitated Insurance Marketplace (Healthcare.gov).
An agent, broker or enrollment counselor. A certified assister must take BeWell-specific training and pass an exam to sell insurance on the marketplace. Their services are free and they can help you apply for and enroll in a health insurance plan. They can make suggestions about which plan to enroll in based on your needs and budget. Certified assisters cannot endorse a specific plan and must represent all carriers equally. Make a free appointment with a certified assister.
Provides low-cost health coverage to children and pregnant women in families earning too much money to qualify for Medicaid. In New Mexico, CHIP is just called Medicaid.
An integrated care approach to managing illness that includes screenings, checkups, monitoring and coordinating treatment and patient education. It can improve your quality of life while reducing your health care costs if you have a chronic disease by preventing or minimizing the effects of a disease.
To receive payment from an insurance carrier, a provider sends a claim to an insurance carrier to describe services that were rendered to a consumer.
A federal law that may allow you to temporarily keep health coverage after your employment ends, after you lose coverage as a dependent of the covered employee, or because of another qualifying life event. If you enroll in COBRA, you will pay 100% of the health insurance premiums, including the share the employer used to pay, plus a small administrative fee.
A percentage of the cost of care you may have to pay. You pay coinsurance plus any deductibles you owe. For instance, if the health insurance plan’s allowed amount for an office visit is $100 and you’ve met your deductible, a coinsurance of 20% means you pay $20. The health insurance or plan pays the rest of the allowed amount. Plans with low monthly health insurance premiums often have higher coinsurance.
Eligibility can be temporarily approved until you provide additional documentation for a final determination. Failure to submit documentation could ultimately result in loss of conditional eligibility.
Medical care and treatment provided to eligible Native Americans and Alaska Natives through a system of contracts with public or private providers. These services are administered by the Indian Health Service (IHS).
A fixed amount (for instance, $15) you pay for a covered health care service after you meet your deductible. This is also called a copay. Most of the time, you make the payment when you get the service. The copay can vary by the type of covered health care service. Plans with lower monthly health insurance premiums often have higher copayments.
A discount that lowers how much you must pay for deductibles, copays and coinsurance. In other words, you pay less for services at the doctor’s office, hospital or pharmacy. You can get a CSR if you qualify based on income and household information you provide on your BeWell application and if you choose a Silver level health insurance plan. Native Americans may also qualify for other cost-sharing subsidies and benefits.
The date your health insurance plan coverage starts. Your coverage effective date is the 1st of the next month after you enroll in and pay your binder payment for the health insurance plan. There are some exceptions for those losing Medicaid.
There are four metal levels or coverage levels for health insurance plans: Bronze, Silver, Gold or Turquoise. The levels are based on how you and your health insurance carrier will split costs for that plan and have nothing to do with quality of care.
Learn more about metal levels and what each offers here.
BeWell customer service is available at 833-862-3935 as well as the interactive chat feature on our website. Customer service is open 8am – 5pm Monday – Friday outside open enrollment. During Open Enrollment, customer service is open 7am – 7pm Monday – Friday. If you prefer to speak to someone face to face, you can visit the BeWell office in Albuquerque; 7601 Jefferson NE, Suite 120.
The amount you owe for covered health care services before your health insurance plan starts to pay. For instance, if your plan has a deductible of $1,000, then you have to pay $1,000 of your own money before the plan will start covering your costs.
After you pay your deductible, you will generally only have to pay a copayment or coinsurance for covered services. Your health insurance carrier will cover the rest. The plan pays 100% for some services with no deductible. Generally, plans with lower monthly health insurance premiums have higher deductibles.
A biological child, adopted child, stepchild, foster child, or other person who can be claimed as a dependent on the applicant’s tax return. Children up to age 26 can be dependents on their parents’ health insurance plan. Dependents can also include household members you have legal guardianship over, such as an elderly parent, disabled sibling, foster child, etc. When you apply for health coverage, you’ll include details about your dependents.
A limit in a standard range of physical and/or mental capabilities. Because different health insurance programs have different disability standards, check the program you are interested in for its disability standards.
When you apply for coverage through BeWell, you will get an eligibility determination notice by mail or electronically, depending on your preference, that explains your eligibility for coverage and financial assistance through BeWell. This notice will also include the next steps you need to take to get coverage and financial assistance.
A category of lawfully present individuals who are eligible to enroll in qualified health plans and receive financial assistance for their coverage. To qualify as an eligible alien, you must be a lawful permanent resident (or green card holder), an individual granted parole as a Cuban-Haitian Entrant, or an individual from certain Pacific Island nations legally living in the United States through a Compact of Free Association.
An illness, injury or symptom that is serious or life-threatening. It is so serious that a reasonable person would seek care right away to avoid severe harm.
Services for injury or illness you get in an emergency room.
Plans that provide health and/or drug coverage to former employees or members of a company, and, in some cases, their families. These plans are offered by an employer or employee organization. Many of these plans are not legally required to meet many of the provisions of the Affordable Care Act, such as covering children up to age 26.
Refers to health insurance coverage provided by an employer to its employees as a benefit of employment.
An applicant who has enrolled in a health insurance plan.
An unlicensed but certified employee working for an entity who assists their delegated individuals with account requests and helps consumers with their application. Most enrollment counselors work inside hospitals or clinics.
The enrollment status is:
A minimum set of benefits covered by all health insurance plans in the Marketplace. This includes:
• Outpatient services
• Emergency services
• Hospital treatment
• Maternity and newborn care
• Mental health services
• Prescription drugs
• Rehabilitation services and devices
• Lab services
• Preventive and wellness services
• Pediatric care
While every health insurance plan available through BeWell must cover these benefits, that does not mean all health insurance plans are the same.
A detailed document that outlines your health insurance coverage, including benefits, limitations, exclusions, and cost-sharing responsibilities.
Health care services your plan does not pay for or cover.
A document from your carrier that illustrates how a medical claim was paid. It includes provider charges, the amount paid by the carrier, the customer’s responsibility, and the amount applied to the customer’s deductible. An EOB is not a bill.
Marketplace regulations specify a consumer may not be eligible for advance payments of the premium tax credit (APTC) if the tax filer for the household did not, for the most recent year for which tax data is available:
A Family deductible means the entire family must meet the total deductible amount before the insurance plan starts paying for covered services. This deductible can be met by one family member’s expenses, or by the combined expenses of multiple family members. Once the family deductible is met, the insurance plan starts paying for all covered services for all family members
A federal law that guarantees up to 12 weeks of job-protected leave for certain employees who need time off due to:
When you are on FMLA leave, you can continue coverage under your job-sponsored plan. FMLA may be used all at once or intermittently over the course of 12 months.
A measure of income published every year by the U.S. Department of Health and Human Services (HHS). It is calculated based on household size. FPL is used to determine eligibility for certain programs and benefits, such as Premium Tax Credits (PTC) and Medicaid. BeWell will use the FPL guidelines to calculate eligibility for savings for people who enroll in coverage.
Operated by the Centers for Medicare & Medicaid Services (CMS), the FFM is the federal marketplace, also known as Healthcare.gov, where individuals are able to purchase health insurance. Some states, like New Mexico, have a state-based marketplace that residents enroll through instead of the FFM.
Federally funded nonprofit health centers and clinics provide care in medically underserved areas on a sliding scale fee based on income. FQHCs provide primary care services regardless of your ability to pay.
A group recognized as a Native American tribe by the U.S. Department of the Interior. May include any Native American or Alaska Native tribe, band, nation, pueblo, village, rancheria or community.
A drug list includes the generic and brand-name prescription medications that are covered by a specific health insurance plan.
The required time span under state and federal law when you can terminate coverage without penalties or charges. If you have not made any claims and are not satisfied with the terms and conditions of the policy you enrolled in, you have 10 days from the coverage start date to terminate the policy. You will be refunded for any premiums you have paid.
The health insurance benefits offered to employees who are considered full-time by their employer.
A short period — usually 3 months — after your monthly health insurance premium payment is due. Pay all owed premiums during the grace period to avoid losing your health coverage.
The grace period for health insurance premium payments is usually 3 months if both of the following are true:
If you don’t use the premium tax credit, the grace period is 30 days.
Grace periods do not apply to your first month’s payment (binder payment). You must pay the first month’s health insurance premium to be enrolled in coverage.
Anyone who is eligible can get a health insurance plan regardless of health status, age, gender or other factors. Anyone can renew their plan as long as they keep paying health insurance premiums.
The person who is completing the application and is responsible for managing the health insurance coverage for themselves and any other people listed on the application. Also sometimes referred to as the policyholder or subscriber.
A state fund created specifically to lower health care costs for New Mexicans. State law allows the funds to be used to:
The Fund and programs are administered by the New Mexico Health Care Authority (HCA).
The New Mexico state agency that oversees the state-run Medicaid and other public assistance programs. HCA also administers the SNAP program to provide food benefits to qualified low-income individuals.
The United States Department of Health and Human Services is an executive branch department of the federal government created to protect the health of the Americans by providing essential human services.
Coverage for preventative care, emergency services and more. Types of health insurance coverage includes Medicaid, Medicare, employer-sponsored plans and qualified health plans offered through BeWell.
A type of health insurance plan that usually limits coverage to care from providers who work for or contract with the HMO. These plans generally do not cover health care services from out-of-network providers except in an emergency.
The different plan levels offered by BeWell, where the categories (metal levels) are based on how you and your insurance plan split the cost of using health care services. For each plan category, you’ll pay a different percentage of total costs for care and the health insurance carrier will pay the rest.
Employer-funded group health insurance plans where employees are reimbursed tax-free for qualified medical expenses up to a fixed dollar amount per year. Unused money can be rolled over to be used in subsequent years. HRAs are sometimes called health reimbursement arrangements.
HRAs are not offered in plans available through BeWell.
A type of savings account that lets you set aside pre-tax money to pay for qualified medical expenses. You can lower your overall health care costs by using untaxed dollars in an HSA to pay for deductibles, copayments, coinsurance and some other expenses.
HSAs are not offered in plans available through BeWell.
A plan with a higher deductible than a traditional health insurance plan. The monthly health insurance premium is usually lower but you likely will pay more health care costs yourself before the health insurance carrier starts to pay.
Part of a suite of long-term care services available through the New Mexico Health Care Authority. These services are also known as waiver-funded services or waiver programs. HCBS provides for support and services beyond those covered by Medicaid. HCBS allows a person to stay in a community setting by providing help with such daily tasks as bathing or dressing. Get more information about HCBS.
Health care services a person gets at home.
Services to provide comfort and support for people in the last stages of a terminal illness. Services may also include help for their families.
When you get care in a hospital, you may be admitted as an inpatient. You may stay in the hospital overnight or for several days.
Your household includes you, your spouse and any dependents you claim on your taxes. When you apply for a health insurance plan, you will need to fill out details about your household. For BeWell, you should list these individuals as part of your household, even if they don’t need health coverage:
For the Premium Tax Credit (PTC), your household income is your Modified Adjusted Gross Income (MAGI) plus that of everyone in your household you can claim a personal exemption deduction for and who is required to file federal income taxes. MAGI does not include Supplemental Security Income (SSI). MAGI is the adjusted gross income on your federal income tax return plus any:
A U.S. government agency under the Department of Homeland Security responsible for enforcing immigration laws, investigating customs and trade violations, and combating transnational crime.
A member of a household who files their own tax return separate from the primary tax filer and is not being claimed on another’s tax return.
An agency within the Department of the Interior, responsible for providing federal health services to Native Americans and Alaska Natives.
There are several programs to help families and individuals obtain access to affordable health coverage. The Patient Protection and Affordable Care Act provides opportunities for eligible individuals to reduce the cost of health coverage through the premium tax credit and to reduce out-of-pocket expenses for covered health benefits through cost-sharing reductions (CSRs). Additionally, Medicaid and the Children’s Health Insurance Program (CHIP) are two longstanding programs that provide affordable health coverage to eligible individuals and families.
Health insurance for people who do not enroll in or get employer-sponsored coverage through their job or their spouse’s or domestic partner’s job.
A tax-advantaged retirement savings account that allows individuals to save money for retirement with potential tax benefits. It’s a trust that holds investment assets purchased with a taxpayer’s earned income for their eventual benefit in old age.
A health insurance plan network is the group of providers contracted with your health insurance plan to provide services. You’ll typically pay less for health services from providers in the plan’s network.
Medical care where a patient stays overnight, or for an extended period, in a hospital or other healthcare facility.
The IRS is an agency of the Department of the Treasury of the United States government that manages taxes and enforces tax laws. Visit the IRS website.
The collection, testing, and analysis of patient specimens (like blood, urine, or tissue) in a laboratory setting. These services help health care providers to diagnose, treat, and manage patient conditions, as well as assess their overall health.
A group health insurance plan offered by employers with 51 or more employees.
Lawful permanent residents (LPRs), also known as “green card” holders, are aliens who are lawfully authorized to live permanently within the United States. LPRs may accept an offer of employment without special restrictions, own property, receive financial assistance at public colleges and universities, and join the Armed Forces. They also may apply to become U.S. citizens if they meet certain eligibility requirements.
Individuals who do not speak English as their primary language and who have a limited ability to read, speak, write, or understand English. BeWell has Spanish speakers available to help consumers as well as an interpreter language line that covers more than 100 languages.
The Health Insurance Marketplace Affordability Program lowers premiums and out-of-pocket costs for most people who get coverage through BeWell. This program was established under New Mexico’s Health Care Affordability Fund and administered by the New Mexico Health Care Authority in partnership with BeWell.
Services provided to mothers and their babies before, during, and after pregnancy, focusing on promoting health and preventing complications. This includes before birth, during labor and delivery, and after birth care.
Medicaid is a joint federal and state program that helps cover medical costs for some people with limited income and resources. The federal government has general rules that all state Medicaid programs must follow, but each state runs its own program. This means eligibility requirements and benefits can vary from state to state. You can check if you qualify when you apply for health insurance coverage through BeWell.
A measure of how much of your health insurance premium goes towards paying for actual medical care and quality improvement activities, as opposed to administrative costs, marketing, and profits for the insurance company.
Most plans with Medicare prescription drug coverage (Part D) have a coverage gap, which is called a “donut hole.” This means after you and your drug plan have spent a certain amount of money for covered medications, you must pay all costs out-of-pocket for your prescriptions up to a yearly limit. Once you have spent up to that limit, the donut hole ends, and your drug plan helps pay for covered medications again.
State-administered programs that offer financial assistance to low-income individuals with limited resources.
A New Mexico program that pays the first payment for a health insurance plan, called the binder payment, for individuals transitioning off Medicaid. It’s a premium assistance program designed to help individuals maintain coverage while they transition to Marketplace coverage.
A range of services aimed at promoting and maintaining mental well-being and treating mental health disorders.
Health insurance coverage that satisfies the Affordable Care Act’s shared responsibility provision. All plans through BeWell are MEC plans.
A standard of minimum coverage that applies to job-based health insurance plans. If you are offered a job-based plan from your employer and it meets this standard, you will not be eligible for savings if you enroll in a plan through BeWell instead. To learn whether your job-based health insurance plan meets the minimum value standard, ask your employer for a Summary of Benefits and Coverage (SBC). You can also ask them to fill out the Employer Coverage Tool (PDF).
The figure used to determine whether you are eligible Medicaid or Premium Tax Credits (PTC) and cost-sharing reductions to lower the cost of health coverage and care through a plan on BeWell. MAGI is Adjusted Gross Income (AGI) plus any untaxed foreign income, non-taxable Social Security benefits and tax-exempt interest. MAGI does not include Supplemental Security Income (SSI) and does not appear as a line on your tax return. For many people, MAGI is identical or very close to their AGI.
State financial assistance that offers premium assistance, based on income, for members of federally recognized Tribes.
A group of facilities, providers and suppliers that has contracted with your health insurance carrier to provide health care services. The network usually includes in-network doctors, hospitals and clinics where you can go for health care.
Offers health insurance for residents who are considered uninsurable or those who’ve used all of their COBRA benefits.
State financial assistance that lowers monthly premium payments for most New Mexicans who qualify.
A federal law that protects customers against surprise medical bills that can pose a big financial burden. This is when insured customers inadvertently get care from out-of-network hospitals, doctors or other providers they did not choose. Get more information from the Centers for Medicare & Medicaid Services.
An office of the Health Care Authority that provides administrative hearings consistent with state (NMAC) and federal regulations (CFR). The OFH registers appeals of adverse actions across all public assistance categories as well as Child Support enforcement actions, Managed Care Organization actions, certain actions involving nursing home care and certain administrative actions concerning providers. OFH also serves as the hearing office for appeal of BeWell decisions.
The state-level regulatory body that enforces New Mexico law on insurance matters, including consumer protections, reviews insurance forms and rates for accuracy and fairness, and helps New Mexicans address insurance concerns. OSI oversees and regulates many kinds of insurance in New Mexico and licenses the individuals and agencies that sell insurance in the state. Visit OSI’s website.
Window of time when people can enroll or renew health insurance plans through the Marketplace. For Plan Year 2026, the OEP is from November 1 to January 15. For Plan Year 2027, the OEP will be November 1 to December 31.
A health insurance plan network is the group of providers contracted with your health insurance plan to provide services. A provider that does not contract with your health insurance plan is an “out-of-network provider” or ” non-network provider.” You will typically pay more for health services from out-of-network providers.
Any costs you pay for your health care services. You might pay for services right away when you visit the doctor, or you might be billed later for your share of the costs. Examples of out-of-pocket costs include copayments, coinsurance and deductibles.
Your plan protects you by placing a limit on how much you pay. Plans with higher premiums usually have lower out-of-pocket limits. Once you reach the plan’s out-of-pocket limit (or maximum), it will pay 100% for covered services. You will no longer have to pay copays or coinsurance. The out-of-pocket limit does not include:
Medical care and procedures that do not require an overnight stay at a hospital or other medical facility. Normally patients receive care and return home the same day. These services can be provided in many different settings, like a doctor’s office, clinic, urgent care, or specialized facilities like surgery centers.
A specialized branch of medicine focused on the health and well-being of children from birth to young adulthood.
The process of using electronic data sources to identify individuals enrolled in a health insurance to ensure they still meet the eligibility criteria.
Information that can be used to distinguish or trace an individual’s identity, either alone or when combined with other information linked or linkable to a specific individual.
A doctor who directly provides or coordinates health care for a patient. There are two types of doctors: a Medical Doctor (MD) and a Doctor of Osteopathic Medicine (DO).
The legal document with the terms of the insurance arrangement. It is also known as the Evidence of Coverage (EOC).
The person who purchased and owns the health insurance policy.
Any physical or mental condition (including a disability) for which medical advice, diagnosis, care or treatment was recommended or given within the six-month period ending on your enrollment date in a health insurance plan. All plans through BeWell cover pre-existing conditions. Under the Affordable Care Act, health insurance carriers cannot exclude people with pre-existing conditions from getting coverage or charge them more for coverage compared to others.
A type of health insurance plan that contracts with health care providers to create a network of participating providers. You pay less if you use providers that belong to the PPO’s network. You can use doctors, hospitals and providers outside of the network for an additional cost.
The amount due each month for your health insurance plan. Other costs for accessing health care outside the premium may include deductibles, copayments and coinsurance. If you have a health insurance plan through BeWell, you may be able to lower your monthly premium if you qualify for financial assistance. Your premium must be paid to keep your health insurance.
Discounts to help pay for a health insurance plan. Subsidies are only available through BeWell. If you qualify based on your estimated household income, the number of people in your household and other factors, a premium subsidy can lower the cost of your premium. That means you pay less every month. Instead of receiving part of the tax credit each month, you may claim the credit all at once when you file your taxes.
Medicine that by law requires a doctor’s order (prescription).
Health insurance that helps pay for prescription medications. You can use the formulary tool in the enrollment portal to check if your medications are covered by your selected plan before enrolling.
Routine health care visits to help you stay healthy. This includes screenings, vaccines, checkups and counseling to prevent illness and other health problems.
A health care professional who provides health services to prevent or treat common illnesses. A primary care provider (PCP) can be a doctor, nurse practitioner, nurse, clinical nurse specialist or physician assistant. The PCP provides, coordinates or helps you access a range of health care services.
The tax filer whose household and tax information are used to determine eligibility for subsidies and how much you can get. This is not the same as being the head of household on a tax return.
PHI is your personal health information and could identify who you are. It relates to:
Examples of PHI include many common identifiers such as your medical records, name, address, birth date, demographic data and Social Security Number. PHI is protected by the HIPAA Privacy Rule.
The program that purchases services from private health care providers for eligible Native American and Alaska Natives when:
PRC funds supplement healthcare resources for Native American and Alaska Native patients. Due to limited IHS appropriations, PRC regulations determine eligibility and medical priority. IHS is the payer of last resort, meaning all other resources must be used first.
A health insurance plan approved by the Office of Superintendent of Insurance certified by BeWell to be offered on the marketplace. A QHP provides essential health benefits, follows cost-sharing rules and meets the requirements of the application process.
A Medicare beneficiary with limited income and resources who qualifies for help with Medicare Part A and B premiums, deductibles, coinsurance, and copayments.
Non-citizen is an immigration status generally eligible for Medicaid coverage if they meet New Mexico’s income and residency rules. Qualified non-citizens include:
A Health Reimbursement Arrangement (HRA) offered by an employer with fewer than 50 full-time employees.
Any health insurance plan that meets the Affordable Care Act standards for comprehensive coverage. A QHC is also called Minimum Essential Coverage (MEC). All plans available through BeWell must meet these standards and must cover the 10 essential health benefits.
A person who meets specific criteria to be eligible for certain benefits or programs. This might include having a specific income level, meeting asset limits, or experiencing a qualifying life event.
A life change that may make you eligible to enroll in health coverage during a Special Enrollment Period (SEP). You may be able to enroll or change your health insurance plan if you:
Some QLEs must be verified by BeWell. Keep your family and financial information handy when you apply.
A defined period of time during which an individual or family can provide necessary documentation to verify their eligibility for benefits.
How you find out whether you used the right amount of Advance Premium Tax Credit (APTC) during the year. To reconcile, you compare two figures: the amount of APTC you used in advance during the year and the amount of tax credit you qualified for based on your final income. You will use IRS Form 8962 to reconcile. If you used more APTC than you qualified for, you will pay the difference with your federal taxes. If you used less, you will get the difference as a credit. You must reconcile every year you take APTC.
A broad range of services to help individuals recover from illness, injury, or disability, enabling them to regain or improve their physical, mental, and cognitive abilities. These services are often delivered by specialists like physical therapists and occupational therapists.
The process of validating personal and demographic information such as name, address, date of birth or social security number to verify a person’s identity.
The process where BeWell verifies information provided by applicants (like income, citizenship, or immigration status). An RFI happens when the information submitted by an applicant doesn’t match what’s found in the external databases. The RFI will require the applicant to provide documentation to resolve the discrepancy.
The second-lowest cost health insurance plan through BeWell in the Silver metal level. You will need to know the SLCSP premium to figure out your final Premium Tax Credit (PTC) even if you were not enrolled in that plan. In most cases, you will find your SLCSP premium on IRS Form 1095-A. BeWell will send Form 1095-A early in the year after a plan year in which someone in your household had health coverage through BeWell.
View our Second Lowest Cost Silver Plan Calculator.
Household members who can shop and enroll in a health insurance plan together. The shopping group is based on the program eligibility of each household member.
The application you fill out to see if you are eligible for coverage through BeWell. This application also checks to see if you are eligible for Medicaid. If you are, the SSAP will be transferred to the Health Care Authority (HCA) to process for Medicaid.
If you fill out an SSAP with Medicaid first and are determined ineligible for Medicaid but eligible to enroll through BeWell, the HCA will transfer your SSAP automatically to BeWell.
Skilled nursing care and rehabilitation services provided on a continuous, daily basis in a skilled nursing facility. Examples include physical therapy or IV injections that can only be given by a registered nurse or doctor.
The federal agency that manages the United States social insurance program, consisting of retirement, survivors and disability insurance programs (Social Security). The SSA:
Monthly payments to people who have a disability that stops or limits their ability to work.
A unique nine-digit identification number issued by the U.S. government to individuals.
Social Security benefits based on the record of a person who dies and that are paid to their:
A time outside of the Open Enrollment Period (OEP) when you may be able to enroll or change your health insurance plan. You may be able to enroll in a health insurance plan during a SEP if you have a Qualifying Life Event (QLE) such as getting married or divorced, having a baby, adopting a child or losing coverage. Most SEPs last 60-days from the date of the QLE.
Health care and related needs of dependents with chronic physical, developmental, behavioral or emotional conditions that require more care than a person generally needs.
A provider who specializes in a certain area of medicine or a group of patients, such as a cardiologist or neurologist. They diagnose, manage, prevent or treat certain types of symptoms and conditions.
A program that helps pay for Medicaid Part B premiums, for those who have both Part A and Part B. It also helps pay for prescription drugs and caps their out-of-pocket cost.
A separate insurance plan that covers dental care, distinct from a medical health insurance plan.
A health insurance marketplace, also known as an exchange, that is operated and managed at the state level. These marketplaces, along with the federal marketplace (HealthCare.gov), provide a platform for individuals and families to shop for and enroll in health insurance plans that meet the requirements of the Affordable Care Act (ACA). BeWell is New Mexico’s state-based marketplace.
New Mexico SHIP provides free, unbiased, expert health insurance related issues, including Medicare, prescription drug assistance, financial assistance and long-term care insurance. SHIP works with other state agencies and partners that provide social services and help to older adults and people with disabilities.
Funded by the Health Care Affordability Fund, SOPA provides extra savings on out-of-pocket costs for certain plans. Plans with SOPA are labeled as Turquoise Plans. To benefit from SOPA, when plan shopping, individuals must select a Turquoise Plan.
An easy-to-read summary comparing costs and coverage between health insurance plans. You can compare options based on price, benefits and other features. You can view the SBC when you shop for coverage, or you can request it from your health insurance carrier.
Monthly payments to people with disabilities and older adults who have little or no income or resources.
Includes the following household members:
The minimum amount of income required to file a federal tax return. For 2025, the filing requirements for most taxpayers is: Gross income of at least $14,600 (individuals) or $29,200 (married filing jointly). Different thresholds apply for dependents, people age 65 and older and those who use other tax filing statuses. If you received Premium Tax Credits (PTC), you must file a federal income tax return.
The net monthly premium or first month’s payment you must pay to the health insurance carrier. The total amount owed is calculated by subtracting the Advance Premium Tax Credit (APTC) and any state subsidies from the premium amount total (gross monthly premium).
New Mexico’s Medicaid Program. Turquoise Care is not run by BeWell, it’s a program under the New Mexico Health Care Authority. Learn more about Turquoise Care.
An executive department of the United States federal government responsible for developing and implementing policies related to food, agriculture, natural resources, rural development, nutrition and related issues.
When you need quick medical care, but it’s not an emergency.
Out-of-pocket fees a health insurance policyholder must pay for services. UCR fees are based on the services provided to policyholders, as well as the area of the country where the services are being provided.
A well-recognized component of a cost management approach in the health care service delivery and payment arenas. UM processes include interventions that take place before, during and after the clinical encounter.
The U.S. Department of Veterans Affairs (VA) runs programs benefiting veterans and members of their families. It offers education opportunities and rehabilitation services and provides compensation payments for disabilities or death related to military service, home loan guaranties, pensions, burials, and health care that includes the services of nursing homes, clinics, and medical centers.
A health benefit that covers vision care, such as eye exams and glasses. All health insurance plans offered by BeWell include vision coverage for children. Some include vision coverage for adults.
The time that must pass before coverage can become effective under an employer-sponsored health insurance plan.
Routine doctor visits for preventive health services and annual visits for young people from birth until age 21. Services include physical exams, measurements, vision and hearing screenings and oral health risk assessments.
Proactive, preventative health care initiatives focused on promoting and maintaining overall well-being, rather than solely treating illness. These services encompass a range of activities and programs aimed at enhancing physical, mental, and social health through lifestyle modifications and preventive care.
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