• Getting Health Insurance in Mexico as an Expat & Costs

Getting Health Insurance in Mexico as an Expat & Costs

Getting health insurance in Mexico as an expat is a relatively easy straight-forward process. Unlike registering a car, getting a driver’s license, and opening a bank account – this is one of the big “expat” things to do here that does not require residency. I’m going to share how I, as a resident of Mexico got health insurance in Mexico as an expat from the USA and my boyfriend, a non-resident of Mexico, who is from the UK.

Getting Health Insurance in Mexico as an Expat

While getting the national Mexican Social Security Institute insurance (IMSS) would require residency, we have been told by various Mexican friends that anyone here who can afford private insurance should get it – this is due to lack of great government hospitals and a long wait time. You’ll have more chance of an English-speaking doctor at a private hospital than a government one. If you are a resident and you only want the Mexican health insurance that’s an option for you. For us, we wanted to make sure we were covered at all the 5-star hospitals in Merida like Star Medica, coverage for accidents all over Mexico, and coverage and flights back to Mexico if we had an accident abroad. We needed private insurance. IMSS is usually around 5,000 MXN per year (for a whole family, but we aren’t a family) from what I’m told so it was a no-brainer for us to get better coverage at better hospitals with less waiting time for just a couple thousand pesos more a year.

People sometimes ask about getting into Seguro Popular de Salud but this is a kind of “safety net” insurance which is for people who cannot afford the IMSS insurance or have pre-existing conditions and is based on a socioeconomic basis. This is a step down from IMSS. Foreigners who have residency here do qualify for this as I see retirees and others talking about using it on Facebook groups – but you do have to prove you have a very low income. With this insurance, you would be able to use the Seguro medical center only and from what I understand, by paying into Seguro, you wouldn’t have a bill at the hospital.

If you’ve heard of folks getting free doctor’s visits that is possible for anyone at most big pharmacies here. I’ve done this once because there is one up the road and I wanted to see which allergy meds would be best for me. It was fine and they are paid by the pharmacy. You then buy your medications from the pharmacy – think of it like a “minute clinic” in the USA. I needed a shot, bought the meds and needle myself, brought it back in and she gave it to me.

If you want information on becoming a resident, read this article which explains the exact steps I took to become a resident of Mexico.

A few things to note ahead of time in case you are a retiree is that your USA coverage does not link here in Mexico and that goes for Medicare, too. You will pay out of pocket unless you have a USA plan that specifically includes health care here in Mexico – so you need to check your plan closely if you intend on keeping it. Living here as an expat will likely disqualify coverage under the scope of travel insurance in most cases. If you are coming short-term, I always recommend World Nomads. This article is for those who intend to live in Mexico long-term. If you are a resident of Mexico, you are going to need Mexican insurance in most cases.

*unless otherwise noted with USD, all prices here are in MXN.

Get a broker for health insurance in Mexico

You can get insurance yourself online – you would fill out the application forms (which are in Spanish) and then submit additional paperwork like your passport copy and proof of address.

While you don’t need residency, you will need proof address like a bill in your name. If you have a lease in Mexico, it’s no problem – you just take the lease, a copy of the lease, and a copy of your passport with you to the electricity bill office and ask them to change it over to your name. It takes ten minutes!

If you want to compare multiple plans from top private insurance companies in Mexico, it’s best to go through a broker who you can talk to about your budget, deductibles you want, coverage you’re looking for, and more so that you can get multiple options.

After looking over various plans, we went with AXA Mexico. Other top companies are GNP, Metlife, and DVK.

Ben and I are unmarried so we did have to get two separate plans. The “policy rights” itself costs around 1,000 MXN so that meant we had to pay that twice.

Another reason to go through a broker is that when you need to make a claim, he/she is there for you and will help you through the process which will be complicated and in Spanish.

In Merida, Mexico, we went with Ricardo Castilla who also did our car insurance for us. You can contact him at yucataninsurance@gmail.com. We found him through the recommendation of the Expats in the Yucatan Facebook group which is run by Yucatan Transitional Services.

Once you decide on a plan, you apply which is on the website, print it out, wait for approval, then pay and get your insurance card and final contract.

What to look for in health insurance in Mexico

It’s not the same in all countries so in case you aren’t used to Mexican insurance, here are the main things to make choices on:

  1. Level of the hospitals you want – it is by stars here like a hotel would be. We wanted 5-star service, so asked for 5-star hospitals!
  2. Region – do you want just your state, do you want all of Mexico? Do you want international insurance? You’ll have to decide this for a quote
  3. Max insured sum – typically 100 million pesos is enough for a maximum of coverage PER event
  4. Deductible – the deductible can range to whatever you want, but we did 25,000.
  5. Coinsurance – we went with 10% but I’ll explain this more later
  6. Coinsurance limit – you want this to be low, we went with 35,000 MXN on our plan
  7. “Travel” insurance – do you want to add in accident insurance in case you are abroad? For us, it only took the quote up 300 MXN ($15) for care in an American hospital if an accident happens. Without this, the basic coverage still included a plane ride back if needed but wouldn’t cover your American bills (or wherever in the world you would be)
  8. Do you want added extras like room upgrades?
  9. What is included in your emergency list: C-section, accidents like a road accident or broken bone, organ transplants, hospitalization fees, surgery, doctors fees, delivery and cesarean, medicine, medical orientation 24/7, lab analysis, emergencies with no deductible, accidental dental coverage
  10. Tabulator – You want this set to as high as you can afford, I’ll explain later

health insurance

Coinsurance and deductible – how does it work for health insurance in Mexico?

This is how you can think about what you’d actually pay in a situation with a couple of examples.

When you have an accident, you do NOT pay a deductible once it’s over your deductible reduction with you can see on mine is set at 2,000 MXN.

When you have an illness, you DO pay a deductible.

You always pay your coinsurance percentage up to the limit that is listed.

So, you are in a car accident and it’s 40,000 MXN for a broken arm, which is quite a good guess on the cost of this, in total. That means you will get a bill that is 10% of that and you owe 4,000 MXN, or around $230 USD.

If you are in an accident which is 300,000 MXN, you would pay 10% of that which is 30,000 MXN.

If you are in an accident which is 1,000,000 MXN, and the 10% is 10,000 MXN, you only pay up to your limit, and in my case, that is set at 35,000 MXN which is around $1,700 USD. So you won’t ever pay more than that when it is an accident.

If you are not in an accident and have an illness that needs to be treated, you have to pay your deductible and your coinsurance.

Here is an example. Your medical bills in total are 100,000 MXN. You’re deductible is 25,000. You subtract that first and pay 10% only on the remainder which is 75,000 MXN, making your payment 7,500 MXN.

You can use these tools to test out what you are willing to pay. If you get sick often, you might want a lower deductible and a lower coinsurance percentage. If you are accident-prone, you might want a lower coinsurance percentage or a lower cap on the coinsurance limit. It’s really up to you!

What is a tabulator?

This was one thing on my quotes that confused me! In Mexico, doctors are under different networks so if you have Doctors X,Y, Z available with your health insurance because they have a deal with the insurance that they will do their 40,000 surgery for just 12,000 through the insurance, that is great. But what if you heard Doctor B is the best? If you set the tabulator to “High” then your 12,000 limit will be set higher at something like 17,000 and then you just pay the rest – this is if you want to go outside your network.

The cost of health insurance in Mexico

It really depends on what you choose for what your cost will be. I told you above what we chose and that cost for us came to around 7,000 MXN per person for the year. That is $354 USD. We are both healthy people with no pre-existing conditions.

If you have pre-existing conditions, are a heavy smoker, and other things you’ll have to answer in your application, you will pay a higher amount and have an additional fee or in some cases could be declined coverage when you apply.

Things to note about health insurance policies in Mexico

Planning to have a baby? You need to have this policy 10 months before you are due that means you cannot be pregnant then sign up. Bad knees but it “just started hurting after you got the policy”? You have to wait 24 months for nearly everything along those lines – it weeds out people who are using the policies but hiding pre-existing conditions and really is good for only accidents in the first two years you have a policy.

If you extend each year, you will not be punished if you do end up with a condition later on that is expensive to the company.

Mexico’s health insurance is not preventative in any way – that means routine check-ups for dental care, vision, OB/GYN, dermatologist – all out of pocket. While a dental surgery might be covered or discounted, preventative won’t be so you can forget those $10 co-pays you are used to in the USA. I have been to the ER already once and my visit without meds was $50 just to see the doctor. I had swine flu – the meds I got later cost $20 and the lab draw I got cost around $20, too. That isn’t something your insurance can kick in for. You CAN get a more comprehensive plan that would cover these doctors visit and such, but you’re looking at over 20,000 for the year. We went with what is called a “catastrophic” plan since we really want it more for emergencies. Prices here are similar to India’s healthcare where we lived and paid out of pocket for five years, and we are more than happy to continue doing that for simple doctors visits and medicines. You’ll have to decide what works for you based on your own health.

Medications are mostly over the counter but even ones with prescriptions you just pay for yourself unless they were prescribed in the case of an injury or illness that was over your deductible and you went through insurance for them.

In accidents, you’ll just have to pay and then get reimbursed but if you are sick you can present your insurance ahead of time and have them pay it to the hospital.

Our policy isn’t “great”. Our deductible is high and so is our coinsurance limit, but really for us it is what worked best when we balanced out the risks and benefits and costs. You’ll find one that is perfect for you, too.

If you’d rather not get private healthcare in Mexico and are a resident, you can apply for the national medical care.

 

2018-11-20T01:01:37+00:00

About the Author:

Rachel Jones left a career in nursing and lived on the beaches of Goa, India for the five years. Now she lives in Mexico where she gives advice on the 40+ countries she’s visited in the last 10 years. She’s the author of two India travel e-books: Guide to India and Insider’s Guide to Goa. Her blog, Hippie in Heels, like its name, is a contradiction combining off-beat adventurous places with glamorous and bespoke travel. Hippie in Heels has been featured in ELLE, Marie Claire, Grazia, and Cosmopolitan magazines. She’s a writer for Bravo TV.

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