Healthcare insurance in Mexico 101

Moctezuma 2 sep. 2021 healthcare insurance Mexico CURP Immigration Like

Perhaps as many other current and future expats, you're wondering how healthcare insurance works in Mexico. Questions such as: How can I get it? Where do I sign up? What does it cover? How much does it cost? Are there options for coverage? What about public vs Private? Well, if that’s you, you’re in the right place! I'm pleased to share all that info with you right here!

Introduction: A few words about CURP

CURP is a "Population Code" number each Resident (Permanent and Temporary) and Citizen in Mexico has. (To check the differences between Residents and Citizens please check the link at the end). This number is unique and is useful for pretty much all the paperwork involved with healthcare insurance and many other matters in Mexico. That’s right, this means you cannot have a CURP unless you are a Resident or Citizen of Mexico and, by extension, you cannot get Mexican healthcare insurance (not even private) unless you’re a resident or citizen. There is only 1 exception to this which is for visitors in Mexico for humanitarian reasons. (More on this later).

About Mexico's public healthcare system

In Mexico as you probably already know we have a public healthcare system. In the past it was called “Seguro Popular” and now is called “INSABI”. For this public healthcare system there is but a small charge for the application fee (around $100 pesos, $5 USD). it can be used nationwide and is intended as a "safety net" for emergencies and some other medical care. The only real requirement is to have a CURP number. The application and a current claim can be filed even during an emergency. It is intended for low income individuals and is almost completely funded by the government so service is not so comprehensive. Something you should know is that INSABI hospitals don’t say “INSABI” on their signs. You can access these services at public hospitals, usually called “general hospitals” (example: Hospital General de name of the town/ city ) or “CESSA” name of the town or city).

IMSS

This is probably the most widely known insurance in Mexico. IMSS is an employee benefit funded through taxes paid by both employer and employee. In addition, IMSS in available for purchase directly by individuals and families and this applies to expats who are residents or naturalized citizens.

The fee depends on the age range of the family (or couple) and has some exemptions at the beginning of the coverage period (surgery, for example). Theoretically this is for families (2 members) but if you’re by yourself in Mexico, don’t worry, there is a way to get around this.

On the bright side, services included are: generalist doctors’ appointments, specialty doctors’ appointments, emergencies, medications (if available), teeth cleaning, surgeries and preventive medicine (blood sugar tests, papanicolau, vaccination, HIV tests, blood pressure measurements, mammogram)). If your doctor orders tests such as blood tests and ultrasound these are included. MRI and other more sophisticated tests are included but usually only IMSS Hospitals in larger cities have this equipment so you could be asked to travel to the nearest hospital that has it.

Realistically, you should be aware that the IMSS system is very crowded. So to get an appointment with a primary care physician involves the following: if is NOT urgent, such as follow-up for chronic disease or pregnancy you can make the appointment using an app on your phone and depending on where you live your appointment will be scheduled from 2-4 weeks after the date you’re scheduling. If you need an immediate appointment (not an emergency but still you need attention soon) you need to go to your IMSS hospital before 7 am and stand in the line and once the gate is open you need to run to your doctor’s office inside, The clerk there typically has around 10 appointments to fill (this can vary depending the hospital) and beyond that you'll need to return the following day.

An important rule is that if you have IMSS you cannot use INSABI and vice versa. My personal advice here would be if you can afford private insurance, or at least IMSS, you should leave INSABI for people in need.

* Special note: during the current pandemic situation*: IMSS hospitals are used as Covid hospitals. Because of this, most of the services listed above have been suspended except for emergencies.

Private Healthcare insurance

In Mexico the most common type of private healthcare insurance is “Gastos Médicos mayores” (GMM) which stands for “major medical expenses insurance”. It is designed for accidents, emergencies and non-preexisting conditions with treatments that are priced higher than a personal deductible amount. The deductible amount is set up according to your personal financial situation. A deductible is a recommended amount is supposed to reflect the maximum amount of money you can access in case you have an emergency. The higher the deductible, the lower your annual insurance premium will be. There is other another amount called co-insurance. This is in addition to the deductible and is usually a percentage of the total estimated (usually around 10%) until you reach a limit which is set by the insurance company. Coverage varies. Some insurance companies have the option of not charging the deductible on accidents.

This type of insurance usually covers total expenses of about 300k MXN up to 25 million MXN. The age of the insured person has a huge impact on the annual premium, so the sooner you sign up for insurance the better the price will be for you in the future, and you should always keep renewing, if you let your insurance coverage lapse, most insurance companies won’t issue new policies to people older than 65 years old and very few will take you after you are 69.

There are a few insurance companies that offer a special “low medical expenses” insurance which gives you preferred rates with doctors in their network.

OK, what does health insurance coverage typically look like? For example, let’s say you need to cover an emergency of about 400k MXN, Your deductible amount is 30k and your co-insurance 10% limited to 70k MXN. In this case the co-insurance you will pay additional to the deductible is 40k (10%), so you will pay 70k in total and the insurance company will cover 330K MXN.

Now, let’s say you need to cover a medical incident totaling 900k MXN. Coinsurance in this case will still be 70k because that is the limit set up for this policy. In this case the 10% will be 90k (which is higher than the limit) the insurance company will ask for the co-insurance limit instead of the 10%. In this case, you will pay a total 100k MXN and insurance will cover 800k MXN.

I know to reach these figures on medical expenses in Mexico may sound shocking or unlikely. The truth is that even public hospitals have a higher rate for “non-insured” patients that could easily exceed this amount when you are facing a severe condition since every resource will be charged (daily in-patient services, medical staff, medications, any device they may use, any labs done, Operating Room expenses, etc.) Just as an example, the most "expensive" COVID case in Mexico so far cost around 29 million MXN.

Please remember that these financial figures are illustrative and not meant to be specific for your situation. For those of you abroad, the current exchange rate these days is about 18-19 Mexican pesos to 1 US Dollar.

Side note: This is most relevant for those who live in Mexico on 180-day (or less) TOURIST immigration status (the papercard FMM forms you get stamped at the border or airport and return when you depart). These individuals are not eligible for any type of insurance but travel insurance. Eligibility for insurance would be an incentive to get moving towards Temporary or Permanent Residency.

Waiting periods

Both, IMSS and private insurance have waiting periods to start coverage for certain health conditions. IMSS, for example doesn’t cover surgeries for at least the 1st year and private insurance usually has more specific guidelines. Generally speaking, for illness, the waiting period is usually 30 days, for pregnancies it is 9 months For accidents and emergencies you are covered on DAY ONE.

I think it’s important to mention that COVID may be viewed either as an illness or as an emergency depending on the severity of the case, So if you get diagnosed before the 30 days period it won’t be covered at the beginning but if it becomes an emergency then will be covered immediately (after you reach your deductible coinsurance).

Well, I hope this is enough general info to get you started! We offer nationwide remote service to guide you through the application process for both IMSS and private insurance and we have in-person service available for you in Oaxaca City, Puerto Escondido and Huatulco Oaxaca. So, feel free to contact us for a quote at contacto@immigratetomexico.com

Discount opportunity: You can receive a discount on our services if you send us proof that you have shared this post with at least 10 friends, you will get a 10% discount on the service related to the post you share!

I invite you to check out our other posts and links (shared below)

I hope you and your family are safe and sound whenever you are today!

Always happy to help

Maria