Presbyterian plan ending · Albuquerque · Under 65

Under 65 on Medicare and My Presbyterian Plan Is Ending: What Now?

Most of what is written about the Presbyterian change assumes the reader is 65 or older. If you have Medicare because of a disability, nearly all of it still applies to you. One part does not, and it is the part about going back to Original Medicare with a supplement.

By the New Mexico Medicare Help Data Desk

Reviewed by Brian Penner, Independent Medicare advisor — no pressure · Published October 11, 2026

The dates and options that apply at any age are in our main Presbyterian Medicare Advantage guide.

If you are under 65, have Medicare because of a disability, and are in a Presbyterian Medicare Advantage plan that is ending, you have the same enrollment periods as every other member, and you can join any Medicare Advantage plan offered where you live without answering health questions. What differs is the route back to Original Medicare. Medicare.gov says "Federal law doesn't require companies to sell Medigap policies to people under 65" (Medicare.gov, When can I buy Medigap?), and New Mexico is not among the states CMS lists as requiring it (CMS, Choosing a Medigap Policy, Section 6). So for you the order of the questions changes: find out what supplement you can get, and at what price, before you decide to leave Medicare Advantage.

What is the same for me as for members over 65?

Almost everything about the plan change itself. Presbyterian's notice applies to every member of its Senior Care plans, whatever their age: the plans end on December 31, 2026, your coverage "will remain in place" until then, and "if you do not choose a plan before then, you will automatically be enrolled into Original Medicare (Parts A & B) on January 1, 2027. Original Medicare does not include Part D drug coverage" (Presbyterian). The plan is being discontinued. Your Medicare is not.

Your enrollment windows are the same too. You can choose 2027 coverage during the Annual Enrollment Period, October 15 – December 7, 2026. Because your plan is not being renewed, you also have a Special Enrollment Period that, under CMS's enrollment guidance, "begins December 8 of the contract year and ends the last day of the following February" — December 8, 2026 – February 28, 2027 (CMS, CY2027 enrollment guidance; Medicare.gov, Special Enrollment Periods). A choice made by December 7 starts January 1 with no gap. A choice made in the later window leaves you in Original Medicare without drug coverage until the new plan starts, which the Special Enrollment Period and its gap explains.

And Medicare Advantage itself has no age test. Medicare.gov's eligibility list for joining a plan asks that you have Medicare, that you are a citizen or lawfully present, and that you "live in the service area of the plan you want to join," and adds that you need "both Part A and Part B to join a Medicare Advantage Plan" (Medicare.gov, Joining a plan). Age is not on the list, and a Medicare Advantage application does not ask about your health history. A 52-year-old with Medicare and a 72-year-old with Medicare see the same plans at the same premiums.

You are also not a rare case. CMS counted 48,708 New Mexicans with Medicare on the basis of disability in June 2026, out of 476,263 beneficiaries in the state (CMS Medicare Monthly Enrollment). CMS does not publish how many of them are in the Presbyterian plans that are ending, so we will not guess.

What are my options for 2027?

Six paths, and which are open depends on two facts about you: whether you have Medicaid, and whether a supplement is available to you at a price you can carry. The table uses Bernalillo County figures because most affected members live in and around Albuquerque. Sandoval County's 2027 plan list matches Bernalillo's.

Sources: Medicare.gov, Joining a plan; Medicare.gov, Special Needs Plans; CMS CY2027 Landscape file (September 2026 release), Bernalillo County, counted by Contract Plan ID; CMS, Choosing a Medigap Policy; NMMIP, Medicare Carve-Out Plan and 2026 Summary of Benefits and Coverage; Medicare.gov, Medicare costs. Plan counts are everything CMS lists for the county, not the plans we offer.

For most members under 65, the first row is the practical answer: another Medicare Advantage plan, chosen by checking doctors, then drugs, then the out-of-pocket maximum. The 2027 list for the county is in Medicare Advantage plans in Albuquerque for 2027, and the method is in how to compare Medicare Advantage plans. The rest of this article is about the rows that work differently for you than for someone over 65.

Can I get a Medigap policy under 65 in New Mexico?

Maybe, and you should find out before you count on it. There are three layers to the answer.

Federal law. The six-month Medigap Open Enrollment Period, when a company must sell you any policy it offers, starts the month you are both 65 or older and enrolled in Part B. Before 65, CMS says, "you might not be able to buy the Medigap policy you want, or any Medigap policy, until you turn 65. Federal law generally doesn't require insurance companies to sell Medigap policies to people who are under 65" (CMS, Choosing a Medigap Policy, Section 6).

State law. The same CMS guide lists 33 states that "require insurance companies to offer at least one kind of Medigap policy to people with Medicare under 65." New Mexico is not on that list. New Mexico's own Medicare supplement rule ties open enrollment to the month a person "is both 65 years of age or older and is enrolled for benefits under Medicare Part B" (13.10.25.17 NMAC). The birthday-month switching window that begins in 2027 is also written for policyholders 65 and older, as switching Medigap plans in New Mexico explains. CMS adds that "some insurance companies may voluntarily sell Medigap policies to people who are under 65, although they'll probably cost more than Medigap policies sold to people over 65, and they probably use medical underwriting."

The plan-ending right. This is where your situation is unusual, and where we want to be careful. When a Medicare Advantage plan is discontinued, members who return to Original Medicare get a guaranteed-issue right to buy certain Medigap policies without health questions; for a plan ending December 31, 2026, the window to apply closes March 4, 2027. New Mexico's rule describes the eligible person as an individual "enrolled with a Medicare Advantage organization under a Medicare Advantage plan" where "the organization has terminated or otherwise discontinued providing the plan in the area in which the individual resides" (13.10.25.18 NMAC). That paragraph states no age. CMS, for its part, says only that "some of the federal guaranteed rights are available to people with Medicare under 65."

Two limits in the same rule matter. The right applies to a policy "that is offered and is available for issuance to new enrollees by the issuer," so what a company makes available to applicants under 65 is the practical question. And the rule bars a company from pricing the policy "because of health status, claims experience, receipt of health care, or medical condition"; it does not say an under-65 rate must equal the rate at 65, and the rule elsewhere treats "coverage to individuals eligible for Medicare by reason of disability" as its own category for rate filings. We are insurance agents, not lawyers, and we will not tell you how a particular company or the regulator will read this. What we can tell you is how to find out:

• Ask each company in writing: "I am under 65, on Medicare because of a disability, and my Medicare Advantage plan is being discontinued on December 31, 2026. Which Medigap plans will you issue to me under guaranteed issue, and at what monthly premium?"
• Call the New Mexico Office of Superintendent of Insurance at 1-855-427-5674 if a company declines or you are unsure of your rights (OSI). CMS's guide sends under-65 readers to the state insurance department for exactly this.
• Call New Mexico's SHIP at 1-800-432-2080 for free, unbiased counseling (NM Aging & Long-Term Services Department).
• Keep your non-renewal letter. It is the proof of the date your plan ends.

Do this in October or November, while every Medicare Advantage option is still open to you. The general version of the right, for members of any age, is in Medigap guaranteed-issue rights in New Mexico.

What is the Medical Insurance Pool's Medicare Carve-Out plan?

It is the option most articles about the Presbyterian change leave out, because it exists only for people under 65. The New Mexico Medical Insurance Pool is the state's high-risk pool. Its Medicare Carve-Out Plan "is available to individuals under the age of 65 who are enrolled in Medicare due to a disability. You must have both Medicare Part A and Part B to be eligible" (NMMIP). The Pool describes how it works: "Medicare is called the 'primary' coverage or carrier and pays its benefits first. The NMMIP is the 'secondary' coverage."

The Pool's 2026 summary of benefits for the plan shows a $500 yearly deductible and a $3,300 out-of-pocket limit, and says the plan "does not have a network" (NMMIP 2026 Summary of Benefits and Coverage). It is not a Medigap policy and it does not replace Part D; you would still need a stand-alone drug plan. The premium depends on your age.

Source: NMMIP, Medicare Carveout (MC) Plan Premium Rates, January 2026 (exhibit dated 10/29/25), standard monthly premium, all New Mexico counties. 2027 rates had not been posted when we checked on October 11, 2026.

Those are the full rates. The same exhibit shows the Pool's Low Income Premium Program: at age 64 the monthly premium is $310 for a household under 200% of the federal poverty level, $619 from 200% to 299%, and $929 from 300% to 399%, against $1,238 at the standard rate. Even discounted, that is a large bill beside a Medicare Advantage plan with a low or $0 plan premium, so the Carve-Out tends to make sense for someone who needs Original Medicare's open choice of doctors and cannot get a Medigap policy.

The Pool has its own eligibility rules. Its site says you are not eligible if you "are eligible for Medicaid" or have other comprehensive coverage (NMMIP, Benefits and Eligibility). We do not enroll people in the Pool. Call it directly at 1-866-306-1882 to confirm that you qualify, how a discontinued Medicare Advantage plan is treated, when coverage could start, and what the 2027 premium will be.

Do I qualify for a Special Needs Plan?

You might, and it is worth five minutes to check. A Special Needs Plan is a Medicare Advantage plan that limits membership to a particular group and, in Medicare.gov's words, tailors its "benefits, provider choices, and drug lists (formularies) to best meet the specific needs of the groups they serve" (Medicare.gov, Special Needs Plans). Two kinds are relevant.

If you have Medicaid as well as Medicare, look at Dual Eligible Special Needs Plans. CMS's landscape file lists 7 for Bernalillo County for 2027. One of them is Presbyterian Dual Plus, which continues, so if that is the card in your wallet your plan is not ending at all. Who keeps their plan shows how to tell. If you get Extra Help with drug costs but are not in Dual Plus, see what happens to your Extra Help.

If you have diabetes or a heart condition, look at Chronic Condition Special Needs Plans. The landscape file lists 8 for Bernalillo County for 2027, and every one of them is listed for cardiovascular disorders, chronic heart failure or diabetes mellitus (CMS CY2027 Landscape file). None is listed for another condition, so if your disability is something else these plans are not built for you. Medicare.gov notes that "you can stay enrolled in a Medicare SNP only if you continue to meet the condition served by the plan." A C-SNP is still a network plan: check your doctors and drugs the same way you would for any other.

What if I return to Original Medicare with no supplement?

That is what happens automatically if you choose nothing, and it carries two exposures. The first is drugs: Original Medicare "does not include Part D drug coverage," in Presbyterian's words, so you would need to enroll in a stand-alone Part D plan yourself. The second is the 20%. Under Part B you pay the yearly deductible — $283 in 2026 — and then usually 20% of the Medicare-approved amount for each service, and Medicare.gov says "there's no yearly limit on what you pay out-of-pocket, unless you have supplemental coverage" (Medicare.gov, Medicare costs). The 2027 amounts had not been posted on that page when we checked on October 11, 2026.

For someone with frequent specialist visits, infusions, imaging or equipment, 20% with no ceiling can pass a Medicare Advantage plan's out-of-pocket maximum in a single hard year. The general plans listed for Bernalillo County for 2027 cap in-network costs between $3,800 and $8,000 (CMS CY2027 Landscape file). Original Medicare does give you any doctor in the country who takes Medicare, and for some people that is worth the exposure. Go in knowing the number. What the default looks like day to day is in what happens if you do nothing.

What changes when I turn 65?

Medigap opens up. CMS's guide is direct: "If you already have Medicare Part B (Medical Insurance), you'll still get a Medigap Open Enrollment Period when you turn 65. You'll probably have more Medigap policy options and be able to get a lower premium at that time. During the Medigap Open Enrollment Period, insurance companies can't refuse to sell you any Medigap policy due to a disability or other health problem, or charge you a higher premium (based on health status) than they charge other people who are 65" (CMS, Choosing a Medigap Policy, Section 6). It adds that because Medicare counts as creditable coverage, "if you had Medicare for more than 6 months before you turned 65, you may not have a pre-existing condition waiting period."

So if you are 62 or 63 and want Original Medicare with a Medigap policy in the long run, your 2027 choice may be a bridge rather than a permanent decision: a Medicare Advantage plan, or the Carve-Out, until the month you turn 65. Put that month on the calendar now. The window lasts six months and does not repeat.

What should I do, in order?

1. Find out whether you have Medicaid or Extra Help. If you have full Medicaid, a D-SNP may be the closest match to what you have now, and Presbyterian Dual Plus members are not losing their plan. If you are not sure, New Mexico's SHIP counselors can check at no cost.
2. List your doctors, your prescriptions and your equipment suppliers. For many people on Medicare because of a disability, the specialist and the supplier matter more than the premium. Write down the names, the clinic addresses and each drug with its dose.
3. Compare the Medicare Advantage plans in your county. Check each doctor and drug against each plan, then look at the out-of-pocket maximum. If you have diabetes or a heart condition, include the C-SNPs.
4. If you want Original Medicare, settle the supplement question first. Call the Medigap companies and the New Mexico Medical Insurance Pool before you decide. Get any offer, price and start date in writing. Do not let a Medicare Advantage choice lapse on the assumption that a supplement will be there.
5. Enroll, and add Part D if you go to Original Medicare. The Annual Enrollment Period ends December 7. A plan chosen by then starts January 1 with no gap.
6. Mark your 65th birthday. That month opens a new six-month Medigap Open Enrollment Period, when companies cannot turn you down or charge more for a health condition.

Presbyterian's helpline for this change is (505) 923-2000 (TTY 711), seven days a week, 8 a.m. to 8 p.m. (Presbyterian). If prior authorizations, equipment or an ongoing course of treatment are part of your picture, whether a prior authorization transfers covers what a new plan has to honor.

When we compare plans for a member under 65, we follow the same order we use for everyone — doctors, then prescriptions, then the out-of-pocket maximum — against the 2027 plans we are contracted to offer in your county. We do not offer every plan available in your area; any information we provide is limited to the plans we do offer. The full list for your ZIP code is on Medicare.gov's Plan Compare and at 1-800-MEDICARE. There is no charge to you for our help; carriers pay our fee. This is education, not a recommendation to pick a particular plan. Our plan comparison page lists what to gather, and the annual coverage review is where we re-check the plan each autumn.

How we know all this: the New Mexico Medicare Help Data Desk frames every article with public data — here, Presbyterian Health Plan's own notice of its 2027 plan changes; Medicare.gov's pages on joining a plan, buying Medigap, Special Needs Plans and Medicare costs; CMS's publication Choosing a Medigap Policy and its CY2027 enrollment guidance; New Mexico's Medicare supplement rule, 13.10.25 NMAC; CMS Medicare Monthly Enrollment for New Mexico; the CMS CY2027 landscape file; and the New Mexico Medical Insurance Pool's published 2026 plan documents. We quote the state rule; we do not interpret it for your case. This is education, not legal or insurance advice; confirm eligibility, premiums, networks and drug coverage with each plan or program before you enroll. 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. Presbyterian and the New Mexico Medical Insurance Pool are named as a matter of fact; we are not affiliated with either.

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