What Wikipedia Can't Tell You About Healthcare in Mexico
Updated May 2020
What types of health insurance are available in Mexico?
The horrifying rise in costs of healthcare in the U.S. was a key factor in my coming to Mexico, as it is for many if not most expats. One of the most vexing questions for me as an expat in Mexico has been what to do about health insurance, as while any plan is cheaper than than the U.S., there are a number of options.
If you read up on what expats say about doctors, hospitals and treatments in Mexico, you will see the reviews are overwhelmingly positive.
Patients summarize their praise with comments on how much less it all costs, from 50% less to a fraction of the cost in the U.S. They are grateful for both the quality of care they’ve received and the quality of life they can still afford to keep/
Of course the cost varies by doctor, hospital, and what illness you have, just like the U.S, but costs are always lower, sometimes to the extreme. For starters, in Mexico an office visit with a doctor or specialist will cost 350 to 500 pesos (about $30 to $43). Doctors still make house calls and those visits cost about the same. Lab tests will cost about a third of what they cost in the U.S. An overnight stay in a private hospital room generally costs less than $120.
These should at least be filled with twenties.
Expats who live in Mexico full-time or stay over 180 days at a time have either resident visas or visas temporal, the latter being something between a tourist visa and a resident visa. With either, you can apply for the two major public health insurance types available in Mexico, IMSS or Seguro Popular.
IMSS coverage costs from 3,200 - 6,200 pesos ($177- $400 U.S.) a year. Many expats opt for IMSS insurance if they are covered in the U.S. by other insurance, like Social Security. They feel that IMSS coverage can cover them in an emergency if it arose and routine care. If a major condition developed, they’d return to the U.S. for care.
The former Segura Popular is now known as the Instituto de Salud por Bienestar. Known for covering Mexico's poor, in some areas it is as good in quality as IMSS. Both are no-frills systems, which have been compared to the U.S. system of HMOs (again, this must depend on where you are). Along with the new name, you can expect reorganization of the free healthcare system, which hasn’t yet fallen into place.
The doctors in the two government systems work in the private sector as well, meaning that people with private insurance see the same doctors as those who have government insurance. Doctors in Mexico are required to divide their time between the private and public sector to earn their pensions.
People tell me that the care in the IMSS system is excellent. The downside is not the quality of care from the doctors but rather the ease, or lack of ease I should say, of getting prescriptions filled, long wait times and the difficulty of making appointments (sometimes you have to make them in person - and then they still see people first-come-first-serve basis even when you have an appointment).
Some differences in healthcare benefits are culturally based
If you have a hospital stay, you will need to provide your own nursing care if you are on a government health insurance plan. In the Mexican culture, where most people have extensive family networks, this makes a lot of sense.
Given this feature, Mexican hospitals are much less restrictive about visitors. Rooms in hospitals usually have space and couches for family members to stay overnight. During my own surgery in Mexico, while I had nurses, a Mexican friend's niece stayed with me one night, an adult nephew the other. Seeing it from that perspective, I saw how much sense it made (and I rather liked the attention.)
As an American without an extensive network, if you are part of a couple, the government plans would be workable if your spouse and friends could be reliable caregivers. Retired expats tend form strong networks for exactly this type of scenario.
Part-timers who are here only a few months often opt for travel insurance, enough coverage to get them stabilized here, then home in an emergency. Travel insurance that covers health emergencies only is much more reasonable than comprehensive travel insurance.
Private insurance in Mexico
Juan F. Chong
As a single person and lacking the depth of social support I would need if taking the public insurance options, I decided to talk to a health insurance broker about private healthcare through a Mexican carrier.
Most of the expats in Mazatlán are clients of Juan F. Chong.
I set up a visit with him to find out more about Mexican coverage and what my options would be based on six-to-11 months a year in Mexico. Most of Mr. Chong’s clients come to him to purchase health insurance from a Mexican or global carrier. Global carriers will generally let you receive treatment anywhere but the U.S. (quite telling, isn't it?)
Me: What are greatest concerns of expats who come to you?
J.C. - Catastrophic illness; cancer, heart disease or diabetes, for example.
Me: What are some of the most important factors in choosing a plan?
J.C. One of the most important factors to consider is the level of hospital included in your coverage, that the best hospitals are included. Here in Mazatlán, that would be Sharpe Hospital, Hospital Bilboa, Worldclass and Hospital Marina. You can also go to any other top level hospital in Mexico. Mexico City, Guadalajara and Monterrey are considered the cities with finest hospitals and specialists in the country [It's a very big country].
With these upper-tier policies, the insurers pay the hospital directly, rather than reimbursing you. Costs are easier to track here because hospitals use a single claim system.
Me: What are the standard deductibles people take?
J.C - Policies deductibles my clients take range from 25,000 to 35,000 pesos ($1,388 - 1,944 dollars based on an exchange rate of 18 pesos to the dollar).
[As a comparison, some of my healthy friends over 50 in the U.S. have yearly deductibles of $5,000 and still pay over $600/month in premiums. Mexican coverage would cost at age 58 and healthy, about $1,700 dollars U.S a year ($140/month). At age 62, the cost for a private health plan would run about $2,200 a year.]
One important difference in Mexico concerning those deductibles is that a deductible applies to the lifetime of a single medical “event” or incidence. They are not paid every calendar year. If you are being treated for an illness multiple years, you don’t have to pay that deductible every year. You pay deductibles per diagnosis.
Let’s say for example you got diagnosed with lymphoma. Your deductible, once paid for, would apply for the remainder of the period of your treatment. If you were diagnosed with a second illness however, you would have another deductible to cover.
Me: What about co-pays?
The insurance company pays a percentage of the bill, usually 90/10. It’s important when choosing a policy to make sure that the policy has a cap on how much you have to pay on co-pays. Typically, that cap should be 35,000 pesos ($1,945).
Me: What are the considerations regarding age?
JC: People who are considering retiring to Mexico need to understand that unless they are in terrific health, it will be very hard to get approved for a policy after the age of 64. The time to enroll is when your are healthy.
Me: I understand that new health insurance policies do not cover pre-existing conditions, just like U.S. policies did not until Obamacare.
J.C: That’s correct. The waiting period before you are covered for certain illnesses like cancer and diabetes can range anywhere from one to three years. This is another reason to get insured sooner rather than later. If you get diagnosed with a serious illness, you probably won’t be approved for coverage.
Me: So you can’t get insurance at all if you have a preexisting condition?
J.C. You can be covered but with exceptions, exclusions for that condition. You will have to pay the costs associated with that condition.
Me: When I was looking online for expat policies, there were many to choose from online. Why should I use a health insurance broker?
J.C: Insurance brokers are familiar with the paperwork required to be admitted for surgery and what forms are required by doctors and underwriters. To guard against fraud there are a number of forms that require verification of identity for example.
You might need someone who can help negotiate with insurance companies. If, because of an emergency, you are taken to a secondary hospital, the broker can orchestrate the process of reimbursement. Even if your Spanish was exceptional, that can be quite a challenge.
People should make sure that they are working with a licensed broker, someone who has passed the exams and is authorized to sell insurance. For some years people were getting away with selling insurance without those licenses and the special training they require, although that’s been cracked down on in recent years.
Me: What’s important to consider when choosing a carrier? Which are the best?
J.C: If you are considering among the top 4-5, I’d advise to choose one with a local office in the city in which you live.
Me: What about national health insurance [Public Insurance like IMSS and Seguro Popular]? Can expats get that?
J.C: Yes, but you do have to have at least a Visa Temporal {and there are requirements to be able to procure one]
Me: What about drug coverage?
J.C: Medications are all covered by diagnosis.
Me: I understand that you need to give the hospital your credit card when you’re admitted.
J.C: Yes. Expats need to realize that they will need to have some cash available for some expenses that will be incurred at the beginning, x-rays and doctors visits for example. Some will be reimbursed. Some will be out of pocket. Medical insurance does not pay for everything upfront.
[End of interview]
Other considerations in calculating how much insurance you need
When determining the plan you need and upfront costs such as tests, MRI's and blood work in Mexico, you need to remember that these costs will add up to a fraction of the cost of the same items in U.S. A MRI might cost a few hundred dollars in Mexico. In the U.S.. the average cost is $2,611.
The costs is so much lower in Mexico that on many procedures, expats self-insure if they are on Medicare. They pay for their treatment out of pocket and still come out ahead when compared to the United States (I know, I know...unbelievable).
Even with medical insurance with a private carrier here, expats still might self-insure for minor, less expensive injuries (When a band-aid can cost $629 in the U.S., you question if there’s any such thing as a minor injury in the U.S).
Many people blend Mexican plans and features. For example, one couple I know who has public insurance in Mexico purchased medevac policies for several thousand a year for each of them as well.
Expats may decide to keep their Social Security coverage and still purchase private or public Mexican insurance if they can handle the tricky business of establishing residency in both countries.
The American Healthcare Crisis
Many people in the U.S. are scared silly that in the event of a major illness they would have to spend their whole retirement savings out-of-pocket costs to cover their healthcare. This scenario happens every day in our country. In addition to fighting for their lives, they are having to try to find resources to pay for care when the money is gone.
Rather that putting their head in the sand because they still have their health, many are electing to look at the facts and be proactive by planning a new life in Mexico.
Related links: Mexico: What is the difference between ISSSTE and IMSS by Quora
America's most costly drugs and their price in Mexico - Ventanas Mexico
Monica Paxon's "English Speaker's Guide to Medical Care in Mexico."
Barron's reports on the real cost of healthcare in retirement. While hard to pin down exactly, none of the numbers are good news.
Most recent: Enjoy the arts in any major expat community in Mexico for less.
About the author, Kerry Baker
Kerry Baker is a partner with Ventanas Mexico and the author of "If Only I Had a Place," on renting in Mexico.
Her first love was writing the "Interactive Guide to Learning Spanish Free Online,' which is geared to older adults thinking about moving or retiring to a Spanish-speaking country. The Guide takes you, through interactive links, to the best free Spanish learning sites and features on the webs. Resources you would never find in a Google Search, like sites in Spain. You can learn Spanish later in life. Get the most out of expat life by starting today!
The second book “If I Only Had a Place” guides you though the process of renting in Mexico luxuriously for less. The rules and protections are different in Mexico. Read up and establish the infrastructure for the best possible life as an expat.
Her third book is “The Mexico Solution: Saving your money, sanity, and quality of life through part-time life in Mexico.”