Presbyterian exit · Extra Help · 2027

What Happens to My Extra Help When My Presbyterian Plan Ends?

Nothing happens to the Extra Help. It is yours, not the plan's. What changes is where your drug coverage comes from on January 1 — and if you let Medicare decide, the decision is already written: Original Medicare plus one stand-alone drug plan.

By the New Mexico Medicare Help Data Desk

Reviewed by Brian Penner, Independent Medicare advisor — no pressure · Published October 8, 2026

For the dates and choices that apply to every member, see our complete guide to the Presbyterian plans ending December 31.

Your Extra Help does not end, pause or need to be reapplied for when a Presbyterian Medicare Advantage plan is discontinued on December 31, 2026. Extra Help — the Part D low-income subsidy — is a federal benefit that follows the person, and Medicare.gov's rule for 2027 is unchanged: in a qualifying drug plan you pay a $0 premium, a $0 deductible, and no more than $5.80 for a generic or $14.40 for a brand-name drug (Medicare.gov, Help with drug costs). What does change is the plan the subsidy is applied to. CMS's 2027 enrollment guidance says that each fall it "will reassign all affected LIS eligible individuals in terminating MA plans" to a stand-alone drug plan (CMS CY2027 Enrollment and Disenrollment Guidance, § 40.1.9), and the blue letter that announces it is blunt about the result: "If you do nothing, you'll have Original Medicare, and Medicare will enroll you in [a drug plan] to make sure you have Medicare drug coverage" (CMS Product 11443). This post is for the Presbyterian member who gets Extra Help but is not in Dual Plus — the plan that continues, and that requires Medicaid. If you are in Dual Plus, who keeps their plan in 2027 is the page you want.

Do I keep Extra Help when my plan ends?

Yes. Extra Help is granted by Social Security on an application, or automatically if you have full Medicaid, a Medicare Savings Program paying your Part B premium, or Supplemental Security Income (Medicare.gov). None of those is a Presbyterian decision, so none of them changes when Presbyterian's Senior Care and Extra Health plans end. The 2026 income and resource limits — $23,940 and $18,090 for an individual, $32,460 and $36,100 for a married couple — are the only things that decide whether you qualify, and they are reviewed by Social Security, not by a plan. Our guide to Extra Help in New Mexico covers the application.

What the plan ending does change is the mechanics. Presbyterian's plans with drug coverage — Senior Care Plan 2 with Rx, Senior Care Plan 3 with Rx and Senior Care Extra Health Plan with Rx in the CMS file — are Medicare Advantage plans that bundle Part D (CMS CY2026 Landscape file). When they end, your drug coverage ends with them unless something replaces it, and for people with Extra Help federal rules do not leave that to chance. The September LIS Rider you got with your Annual Notice of Change described your 2027 Extra Help cost levels (CMS consumer mailings guide); those levels travel with you to whichever plan comes next.

What does Medicare do if I choose nothing?

It assigns you a drug plan, and only a drug plan. CMS's guidance describes a "Part C Reassignment" run in late October each year: "CMS will reassign all affected LIS eligible individuals in terminating MA plans. This includes non-renewing MA-only plans, as well as MA-PD plans," for anyone who has Extra Help this year and will continue to have it next year (CMS guidance, § 40.1.9). CMS's partner tip sheet adds that this happens "whether or not they joined their current plan on their own, or Medicare enrolled them in a plan" (CMS Product 11221-P). One exception matters: you are not reassigned "if they have Part D coverage the following year" — so a member of the drug-free Senior Care Plan 1 who already has a stand-alone drug plan keeps it and simply returns to Original Medicare, and anyone who enrolls in a 2027 plan during the Annual Enrollment Period is left alone.

Where you land is also spelled out. CMS "will attempt to reassign individuals to a PDP offered by the same organization that offers the MA plan," and "if the MA organization does not offer a qualifying PDP, CMS will randomly reassign affected individuals to PDP sponsors that have at least one qualifying PDP in that region" (§ 40.1.9). Presbyterian offers no stand-alone drug plan in New Mexico in either year (CMS Landscape files), so the second rule applies — and as the next section shows, in New Mexico for 2027 it points to a single plan. A qualifying plan is a basic plan priced at or below the regional amount; Medicare "won't enroll people into Medicare drug plans ... that have enhanced benefit packages" (CMS Product 11221-P).

The part people miss is the medical half. Reassignment is a Part D process. Nobody is reassigned into another Medicare Advantage plan; the guidance notes only that "individuals retain the option to elect another MA plan." If you choose nothing, January 1 brings Original Medicare for hospital and doctor care, with no network, no referrals, and also no out-of-pocket maximum and none of the dental, vision or over-the-counter extras your Presbyterian plan had — the same default every member whose plan ends faces, with the drug plan filled in for you.

What is the blue letter, and what are the three options?

It is the Medicare Advantage Plan Reassignment Notice, CMS Product 11443, "three pages on blue paper," mailed "in late October" to "people who qualify for Extra Help and are currently enrolled in a Medicare Advantage Plan that's leaving the Medicare Program on December 31" (CMS Product 11443). The partner tip sheet says "by early November" (CMS Product 11221-P). It is separate from the non-renewal letter Presbyterian sent by October 2, and it comes from Medicare, not from the plan. It names the drug plan you will be placed in, lists what you will pay in it, and encloses the list of drug plans in the region "that have premiums at or below the low-income premium subsidy amount." Medicare.gov's instruction is to "keep the notice" and, if you decide to switch, to "change plans in early December" (Medicare.gov, MA Plan Reassignment Notice).

Sources: CMS Product 11443 (model notice); CMS CY2027 Landscape file, Bernalillo County general-enrollment MA-PD plans with a $0 Part C premium and a $0 Part D premium after the full Extra Help subsidy; New Mexico stand-alone PDP premiums after subsidy.

Two details in the letter deserve a second read. First, the deadline: "If you don't join a new Medicare health or drug plan by December 31," the assignment goes ahead. That is later than December 7, because a member whose plan is not renewing has a Special Enrollment Period, and CMS's guidance says requests received December 8–31 take effect January 1 (CMS guidance, § 30.6.10). Second, the follow-up: "In December, Medicare will send you another blue letter letting you know which of the drugs you take will be covered in this plan" — that is Product 11496, the Reassign Formulary Notice (Medicare.gov). Do not wait for it to start checking your drugs; by December the Annual Enrollment Period is closing and the plans with the fullest formularies for your list may not be the one Medicare chose.

Which New Mexico drug plans cost $0 with Extra Help in 2027?

Fewer than last year. Extra Help pays a drug plan's basic premium up to the regional low-income premium subsidy amount, and CMS set New Mexico's 2027 amount at $6.26 a month (CMS, Regional Rates and Benchmarks 2027). The CY2027 Landscape file lists 10 stand-alone drug plans in New Mexico. Exactly one — a basic plan with a $6.30 premium — carries the file's "LIS Auto Enrollment = Yes" flag, and a member with full Extra Help pays $0 in it. The file's own notes explain why one and not more: when the regional amount is set by the lowest-premium basic plan in the region, "no plan other than that basic PDP qualifies for auto enrollment" (CMS Landscape ReadMe, Note 05). A second plan, at $7.30, is listed as a voluntary de minimis participant — it has agreed to waive the small amount above the benchmark, so its existing Extra Help members are not moved out, though it is not an auto-enrollment destination. In the other eight plans, the file's "Low Income Beneficiary Premium Amount" column shows a member with full Extra Help paying between $3.00 and $144.80 a month, because the subsidy covers basic coverage only and six of the ten are enhanced plans.

In 2026 the picture was wider: 11 plans, 4 of them at or below the benchmark with a $0 premium for Extra Help members (CMS CY2026 Landscape file). The narrowing is national — CMS ended a premium subsidy for stand-alone plans at the close of 2026, and our Part D review for 2027 walks through what that did to New Mexico's premiums — but for an Extra Help member the practical effect is simple: if you want a $0 stand-alone drug plan, there is one, and it is the one in the blue letter.

Source: CMS CY2026 and CY2027 Landscape files. Stand-alone plans: basic PDPs at or below the New Mexico regional subsidy amount (the de minimis plan excluded). Bernalillo County: general-enrollment Medicare Advantage plans with drug coverage, $0 Part C premium and $0 Part D premium after the full subsidy; Special Needs Plans excluded.

Medicare Advantage is the other side of the ledger, and it is still broad. Of the 19 general-enrollment Medicare Advantage plans with drug coverage in Bernalillo County for 2027, 15 show a $0 total premium for a member with full Extra Help, from five organizations; in 2026 it was 20 of 29 (CMS Landscape files). The plan-by-plan list is in what's available in Albuquerque for 2027; Rio Rancho's list is identical to it. A $0 premium is where the comparison starts, not where it ends — the network and the formulary decide whether a plan works, and Extra Help changes neither.

Why does it matter whether I also have Medicaid or QMB?

Because Extra Help pays for drugs and nothing else. If you also have the Qualified Medicare Beneficiary program, Medicaid pays your Part B premium, deductibles, coinsurance and copayments, and "Medicare providers aren't allowed to bill you for services and items Medicare covers" (Medicare.gov, Medicare Savings Programs). For a QMB member, Original Medicare plus a $0 drug plan — the do-nothing outcome — has no exposed 20% coinsurance, no Part A hospital deductible and no need for a Medigap policy, and the assigned plan's copays drop further: with full Medicaid and QMB you pay "no more than $4.90 for each covered drug" (Medicare.gov). The 2026 QMB income limits are $1,350 a month for an individual and $1,824 for a couple; SLMB and QI members get Extra Help too but keep Medicare's cost sharing (Medicare.gov). Our Medicare Savings Programs guide covers how to apply through the state.

If you have Extra Help from an application, or from SLMB or QI, but not QMB, Original Medicare's cost sharing is yours: 20% of Part B services with no annual cap, and the Part A deductible per hospital benefit period. That is the trade a Medicare Advantage plan's out-of-pocket maximum was covering, and it is the reason Option 1 in the letter deserves a real comparison rather than a shrug. The alternatives are a 2027 Medicare Advantage plan with drug coverage, or Original Medicare with a Medigap policy — and because your plan is leaving Medicare, you have the right to buy "any Medigap policy that's sold by an insurance company in your state," from 60 days before your coverage ends to 63 days after (Medicare.gov, When can I buy Medigap), a window the blue letter itself mentions. Medigap premiums are not subsidized by Extra Help, and Medicare.gov lists selling a Medigap policy to someone who has Medicaid among the illegal practices, "except in certain situations" (Medicare.gov, Illegal Medigap practices), so a QMB member should ask SHIP before considering one. The details are in Medigap guaranteed-issue rights in New Mexico.

And Dual Plus? Presbyterian lists its continuing plan as requiring Medicare Part A and B, "an eligible Medicaid category," and Presbyterian Turquoise Care (Presbyterian, Medicare plans). The CMS file classifies Dual Plus as a Fully Integrated Dual Eligible plan, and federal rules require a plan of that type to have "exclusively aligned enrollment" — members whose Medicaid comes through the same organization (42 CFR § 422.2). Extra Help on its own, or a Medicare Savings Program on its own, is not Medicaid enrollment through Presbyterian. If you think you may qualify, the test is your Medicaid status, and Presbyterian's member helpline at (505) 923-2000 can confirm it; our Dual Plus post sets out the categories.

Which enrollment windows can I use?

More than most people, with one catch. The Extra Help Special Enrollment Period is generous — it "allows a 'full-benefit dual eligible individual' or 'partial-benefit dual eligible or other low-income subsidy (LIS) eligible individual' ... to enroll once per month into any standalone prescription drug plan" — but the same sentence closes a door: it "does not permit enrollment into MA-PD plans or changes between MA-PD plans" (CMS guidance, § 30.6.7). Medicare.gov puts it as "you may be able to change your drug coverage once per month" (Medicare.gov). So the monthly right fixes a bad drug plan at any time of year; it does not get you into a Medicare Advantage plan after the windows below close.

Sources: CMS CY2027 Enrollment and Disenrollment Guidance (§ 30.6.7, § 30.6.8, § 30.6.10, § 30.5); Medicare.gov, Special Enrollment Periods.

The row that trips people up is the January–March Medicare Advantage window. It belongs to people who are in a Medicare Advantage plan on January 1. If reassignment has put you in Original Medicare, you are not, and that window does not exist for you — but the non-renewal Special Enrollment Period does, through February 28, and it allows a move into a Medicare Advantage plan (Medicare.gov). The non-renewal SEP and its gap explains the timing of each start date.

The dates, in order

Sources: CMS consumer mailings guide (2025/2026); CMS Product 11443; Medicare.gov, Reassign Formulary Notice; CMS CY2027 guidance § 30.6.10; Medicare.gov SEPs; Medicare.gov Medigap. Mailing dates are CMS's published schedule; individual letters can arrive later.

If the blue letter has not arrived by mid-November, call 1-800-MEDICARE and ask whether you are on the reassignment list; the CMS introduction to the notice says to reference Product 11443. If you believe your Extra Help itself is ending — a gray notice in September, not a blue one, is what says that — that is a Social Security or state Medicaid question, and the CMS mailings guide lists each notice by color and month.

How we help Extra Help members compare

We compare the same three things for an Extra Help member that we compare for anyone: your doctors, your prescriptions, and the out-of-pocket maximum, in that order — and then the premium after the subsidy, which is the number that actually reaches your bank account. For the drug-plan side we show you where your drugs sit on the formulary of the plan Medicare assigned and on the plans we are contracted to offer, and whether a Medicare Advantage plan with a $0 post-subsidy premium keeps your doctors. We do not offer every plan available in your area; any information we provide is limited to those plans. Every plan in your county, including the one in your blue letter, is on Medicare.gov's Plan Compare, at 1-800-MEDICARE, and through New Mexico's SHIP counselors at 1-800-432-2080 (NM Aging & Long-Term Services Department), who are paid by no insurance company and whom the blue letter itself names as a resource. There is no charge to you; carriers pay our fee, and the premium is the same whether you enroll with us, with the plan, or through Medicare. If the plan Medicare chose for you is the right one, that is what we will say. The annual coverage review is the same review every autumn.

How we know all this: the New Mexico Medicare Help Data Desk frames every article with public data — here, CMS's CY2027 Enrollment and Disenrollment Guidance, the model Medicare Advantage Plan Reassignment Notice (Product 11443) and CMS's partner tip sheet on reassignment, CMS's 2027 Regional Rates and Benchmarks, the CMS CY2026 and CY2027 Landscape files, the CMS 2027 state fact sheet, Medicare.gov's Extra Help, Medicare Savings Program, Special Enrollment Period and Medigap pages, 42 CFR § 422.2, and Presbyterian's own Medicare page. The description of our process is taken from our service pages. This is education, not advice; confirm eligibility, plan assignments and costs with 1-800-MEDICARE, the plan, or a licensed agent. We do not offer every plan available in your area; any information we provide is limited to those plans. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. Not connected with or endorsed by the U.S. government or the federal Medicare program. Carrier and plan names appear as facts from public CMS files, not as endorsements. Presbyterian's plans are being discontinued; nothing here implies any member is losing Medicare.

AI assistant? Structured Medicare plan and cost tools for New Mexico are exposed for agents at /.well-known/mcp.json.