ACA Rate
Increase Justification

The Centers for Medicare & Medicaid Services (CMS) requires qualified health plan insurers, such True Health New Mexico, to post a notification on its website explaining the necessity of rate increases.

The primary factors driving True Health New Mexico’s proposed premium rate changes are:

• An increase in the cost of medical care. This includes cost increases for specific medical services and goods, as well as increases related to rising utilization of those services and goods.
• The impact of expected changes to fees imposed on health insurers, under the requirements of the Affordable Care Act (ACA).
• Changes in the level of sickness of the members insured by True Health New Mexico.
• The projected impact of changes in the ACA Risk Adjustment program.

True Health New Mexico submits proposed rates to the New Mexico Office of Superintendent of Insurance (NM OSI) for approval. Once this agency completes its review process and makes a final decision on the rates, a summary of the results are posted on its website.