The Blue Cross and Blue Shield of New Mexico health plan rates may change in the coming year. These changes are based on a number of factors, like your zip code and family size. Please note that the rate change average may not apply to you and your family.
2025 Rate Changes
Download a PDF explaining the 2025 rate change justification:
If you're shopping for a 2024 plan, review the 2024 justification for the proposed rate increase.
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Scope, Range, and Best Estimate of the Rate Increase
BCBSNM is filing new rates to be effective January 1, 2025, for its Individual ACA metallic coverage. As measured in the Unified Rate Review Template (URRT), the range of rate changes for these plans is an increase of 5.8% to an increase of 9.8%. The following is the average rate increase:
- Blue Community: 9.0%
The cost relativities among plans are different from the experience period to the prospective rating period due to anticipated non-uniform changes in network reimbursement levels. Additionally, the rates vary by plan due to the leveraging and utilization differences driven by variations in member cost sharing. Therefore, the proposed rates and rate changes may vary by plan.
Changes in allowable rating factors, such as age and geographical area, may also impact the premium amount for the coverage.
There are currently 30,363 members on Individual Affordable Care Act (ACA) plans that may be affected by these proposed rates.1
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Financial Experience of the Product
Consistent with the filed URRT, earned premiums for Individual plans during calendar year 2023 were $155,189,734 and total claims incurred were $146,419,819.
The proposed rates effective January 1, 2025, are expected to achieve the loss ratio assumed in the rate development.
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Changes in Medical Service Costs
The proposed rates reflect expected change in year over year medical service and prescription drug costs, which includes changes in reimbursement rates to providers, changes in expected utilization of services, the mix and intensity of services, and the introduction of new procedures and technologies.
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Changes in Benefits
Cost-sharing changes were made within these products allowing plans to maintain their metal status and to comply with 2025 Plan Year Standardized Health Plan requirements prescribed by the BeWell Board of Directors, which can contribute to the change in rates.
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State Mandated Changes
The proposed rates reflect the impact of New Mexico legislation items and/or regulatory changes effective on January 1, 2025, as well as the New Mexico Office of the Superintendent of Insurance (OSI)’s requirement for issuers to use a 44% CSR adjustment factor for Silver plans sold on the Exchange.
Plan offerings comply with 2025 Plan Year Individual QHP and Small Group Market Rate Filing Guidance to set the tobacco rating multiplier at 1.0 for all individual on-and-off-exchange plans, offer only two on-exchange non-standardized Silver and Gold plans in any rating area, and keep the minimum premium differential for a 21-year-old between any two non-standardized silver plans in a single area above $10 PMPM.
In addition, Turquoise variants are made available for each Silver and Gold plan with the expansion of Turquoise 3 eligibility to 200-400% FPL and the introduction of -13 variant for Native Americans between 300-400% FPL and participate in Gold plans, as mandated by the Health Insurance Marketplace Affordability Program Policy and Procedures Manual.
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Administrative Costs and Anticipated Margins
The Affordable Care Act expects health plans in the individual market to spend at least 80% of each premium dollar they collect to pay for medical care and activities that improve health care quality for members. If health plans fail to spend at least 80% on medical claims and health care quality initiatives, they are required to give back money to consumers through a premium rebate. These rates assume BCBSNM will once again exceed the 80% threshold.
1 Member count reflects the accurate count at the time the rate increase notice was created.