We receive many questions each month about expat access to public healthcare programs in Mexico. The good news is the government has promised its citizens universal medical care and many of those benefits are extended to foreign residents as well.
The two public healthcare programs discussed in this article are IMSS (Instituto Mexicano del Seguro Social) and INSABI (El Institution de Salud para el Bienestar, or sometimes called just Bienestar). There is a third, a National research program, that has very few facilities, and only takes patients on a selective basis. There are also programs for government workers, but they are not available to the public.
Both INSABI and IMSS are available to those who have a CURP (Mexico’s 18-digit social security number, normally obtained as part of the visa application process) and includes both those with temporary and permanent resident visas. Given that most private insurance programs charge high premiums for adults age 70 or over and the costs of self-paid private hospital care can also be a budget breaker, these programs are a blessing for many expats of retirement age living in Mexico.
While both of these programs provide local care for many conditions, not all treatments can be done locally and you may be sent to a larger city, such as Guadalajara, Mexico City, Monterrey or Tijuana, for surgery or longer-term care. When searching for a location in Mexico, consider that not all towns have doctors who are certified in every specialty. If you have a pre-existing condition, this could be a factor in where you decide to live.
Before we get into the differences between these programs, it is important to discuss the fact that these are national programs in a vast country. Both programs have their own hospitals and clinics and you are assigned facilities and doctors. The age and characteristics of the infrastructure may vary from 1950s-style institutional structures to the most modern newly-built medical facilities.
You will find that the medical care offered is considered good to excellent. Many of the senior doctors are skillful surgeons and most are board-certified physicians. Many of the facilities are teaching hospitals and interns and nursing students are from the numerous medical and nursing schools in Mexico. Often interns are fulfilling their part in an exchange: medical services in repayment for their otherwise free education. Working in the public sector is an attractive option for some doctors because of the generous retirement benefits offered.
Although it varies from place to place, the burden of serving the local citizenry leads to overcrowding in many places, and long waits for routine appointments or surgery. For example, if you are admitted through the emergency room, you may need to wait until a room becomes available. Some facilities experience shortages of medical supplies and medications. I recommend that you physically visit local hospitals and hear the experiences of local people before deciding which program suits your needs better when both are available.
IMSS is generally for employed people and coverage for most participants is paid through a private-sector employer. Anyone who is formally employed in Mexico must enroll even if they have other private health insurance. Employee IMSS contributions are paid by the employer. However, it is also available to expats with residence visas who are not employed on a self-paid “voluntary” basis. (Foreigners with only FMM visitor permits are not eligible.) The cost will vary depending on your age, and there are some exclusions or limitations on coverage you will want to be aware of, especially if you have pre-existing conditions. The fee, paid annually, is $7,650 to $1,4850 Mexican pesos for an 80-year-old (US$376 to $730). Unless you have a serious pre-existing condition that is excluded, IMSS is generally the preferred public program for expats.
To apply for IMSS, go to the sub-delegation or IMSS hospital that serves the area you live in from Monday to Friday between 8 a.m. and 3:30 p.m. Be sure to bring your official identification, birth certificate, CURP and proof of address, and where appropriate, marriage certificate.
The following pre-existing diseases will exclude you from enrollment or limit your coverage by applying a waiting period:
- Malignant tumors
- Chronic degenerative diseases such as late complications of diabetes mellitus, hoarding diseases (Gaucher disease), chronic liver diseases, chronic renal failure, heart valve disease, heart failure, sequelae of ischemic heart disease (arrhythmia, angina or myocardial infarction) and chronic obstructive pulmonary disease with respiratory failure.
- Chronic systemic connective tissue diseases.
- Addictions such as alcoholism and other drug addictions.
- Mental disorders such as psychosis and dementias.
- Congenital diseases.
- Acquired Immunodeficiency Syndrome or Positive Human Acquired
- Immunodeficiency Virus (HIV).
Diseases with waiting periods:
Benign breast lump.
- Surgery for gynecological conditions, except malignant neoplasms of the uterus, ovaries and perineal floor.
- Surgery for venous insufficiency and varicose veins.
- Sinus and nose surgery.
- Varicocele surgery.
- Hemorrhoidectomy and rectal fistula surgery and rectal prolapse.
- Tonsillectomy and adenoidectomy.
- Hernia surgery, except intervertebral disc herniation.
- Hallux valgus surgery.
- Strabismus surgery.
INSABI Bienestar Program
Since many people in Mexico are self-employed, such as rural workers, there needed to be a way to fulfill the promise of universal care, and so INSABI offers a program for those who are not covered by IMSS. (Formerly this program was called Seguro Popular, and you may still hear it referred to that way, however the benefits for serious illnesses are much more limited.)
While the basic coverage is free, INSABI does not cover all conditions and the more serious medical conditions are not covered 100 percent. For example, cancer, heart attacks, cardiovascular failure, diabetes, Hepatitis-C, major surgeries and long-term treatments are among the things that INSABI does not fully cover. INSABI makes judgements about what they will and will not cover fully based on the diagnosis and severity of a person’s condition, thus there is no complete list of conditions that INSABI will not cover. Payment may be adjusted on a sliding scale based on income.
If you are from the U.S. or Canada and are receiving care within the public system, you need to adjust your expectations. Many of the assumptions that you bring with you from your home country will simply not apply to hospitals in Mexico. For example, most facilities are designed using wards with multiple patients rather than private rooms. Being in a room with other patients and their family member means there is a lack of privacy and lots of conversation with comings and goings. It is assumed that a family member will take care of a patient’s personal needs (helping with feeding, helping with showering the patient or bathing in bed, assisting with the use of the toilet, and emptying the bedpan and other such things.
The physical facility may seem spartan by American and Canadian standards: a bedside table/cabinet, a rolling table that supports a patient’s food tray, a pitcher and water glass, and a single straight back chair for the only guest allowed. Family members often keep bedside duty in shifts, and the single guest pass is exchanged between family members outside the hospital. An exception is sometimes made for patients in the last hours of life. There will be no bedside phone and even a pillow may not be allowed unless there is a medical need for it.
Theoretically, medicines and supplies are provided, and you will often be given all the medicines and vitamins you will need at home after hospitalization (bring a plastic bag). But at times a doctor or nurse might recommend a different medicine or a better solution or ask your family member to buy the essential dressings they need to replace daily because they do not have any on hand. It is hoped that someone will run to a nearby commercial pharmacy to get what is needed.
There are a couple of serious difficulties for expats being treated within the public health system. The first is that unless you speak Spanish, you may not understand or be understood. You may go for days without encountering anyone who speaks English. When my husband was hospitalized at IMSS for a three week stay, I was often directed to run errands for him, but with my limited Spanish, I did not always understand what was being asked of me. I solved the problem by asking staff to write their instructions so that I could show it to others and ask for help.
The second difficulty is if you have no one who can assist you in the required personal care, you will be placing an extra burden on an already overworked nursing staff. I recommend that you form an alliance with other expats in your community to provide care for each other. There is also the option of hiring a nursing student or private duty nurse to help. Since this work does not generally require nursing skill, you may find a friend whom you can hire.
In many ways, the public medical system in Mexico is a modern miracle. It offers serious medical care for many people, many conditions. That it does not provide everything for everyone is hardly surprising. But for those of us who are helped within either of these systems, we are grateful for the generosity and care.