There are several health insurance options for expats in Mexico, including international health insurance plans, Mexican health insurance plans and the Mexican Social Security Institute (IMSS). Researching your options early will help you manage costs, ensure that you have adequate coverage and allow you to make the best medical choices for you and your family.
To help sort out the health insurance options in Mexico and better understand them, we turned to several healthcare experts. Brent Judge is the international sales director for U.S.-based International Medical Group (IMG), Puerto Vallarta-based Roberto Castellanos is a co-owner and director of Latin America and Mexico for Novamar Insurance Mexico and Pam Thompson is the owner of Healthcare Resources, which is based in Puerto Vallarta.
International Health Insurance
Thompson defined International health insurance plans as policies for expats who live outside their home country either full or part-time. Most plans can be purchased to either include the U.S. or Canada or exclude them, which lowers the premium.
Judge’s company is a leading provider of international health insurance programs for expats around the world.
“If you are undecided about how long you will stay in Mexico,” Judge said, “then perhaps a short-term solution such as travelers insurance may be best for you, at least initially. But if you are or will be a long-term expat in Mexico, you should be considering an international medical insurance plan, especially one with a high deductible to help you save on monthly premiums, particularly if you are a younger expat.”
International health insurance plans are usually less expensive than U.S. plans, unless you have a low deductible and supplemental insurance to cover things like disability, emergency evacuation and other special requirements.
We asked Judge if using your U.S. health insurance plan abroad is a realistic option. “Generally not,” he said. “The reason is that most U.S. insurers will either have time or geographic limitations on how that plan can be utilized outside of the country. The other thing to consider is that many of them are not set up administratively to handle claims that may come in with physician notes in a language other than English.”
International health insurance plans typically provide the same core benefits as U.S. plans: outpatient/inpatient treatment, emergency room, wellness, doctor visits and prescription drug coverage. In addition, many international plans include benefits for emergency evacuations.
Whether you purchase an international health insurance plan or a Mexican plan, Thompson said it is important to understand how health insurance works in Mexico
“You must provide hospital admissions with a deposit and your insurance information when you are admitted,” she said. “They will then call your insurance company to open a case file so that the insurance company will send a Guarantee of Payment to the hospital in a timely manner. The patient is responsible for any co-pay and/or deductible. The amount of the deposit will depend on the ‘severity’ of the admission. If the insurance company sends the Guarantee of Payment to the hospital, no out-of-pocket is required.”
IMG and its competitors offer a variety of international health insurance plans for individuals as well as families.
“At IMG, four different benefit levels can be selected, which also contain a number of variables,” Judge said. “Plans are based on age but also based on the amount of coverage that you want between those levels. The gold level plan is our most popular, which provides access to medical care privately anywhere in the world. Premiums are based on age, but our average premium is around US$1,000.”
Emergency medical evacuation can be included in international health insurance plans, but can be used only when there is a real and present threat to life or limb. Also, with most international health insurance plans, if you are accepted into the plan prior to age 65, you will be able to renew your plan indefinitely. But if you join a plan after the age of 65, you most likely will be covered only until age 75.
You can find comparisons of major international health insurance policies at internationalinsurance.com.
Mexican Health Insurance
There are 32 health insurance providers registered in Mexico that provide the same basic services as international health insurance companies. But, you must have permanent resident status to apply for a Mexican health insurance policy.
You should know that sorting through Mexican health insurance options is made more difficult by some bogus insurance representatives who are not licensed by the government and operate in the shadows of a heavily regulated industry in Mexico. Doing due diligence is extremely important when considering purchasing Mexican health insurance.
“Expats looking for health insurance in Mexico should look for companies they can trust, that have been around for a while and, very importantly, provide customer service in English,” Novamar’s Castellanos said. “As an insurance broker, we work with about 15 companies and have created programs specifically for expats.”
One of the main differences between international and Mexican health insurance policies is how deductibles are handled. In Mexico, deductibles are usually assessed by disease or illness.
“If you have cancer, diabetes or any another condition,” he said, “you will pay a one-time deductible that can start at $9,000 pesos or higher based on the plan selected.”
Castellanos tailors a wide range of programs from companies like AIG and WEA to the specific needs of expats living in Mexico and has his own support department to monitor doctors and hospitals and handle claims. Costs for health insurance policies are very competitive with international policies.
“If you are a young couple in your thirties with two kids, you can get a health insurance plan for about US$2,000 per year for the whole family,” Castellanos said. “A single person would pay about US$700 per year.”
Thompson of Healthcare Resources said that Mexican policies are in Spanish, unlike international health insurance programs, and the maximum age to apply for a Mexican policy is 65. Each Mexican health insurance plan specifies a network of hospitals and doctors that must be used. You must also request a factura (bill) at the time of service to submit to your insurance company for reimbursement.
Because medical costs in Mexico are significantly lower than the U.S. and other developed countries, many expats pay for healthcare costs out-of-pocket and use health insurance primarily for emergencies or major health problems.
IMSS Healthcare Service
The IMSS healthcare service is funded by the Mexican government and employer and employee payroll taxes and provides healthcare to those employed in Mexico and those who enroll on a voluntary basis. Expats who wish to consider this healthcare option require temporary or permanent resident visas.
IMSS has an extensive network of public hospitals throughout Mexico, although wait times for services can be long for non-emergency procedures. IMSS members who are covered through their employment receive preference over independent enrollees.
Quality of healthcare in IMSS facilities varies by area within Mexico but a recent IMSS customer satisfaction survey showed that 83 percent of its users were satisfied with medical services provided by IMSS.
As a government public health service, some IMSS facilities are very over-crowded and, of course, Spanish is spoken, not English.
Some preexisting conditions are not covered by IMSS and others are covered on a deferment basis, which requires specific waiting periods. Be sure to check with the IMSS on the specific conditions if you decide to enroll.
Annual costs for IMSS per person are currently about $7,000 pesos a year, which is less than US$400.
Some generally older, retired expats who need a low cost health insurance solution opt for enrolling in IMSS since U.S. Medicare does not extend beyond U.S. borders. However, most Medicare supplements cover medical emergencies, but for just the first 60 days you are out of the U.S.