Important Links Eligibility HIPAA Eligibility Medical Conditions Summary of Benefits Plan Designs Monthly Premiums Qualifying Rates Premium Assistance Medicare Carve-Out Application/Forms Important Notices		Monthly Premiums:  NEW MEXICO MEDICAL INSURANCE POOL MEDICARE CARVEOUT (MC) PLAN PREMIUM RATES (Monthly) Effective July 1, 2009 through December 31, 2009             Low Income Premium Program   All Members All Members Members Effective Prior To 1/1/2009 Members Effective On Or After 1/1/2009       Attained MC 500 Federal Poverty Income Range: Age Plan  0% to 199%  200% to 299%  300% to 399%  300% to 399%      75% Discount 50% Discount 40% Discount 25% Discount Male             0 - 18 $81 $20 $41 $49 $61 19 $108 $27 $54 $65 $81 20 $108 $27 $54 $65 $81 21 $108 $27 $54 $65 $81 22 $108 $27 $54 $65 $81 23 $108 $27 $54 $65 $81 24 $108 $27 $54 $65 $81 25 $112 $28 $56 $67 $84 26 $116 $29 $58 $70 $87 27 $121 $30 $61 $73 $91 28 $124 $31 $62 $74 $93 29 $128 $32 $64 $77 $96 30 $131 $33 $66 $79 $98 31 $135 $34 $68 $81 $101 32 $139 $35 $70 $83 $104 33 $144 $36 $72 $86 $108 34 $150 $38 $75 $90 $113 35 $155 $39 $78 $93 $116 36 $161 $40 $81 $97 $121 37 $167 $42 $84 $100 $125 38 $172 $43 $86 $103 $129 39 $178 $45 $89 $107 $134 40 $184 $46 $92 $110 $138 41 $190 $48 $95 $114 $143 42 $197 $49 $99 $118 $148 43 $203 $51 $102 $122 $152 44 $209 $52 $105 $125 $157 45 $216 $54 $108 $130 $162 46 $223 $56 $112 $134 $167 47 $230 $58 $115 $138 $173 48 $237 $59 $119 $142 $178 49 $245 $61 $123 $147 $184 50 $252 $63 $126 $151 $189 51 $260 $65 $130 $156 $195 52 $268 $67 $134 $161 $201 53 $275 $69 $138 $165 $206 54 $282 $71 $141 $169 $212 55 $290 $73 $145 $174 $218 56 $297 $74 $149 $178 $223 57 $305 $76 $153 $183 $229 58 $307 $77 $154 $184 $230 59 $309 $77 $155 $185 $232 60 $311 $78 $156 $187 $233 61 $314 $79 $157 $188 $236 62 $316 $79 $158 $190 $237 63 $326 $82 $163 $196 $245 64 $336 $84 $168 $202 $252 Female             0 - 18 $81 $20 $41 $49 $61 19 $126 $32 $63 $76 $95 20 $126 $32 $63 $76 $95 21 $126 $32 $63 $76 $95 22 $126 $32 $63 $76 $95 23 $126 $32 $63 $76 $95 24 $126 $32 $63 $76 $95 25 $132 $33 $66 $79 $99 26 $137 $34 $69 $82 $103 27 $143 $36 $72 $86 $107 28 $148 $37 $74 $89 $111 29 $152 $38 $76 $91 $114 30 $157 $39 $79 $94 $118 31 $162 $41 $81 $97 $121 32 $167 $42 $84 $100 $125 33 $173 $43 $87 $104 $130 34 $179 $45 $90 $107 $134 35 $186 $47 $93 $112 $139 36 $193 $48 $97 $116 $145 37 $200 $50 $100 $120 $150 38 $207 $52 $104 $124 $155 39 $214 $54 $107 $128 $161 40 $221 $55 $111 $133 $166 41 $228 $57 $114 $137 $171 42 $236 $59 $118 $142 $177 43 $243 $61 $122 $146 $182 44 $251 $63 $126 $151 $188 45 $259 $65 $130 $155 $194 46 $267 $67 $134 $160 $200 47 $275 $69 $138 $165 $206 48 $279 $70 $140 $167 $209 49 $284 $71 $142 $170 $213 50 $288 $72 $144 $173 $216 51 $293 $73 $147 $176 $220 52 $297 $74 $149 $178 $223 53 $299 $75 $150 $179 $224 54 $300 $75 $150 $180 $225 55 $302 $76 $151 $181 $227 56 $303 $76 $152 $182 $227 57 $305 $76 $153 $183 $229 58 $307 $77 $154 $184 $230 59 $309 $77 $155 $185 $232 60 $311 $78 $156 $187 $233 61 $314 $79 $157 $188 $236 62 $316 $79 $158 $190 $237 63 $326 $82 $163 $196 $245 64 $335 $84 $168 $201 $251

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