Updated: June 20, 2026
Advertising & Editorial Disclosure
Presbyterian Health Plan is the best Medicare Advantage provider in New Mexico for HMO coverage with $0 monthly premiums, a $6,000 maximum out-of-pocket limit and 3 CMS star rating.
UnitedHealthcare has the best HMO-POS plans in New Mexico at $0 per month with a $5,900 MOOP. Humana leads PPO options at $0 per month. Its average MOOP of $7,850 is $1,950 higher than UnitedHealthcare's HMO-POS average of $5,900.
Before enrolling, confirm your prescriptions are on the plan's formulary and verify your doctors are in that plan's network, not just with the insurer in general.
Presbyterian Health Plan is the top HMO Medicare Advantage insurer in New Mexico, with $0 monthly premiums and a $6,000 maximum out-of-pocket limit. UnitedHealthcare leads HMO-POS coverage with a 4-star CMS rating and a $5,900 MOOP. Humana ranks first among PPO options at $0 per month.
MoneyGeek scored plans across New Mexico on affordability, CMS star ratings and the number of states each insurer serves.
| HMO | Presbyterian Health Plan | 3.00 | $0 | $6,000 | Presbyterian Senior Care Extra Health Plan with Rx (HMO) |
| HMO-POS | UnitedHealthcare | 4.00 | $0 | $5,900 | AARP Medicare Advantage from UHC NM-0010 (HMO-POS) |
| PPO | Humana | 3.50 | $0 | $7,850 | HumanaChoice H5216-223 (PPO) |
Medicare Advantage plans replace Original Medicare with bundled coverage from private insurers that must include everything Parts A and B cover, plus prescription drug coverage in most cases. Extra benefits like dental, vision and hearing are common but vary by plan.
Best HMO
CMS Star Rating
Plan Types
Best HMO-POS
CMS Star Rating
Plan Types
Best PPO
CMS Star Rating
Plan Types
New Mexico has nine HMO Medicare Advantage plans with CMS star ratings from 2.5 to 4.0. Only one plan earns four stars or higher. Seven plans carry $0 monthly premiums. The average MOOP across all nine plans is $4,489, with limits ranging from $3,800 to $6,000.
| Presbyterian Health Plan | 3.00 | $0 | $6,000 | 3 | 5 |
| CHRISTUS Health Advantage | 3.50 | $0 | $4,200 | 1 | 4.75 |
| Cigna HealthCare | 3.00 | $0 | $4,201 | 1 | 4.14 |
| Blue Cross Blue Shield | 2.57 | $3 | $4,200 | 2 | 4 |
Presbyterian Health Plan earned a 5/5 MoneyGeek score. Its $0 average premium and $6,000 average MOOP earned it the highest affordability score among HMO providers in New Mexico. No HMO provider in the ranked table earns above 3.5 stars on CMS quality measures. UnitedHealthcare's HMO-POS plans earn 4 stars, charge $0 per month and set a $5,900 MOOP. Out-of-network access is included at that same $0 cost.
HMO plans have the lowest out-of-pocket costs among Medicare Advantage options in New Mexico. You'll pick a primary care doctor who coordinates all your care. Specialist visits require a referral, which keeps HMO premiums at an average of $15 per month versus $20 for PPO plans. It's the right choice when you have established doctors in the insurer's network and don't need frequent out-of-network access.
UnitedHealthcare is the only HMO-POS Medicare Advantage insurer in New Mexico. Both plans are rated 4 stars and charge $0 per month with a $5,900 MOOP. No other HMO-POS options exist in the state.
| UnitedHealthcare | 4.00 | $0 | $5,900 | 2 | 5 |
UnitedHealthcare is the only HMO-POS insurer in New Mexico. Beneficiaries who want out-of-network access at $0 per month have no other carrier to choose from in this plan type.
HMO-POS plans charge less per month than PPO plans. In New Mexico, HMO-POS plans average $0 per month versus $20 for PPOs. Both plan types cover out-of-network visits, but out-of-network cost-sharing is higher than in-network rates. UnitedHealthcare is the only HMO-POS carrier in New Mexico, so beneficiaries who want this plan type have one provider to evaluate.
New Mexico has 26 PPO Medicare Advantage plans with premiums from $0 to $135 per month. PPO plans average $20 per month versus $15 for HMOs and they remove the referral requirement for specialist visits. The average MOOP statewide is $5,762, and 14 plans earn 4 stars or higher.
| Humana | 3.50 | $0 | $7,850 | 7 | 5 |
| UnitedHealthcare | 4.00 | $12 | $5,747 | 12 | 4.67 |
| Blue Cross Blue Shield | 3.00 | $43 | $6,158 | 7 | 3.25 |
For beneficiaries who use their plan regularly, UnitedHealthcare's 4-star PPO lineup at $12 per month average is the stronger option. The $144 annual premium difference buys a half-star CMS quality advantage over Humana's $0-average PPO plans.
PPO plans average $20 per month in New Mexico, $5 more than HMOs at $15. The extra cost removes the referral requirement and gives you access to any provider, in-network or out, without prior approval. Beneficiaries who travel frequently or see specialists across different health systems get the most value from this plan type.
The right Medicare Advantage plan in New Mexico depends on three factors: whether your doctors are in-network, what your prescriptions cost under each plan's formulary and how much out-of-network access you need.
Contact your doctors and hospitals directly to confirm they're in the specific plan's network. Each plan from the same insurer can have a different provider network.
Plans with no premium often carry higher out-of-pocket costs through copays and deductibles. A $0 premium plan can cost more overall if its copays and specialist visit costs exceed what you'd pay under a higher-premium plan.
Review the drug formulary to confirm your prescriptions are listed and note their tier. Higher-tier medications cost more out of pocket and some require prior authorization before the plan will cover them.
An HMO is the right choice when you have established in-network doctors and want the lowest premiums. HMO-POS adds out-of-network access at the same $0 monthly cost, in New Mexico, only UnitedHealthcare offers this plan type. A PPO is the right choice when you travel frequently or see specialists outside a single health system.
CMS star ratings measure plan quality and member outcomes on a 1-to-5 scale. Plans rated 4 or 5 stars provide better care and customer service than lower-rated options, based on CMS measurement data.
Many New Mexico Medicare Advantage plans include dental, vision and hearing benefits, fitness memberships and over-the-counter allowances. These vary by plan and by insurer, compare them as part of the total value, not just the premium.
A lower MOOP caps your annual out-of-pocket spending. In New Mexico, the lowest available MOOP is $3,400 on Humana's Full Access PPO at $64 per month. If you expect to hit your out-of-pocket maximum, that plan costs less overall than a $0-premium plan with a $7,850 MOOP.
Plan type determines how much you pay for Medicare Advantage in New Mexico. HMO plans average $15 per month, HMO-POS plans average $0 and PPO plans average $20.
| HMO | $0 | $15 | $4,489 |
| HMO-POS | $0 | $0 | $5,900 |
| PPO | $0 | $20 | $5,762 |
HMO plans average $15 per month with a $4,489 average MOOP in New Mexico. HMO-POS plans average $0 per month with a $5,900 MOOP. PPO plans average $20 per month with a $5,762 average MOOP. Plan type is the primary cost driver across all three.
Presbyterian Health Plan is the best starting point for most New Mexico beneficiaries who want $0 premiums and don't need out-of-network access. If you want both $0 premiums and the ability to go out of network, UnitedHealthcare is the right choice. Humana leads for PPO coverage at $0 per month average. Beneficiaries who weigh CMS star ratings heavily will find UnitedHealthcare's 4-star PPO lineup rated higher than Humana's 3.5-star average.
Get answers to common Medicare Advantage questions for New Mexico residents below.
First enroll in Medicare Parts A and B, then select a plan during open enrollment (Oct. 15 to Dec. 7) through Medicare.gov or directly through a licensed agent. Coverage starts Jan. 1, or during another qualifying period if you have a special enrollment event.
Medicare Advantage plans cover everything Original Medicare does. Most plans include prescription drug coverage. Dental, vision and fitness benefits are available on many plans but not all, check each plan's summary of benefits before enrolling.
Medicare Advantage replaces Original Medicare with bundled coverage from a private insurer. Medicare Supplement (Medigap) works alongside Original Medicare to cover costs like deductibles and copays that Original Medicare leaves unpaid.
Medicare Advantage open enrollment in New Mexico is Oct. 15 to Dec. 7 each year. Current members can also make changes Jan. 1 through March 31.
Coverage availability in New Mexico varies by county. Presbyterian Health Plan and UnitedHealthcare both operate statewide networks. Beneficiaries in rural New Mexico counties have the most plan access through these two carriers. Check each plan's provider directory for your specific ZIP code before enrolling, since network coverage in rural New Mexico can differ from what's available in the Albuquerque or Santa Fe metro areas.
Medigap works alongside Original Medicare with no network limits. It charges a monthly premium on top of Part B. Medicare Advantage suits beneficiaries in good health with predictable care needs. Medigap suits anyone with chronic conditions or frequent specialist visits who wants a fixed annual cost ceiling.
We evaluated all Medicare Advantage plans available to New Mexico residents for plan year 2026. MoneyGeek's New Mexico analysis covered nine HMO plans, two HMO-POS plans and 26 PPO plans across all counties where coverage was available. We scored Medicare Advantage plans in New Mexico on three criteria:
About Mark Fitzpatrick
Mark Fitzpatrick, a Licensed Property and Casualty (P&C) Insurance Producer in Connecticut, is MoneyGeek's resident insurance expert. He has spent nearly a decade analyzing the market, first at LendingTree and now at MoneyGeek, where he produces original research on hundreds of carriers and millions of rates across auto, home, renters, health and life insurance.
He covers economics and insurance at MoneyGeek, and his work has been featured in The Washington Post, The New York Times and NPR, among other outlets.
Like all MoneyGeek analysts, he draws on independent cost and consumer experience data. No insurance company partnership influences his recommendations.
Fitzpatrick earned his degrees from Johns Hopkins University (M.A. Economics and International Relations) and Boston College (B.A.). His career began in financial risk management at State Street. He's also a five-time “Jeopardy!” champion.
