Benefit Navigation

Address

413 Sipapu Street Taos, NM 87571

Phone

575-751-8939

Benefit Navigation

The Benefit Navigation program of Holy Cross Hospital is here to help the citizens of our community understand their health insurance enrollment options and provide application assistance.

Centennial Care | Health Exchange | Medicare Education

To meet the health insurance needs of our community the Benefit Navigation Program provides free benefit counseling to help underinsured and uninsured households of Northern New Mexico navigate the application process for Medicaid, Medicare, and the Health Exchange.

The Open Enrollment Period for the Health Exchange is now an annual event occurring November 1- December 15 of every year.

Medicaid Enrollment

Our Benefit Specialists are trained Medicaid Determiners and are available to answer your Medicaid questions and/or assist with an application. There are numerous categories of Medicaid, each with specific eligibility requirements and benefits packages.

The Benefit Navigation Program of Holy Cross Medical Center provides the education necessary to direct clients to the health insurance programs that meet their individual needs and resources.

Medicare Education

The Benefit Navigation Program also provides the education necessary to understand all of the parts of Medicare, including Part A, Part B, C, and D…

The Benefit Navigation Program is a partner of the Northern New Mexico Benefit Enrollment Center.  Working with a screening tool developed by the National Council on Aging, called the Benefit Checkup our Benefit Specialists can identify any additional benefits that are available to anyone receiving Medicare.

Helpful Links:

Free Legal resources for the Elderly:
https://www.nmbar.org/Public/LREP

How to Apply for Medicare:
https://www.ssa.gov/benefits/medicare/

Learn about Medicare and your rights:
https://www.mymedicarematters.org/

More Enrollment Information:

Health Exchange / Affordable Care ActMedicaid Enrollment

Health Insurance Enrollment

Health Exchange / Affordable Care Act

Under the Affordable Care Act, which began in January 2014 all Americans will be eligible for and are required to have health insurance. The Open Enrollment Period for the Health Exchange is now an annual event occurring every November 1 – December 15. All plans are set to begin January 1.

Need to enroll in Health Insurance?

The open enrollment period is much shorter than it ever has been before, only 45 days.

Be prepared:

  • Do you have your user name & password?
  • In case you need to reset your password do you know your security questions?
  • Are you prepared to estimate your income?
  • Have you reconciled/filed taxes for last year? If not, you could lose your tax credits for the new insurance year.
  • Have you received any notices from the Marketplace? It is important to read any notices you receive so if additional information is requested you can submit it before it effects your coverage.
  • Know which insurance plans your doctors accept.
  • Have a list of your current Medications and dosage prepared so you can make the insurance plan you are considering will cover them.

There are a number of ways to apply for health coverage on the Health Exchange Marketplace.

  1. Visit bewellnm.com, or call 1-855-996-6449 (TTY:1-855-851-2018) to find free in-person enrollment assistance in your area from enrollment counselors and insurance brokers.
  2. Go to healthcare.gov to create your own online account and submit an application, or
  3. Call the Health Exchange marketplace call center at 1-800-318-2596 (TTY: 1-855-889-4325) -available 24 hours a day, 7 days a week (Closed Memorial Day, July 4th, Labor Day, Thanksgiving Day, and Christmas Day).

The Benefit Navigation Program of Holy Cross Hospital provides free year-round benefit navigation and enrollment counseling services for the Health Exchange, Medicaid, and Medicare. We have two locations and can provide assistance in both English and Spanish. We can be reached at (575) 751 5764.

Renewal of existing coverage with the Exchange

If you had coverage through the Exchange last year and gave permission for the Exchange to access your income records from 2018, filed your 2017 taxes, are satisfied with your current plan including the type of coverage and the amount of advanced premium tax credits you qualify for, and you make no changes to your current application you will be automatically reenrolled in that plan or a similar plan on December 15, 2018, and your coverage will begin January 1, 2019. Make sure to file your 2017 taxes in 2018 to maintain your tax credit eligibility.

Still Need Health Insurance in 2017:

Consumers who experience certain changes in circumstances outside of open enrollment may be eligible for a Special Enrollment Period (SEP) to enroll in or change marketplace health plans.

A consumer may be eligible for an SEP in the following circumstances:

  • Loosing minimum essential coverage (MEC) -not due to failure to pay premiums
  • Loosing pregnancy-related or medically needed Medicaid coverage that is not MEC
  • Becoming a U.S. citizen, U.S. national or lawfully present individual
  • Gaining or becoming a dependent (e.g. through marriage, birth, adoption, placement for adoption or in foster care, a child support order or other court order)
  • Ending a non-calendar year plan (even if able to renew)
  • Being a survivor of domestic violence or spousal abandonment
  • Permanently moving to a different state or to a place within the same state where different Qualified Health Plans (QHPs) are available in the marketplace (included being released from incarceration)
  • Becoming (or having one’s dependent become) newly eligible or ineligible for APTC’s or having a change in Cost-Sharing Reduction (CSR) eligibility (if enrolled in a QHP)
  • Unintentionally, inadvertently, or erroneously being enrolled (or not enrolled) in a QHP due to error, misrepresentation, misconduct or inaction of the marketplace, the Department of Health and Human Services (HHS) or its employees or agents, or by a non-marketplace entity providing enrollment assistance
  • Having one’s QHP substantially violate a “material provision” of its contract
  • Being a member of a federally recognized American Indian or Alaska Native tribe (can enroll in or change QHP’s once per month)

If you believe you qualify for a SEP please contact our Benefit Navigation Specialists for assistance, (575) 751- 5764.

2018/19 Fines:

The tax bill doesn’t eliminate the penalty until 2019. That means that those who forgo health insurance for 2018 could still face a penalty. The penalty for not having health insurance this year is $695 per adult or 2.5 percent of household income, whichever is greater.

The New Mexico Health Insurance Exchange makes it easy to find an affordable plan. Visit www.healthcare.gov or call Holy Cross Hospital Community Service Office to learn more and enroll in a plan that meets your needs.

To learn more, or to schedule an appointment:
Call: Community Services Office
Phone: (575) 751-5764

Helpful Documents:

  • Social Security Numbers (or document numbers for legal immigrants)
  • Employer and income information for every member of your household who needs coverage (for example, from pay stubs or W-2 forms – Wage and Tax Statements)
  • Policy numbers for any current health insurance plans covering member of your household
  • A completed Employer coverage Tool for every job-based plan you or someone in your household is eligible for (You’ll need to fill out this form even for coverage you’re eligible for but don’t enroll in.)
  • U.S. birth certificate, American Indian Card issued by the Department of Homeland Security, or Passport (can be expired), or documentation of legal status in the United States
  • Current state driver’s license with a picture, a current state ID card with a picture, a school ID card with a picture
  • Documentation of childcare expenses, if applicable
  • Proof of pregnancy, if applicable

To learn more, or to schedule an appointment:
Call: Community Services Office
Phone: (575) 751-5764

The Patient Protection and Affordable Care Act (ACA) was signed into law in 2010. Since then, our health care system has been slowly changing – and we’re concerned that residents of the rural Southwest are not well-enough informed of their new rights and opportunities.

As the many facets of the ACA gradually become law, the Southwest Rural Policy Network (SWRPN) is working to ensure that our rural communities know how, why, and when things are changing – and know exactly what effect the law will have on businesses, families, and individuals. To that end, we developed and distributed some simple materials to providers and community service organizations in our region. This is our effort to put information directly into the hands of the people.

We hope that these materials will help both providers and consumers to educate themselves about the many new opportunities and rights they have under the ACA, and help citizens of the rural Southwest become better advocates for themselves in accessing the health we all deserve.

If you’re interested in requesting materials for your own organization to distribute; if you have questions or ideas about getting your community better-prepared for changes to health care; or if you just want to touch base about the project, please email coord@swruralpolicynetwork.org and we will get back to you!

Medicaid Enrollment

There are numerous categories of Medicaid, each with specific eligibility requirements and benefits packages.
Holy Cross Hospital’s Enrollment Team is happy to help you and your family enroll in Medicaid.

To learn more visit our website.

For assistance please call the Community Services Office at (575) 751-5764.

Support with Medicaid Enrollment

If you’d like help applying for Medicaid, please call us and we can help. There are numerous categories of Medicaid, each with specific eligibility requirements and benefits packages. When applying for Medicaid benefits for any member of your household you will be asked to bring in the following documents to your appointment:

Proof of Income

  • Pay stubs of last 30 days
  • Documents showing any unearned income – such as child support, Social Security benefits, unemployment benefits
  • Proof of New Mexico Residency – This can be a utility bill or mail addressed to the applicant at a New Mexico address
  • Social Security Numbers of individuals needing Medicaid (S.S. Card not needed)
  • Proof of Citizenship or Legal Immigration Status AND Identity:

Citizenship or Legal Immigration Status

  • U.S. Birth Certificate
  • An American Indian Card issued by the Dept. of Homeland Security
  • Passport (can be expired)
  • Legal Immigration Status (applicants who are eligible must have resided in the US for five years)
  • Permanent Resident Card (also known as a “green card”)

Identity

  • A current State Driver’s License with a picture
  • A current State ID card with a picture
  • A school ID card with a picture of the individual
  • Documents proving childcare expenses, if applicable
  • Medical Insurance Card if applicable
  • Proof of Pregnancy if applicable
  • Proof of New Mexico Residency – This can be a utility bill or mail addressed to the applicant at a New Mexico address
  • Social Security Numbers of individuals needing Medicaid (S.S. Card not needed)

We can help with:

1. A Medicaid on site Application

This refers to the process of competing an application for ongoing (as opposed to short-term) Medicaid for low income families, children under 19, pregnant women, and women and men who are seeking family planning services.

2. Presumptive Eligibility

This is a short-term (up to 30 days) determination for Medicaid coverage for children and age 19 or for pregnant women. We “presume” the client’s statement regarding citizenship and income is true and correct.

3. QMB/SLIMB

We can help with filling out a Medicaid Application for:

  • Qualified Medicare Beneficiaries (QMB), and
  • Specified Low Income Medicare Beneficiaries (SLIMB).

Under QMB, you must have or be eligible for Medicare part A (Hospital Insurance). Medicaid will pay your Medicare premiums, deductibles, and co-insurance charges on Medicare covered services only. Medicaid will not cover dental, vision or prescription drugs.

Under SLIMB, you must have Medicare part A. Medicaid will pay your Medicare Part B (Medical Insurance) premium only.

4. Re-Certification

We also assist clients with renewing their Medicaid applications. It is important renewals are submitted annually before the deadline so there is no lapse in Medicaid coverage.

Holy Cross Hospital’s Enrollment Specialists are happy to help you and your family get enrolled in Medicaid.

For assistance please call
Our Benefit Navigation Specialists at
(575) 751-5764.