2027 Plan Year Health Insurance Marketplace Affordability Program Policy and Procedures Manual
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Governs New Mexico's Marketplace affordability programs (MAP, New Mexico Premium Assistance, Native American Premium Assistance, Puente Health) for plans sold on BeWell's individual marketplace and outlines eligibility, program parameters, and payment calculations affecting consumers and issuers.
No material clinical or coverage changes in this revision.
Program Eligibility and Coverage Criteria
MAP and related program criteria
Eligibility criteria and program parameters for New Mexico Premium Assistance, Native American Premium Assistance, and Puente Health for PY27.
Calculation rules
- For consumers under 200% of the FPL: use Gross Monthly SLCSP x 1.1 - Monthly Federal APTC - (Applicable % of income x Expected Annual Household Income / 12)
- For consumers ≥ 200% and ≤ 400% of the FPL (and Native Americans ≥ 300% and ≤ 400% FPL): use Gross Monthly SLCSP - Monthly Federal APTC - (Applicable % of income x Expected Annual Household Income / 12)
Puente Health criteria
Eligibility and premium assistance criteria for Puente Health
SOPA / MTPR criteria
SOPA and MTPR applicability and cost-sharing assistance rules
Turquoise Variant coverage and operational criteria
Design relativity and AV filing requirements for Turquoise Variants
Variant eligibility and replacement rules
Eligibility and replacement rules for federal and New Mexico-specific variants.
Codes, AVs, and Financial Limits
| SLCSP | Second Lowest Cost Silver Plan used as benchmark for APTC and state premium calculations |
| -99 | Turquoise 1 replacement for Silver -06 (under 150% FPL) |
| -95 | Turquoise 2 replacement for Silver -05 (≥150 and <200% FPL) |
| -90 | Turquoise 3 replacement for Gold -01 (≥200 and ≤400% FPL) and for Puente members |
| -13 | Native American Gold variant replacement for -03 for ≥300 and ≤400% FPL with IHS no cost sharing |
| Turquoise 1 | SOPA variant mapped to Silver, 99% AV, Multiplier .042 |
| Turquoise 2 | SOPA variant mapped to Silver, 95% AV, Multiplier .066 |
| Turquoise 3 | SOPA variant mapped to Gold, 90% AV, Multiplier .079 |
| No billing or clinical codes provided in this excerpt. |
Issuer and Provider Obligations
Marketplace-only applicability
MAP applies only to plans sold on BeWell's individual market platform and is not available to consumers who enroll off‑Marketplace.
Issuer obligations for Turquoise variants
Issuers are required to offer Turquoise Variants for Standardized 'Clear Cost' plans on BeWell; Turquoise Variants must follow the standardized plan designs and use the underlying metal tier when capturing AV calculator screenshots.
- All issuers must offer Turquoise Variants for Standardized Health Plans ('Clear Cost' plans).
- When capturing AV calculator screenshots, use the underlying metal tier corresponding to the Standardized Health Plan represented by the Turquoise Variant.
Primary care & generic drug cost‑sharing restriction
For Turquoise Variants, issuers may only apply co-payments — coinsurance is prohibited and deductibles cannot apply — for primary care visits and generic prescription medications.
- Co-payments only for primary care visits and generic prescription medications.
- Coinsurance is not allowed and the deductible cannot apply to these services.
Carryover of OOP accumulators on intra-issuer plan changes
When SOPA-eligible consumers switch plans offered by the same issuer because of mid‑year household or income changes, issuers must carry over any out‑of‑pocket costs incurred in the original plan to the new plan (do not reset accumulators).
Federal variant definitions
The federal variant framework includes multiple variants: standard (01), zero cost sharing for eligible tribal members (02), limited cost sharing for tribal members via Indian health care providers (03), and CSR-linked Silver variants such as the CSR 73 variant (04) for specified income bands.
- 01 Variant — Standard Variant (base plan, no state SOPA or federal CSR applied).
- 02 Variant — Zero Cost Sharing Variant for eligible members of federally‑recognized tribes with income < 300% FPL.
- 03 Variant — Limited Cost Sharing Variant: no out‑of‑pocket costs for services through Indian health care providers; other cost sharing unchanged.
- 04 Variant — CSR 73 Variant for eligible individuals ≥200 and <250% FPL.
State Turquoise variant definitions
New Mexico defines state 'Turquoise' variants that replace certain federal CSR variants: Turquoise 1 (Silver 99) for <150% FPL, Turquoise 2 (Silver 95) for ≥150 and <200% FPL, and Turquoise 3 (Gold 90) for ≥200 and ≤400% FPL; these state variants are required versions of each applicable metal plan and replace the listed federal variants for qualifying individuals.
- Turquoise 1 — State Silver Only, 99% AV, replaces federal 06 variant for individuals with income <150% FPL.
- Turquoise 2 — State Silver Only, 95% AV, replaces federal 05 variant for individuals ≥150 and <200% FPL.
- Turquoise 3 — State Gold Only, 90% AV, required for each Gold plan and available to individuals ≥200 and ≤400% FPL; replaces the 01 variant for Gold plans.
Glossary and Variant Labels
Policy Dates and Revision Log
HCA issued the '2027 Plan Year Health Insurance Marketplace Affordability Program Policy and Procedures Manual' (effective Jan 1, 2027) describing MAP, SOPA, Puente Health, Turquoise variants, and program parameters.
Program parameters and changes described in the manual take effect (Program Effective Date: January 1, 2027).
MAP originally launched on BeWell's Marketplace (MAP launch date: January 1, 2023).
Puente Health program began providing state-funded subsidies to certain lawfully present non-citizens (Puente Health began January 1, 2026).
Reconciled SOPA payments for PY27 will be made to issuers no later than June 30, 2028.
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