Top Questions Regarding Health Insurance in MX

Thinking about moving to Mexico? Or you made the move but never got around to obtaining Health Insurance? Living in Mexico can be a dream and a much better lifestyle than many places but chances are, the medical system with care and insurance is nothing like you experience in other countries. It’s important to be informed and know how the system works. Here are the top questions I receive frequently regarding health insurance in Mexico.

So if you're thinking about moving to Mexico, hopefully these clear up some of your questions. If you already have insurance in place or you're looking at options, hopefully this will help you understand your policy or make a decision on what to do. 

1. Pre-existing conditions, are they covered in Mexico?

Typically, no, but it depends on what you have going on. You do not get a final answer or offer until you submit an application, and let the underwriter of the insurance company offer you coverage, but you don't know until you submit an application. So it's not a yes or no answer. 

2. Do I even need insurance? Everything's so cheap in Mexico.

Well, yes, things are cheaper in Mexico compared to some parts of the world. But if something major medically does happen to you, you're going to wish you had insurance. It is NOT “cheap” if something big happens. And that's why you have insurance. We don't have insurance for the little things, like a stuffy nose or a couple of stitches. 

You can run it through insurance but you have a deductible, which is my next question that I will go over. And the insurance really is designed for covering you if something major happens. 

3. What is a deductible?

Also known as Excess, depending on the country that you are from. This is the amount of money you're going to pay first before the insurance really kicks in to pay. So, for example, let's just say you have a $5,000 deductible. You can get lower deductibles. You can get higher. I'm just picking one for an example. You are going to have major or any medical expense up to $5,000 you're going to pay for.

It could be little things here and there, or it could be one time you're in the hospital, you have a $50,000 claim. You pay the 5,000 and the insurance company will pay 45,000. So it depends on what option you have whether and weather you want a lower or higher deductible that impacts the price as well.

4. Why does my insurance premium go up every year?

The price of an insurance policy is based on age. It is not based on your nationality. It's not based on your health status. Some policies will rate you different depending on your health. But overall, most of the policies used in Mexico are age banded. 

Annual increases are determined by age and inflation every year. And it's the same for everybody of that same age. So if you have a lot of claims or you use it, it's usually not going to impact the price. But think about it. What was the price of a taco a year ago? I mean, the price of everything has really gone up lately, and insurance is one of them, including home and auto.

5. Expat versus Mexican insurance policies.

This is pesos versus dollars.. There's lots and lots of options out there, but you do want to choose a policy that is going to work in the area that you're living in. If you just go find some policy based out of some other part of the world that's not really known in the place that you're living, you want to research those things. 

When you put the expat policy and the Mexican policies side by side and get a similar plan, they pretty much cost the same thing. People tend to think they want a plan in pesos because it will be cheaper, but it typically doesn't really save you that much money or any. 

Mexican policies stop issuing at age 64 and expat policies stop issuing at age 74. You can keep the insurance past these ages on most plans if you obtain before the cutoff date. 

6. Maternity.

People come to me saying, “Hey, I'm pregnant. I need insurance.” Well, it doesn't work that way.

There's a 10-month waiting period on most of the plans, which means you have to wait 10 months before there's any benefit for maternity. Typically, you would like to plan ahead for having this coverage. If you become pregnant during the 10 month waiting period and the delivery will be past the waiting period then that would be covered. 

7. How are claims paid?

This typically depends on the insurance plan, but there are some generalizations. Most of the time the insurance carrier is going to require you to pay for your expenses up front and then get reimbursed, or have it go towards your deductible. If you are in and out of the hospital for something small and you there's no time for the insurance company to speak with the medical provider to verify coverage.

Now, if you are admitted into the hospital and you have something bigger going on then there is time for the insurance carrier to verify the coverage and send the hospital a guarantee of payment, saying yes, we are going to pay for these services. Then there's time for money to be sent direct and you should not have to pay for it up front. Some insurance plans have direct contracts with some medical providers, doctors, offices, they will pay direct, but that is not as common. 

Sometimes it does take a while for the claim to process and send payment and people tend to get frustrated. They want payment to be made right away. It takes a little bit of time for the insurance company to send the money, depending on what's going on.

8. Waiting periods.

Waiting periods do depend on the insurance plan. If you have a Mexican policy, they all have waiting periods for very specific conditions, so if you have not had insurance before and you're coming new to the plan, then there's going be a waiting period for different conditions such 9 months for this 6 months for that, 12 months, 2 years…. The Mexican insurance companies have a little bit odd waiting periods, but that is all described in the policy up front. 

The typical waiting period for several of the expat plans is 30 days but it’s different for each company. Accidents and infectious diseases are covered from day one and the waiting period is for chronic long lasting diseases…But again, it depends on the insurance policy. Some of them have different rules and different things going on. This can sometimes be waived if you can show you have had prior insurance for the last 12 months. 

Maternity: Pretty much all insurance carriers have a 10 month waiting period. It's very unlikely with anything that I've seen where you're going to get coverage right away for maternity. If you become pregnant during the 10 month waiting period then the delivery and benefits will be available once the 10 months are satisfied. 

9. PUBLIC vs PRIVATE Hospitals.

The public hospitals do not have the same quality of care because of the equipment and resources that the private hospitals will have. So, a lot of times public hospitals are not up to the standards most foreigners or expats are used to. Even a lot of Mexican nationals would prefer to go to a private hospital as well. At a private hospital you will find very long wait times for care and they don't have a lot of things that would be nice to have like pain management and nursing services to make you comfortable, so that's a reason that you want to look at private insurance to get you access to those private hospitals 

10. Rates that hospitals charge.

In most hospitals (not all) not everybody gets the same price. If you are a Mexican national, it is different than if you are a resident or a tourist. Nationals will receive the cheapest rate for medical services. Residents will be a bit higher, and you must prove residency with a resident card. A utility bill will typically not work. And tourists will receive the good old tourist pricing that you find in many parts of Mexico. It's just the way it works here. People think it's not fair, but that's the way it works. So be prepared if you do plan on living in Mexico long term and you happen to be doing boarder run thing to avoid getting residency, you will pay more if you end up in the hospital. Also, It's very important for you to get the better rate, because sometimes they'll charge so much that the insurance companies don't pay for unreasonable charges, so get your residency! 

11. How to choose an insurance plan for your situation.

There's lots of different plans out there, so depending on how long you're going to need the insurance is going to impact your choice. If you're looking at a shorter period of time, or you have intentions of returning to your home country in a few years, then you can get a plan with slightly less benefits that's going to be, maybe at a better price point. But if you plan on staying in Mexico or being a nomad for a longtime, traveling year after year, you're gonna want to get a plan that has sufficient coverage with higher benefits over a the long haul. If you're planning on a short period of time, you could even just do a travel plan for 1 year or under which will save you some money. This however will not be sufficient for a long period of time. There's lots of factors that go into picking a plan. This is why you need to get with your broker to go over all the different options for you. 

12. Medical evacuation plan.

This is good question because a lot of people think that their health insurance plan includes this already. When you look through the benefits, there IS medical evacuation, but it is only to the nearest facility that can treat you. It is not to your location of choice or “home.” So if you're in an area where you need some medical care and it's an hour away then there will be either a road evacuation or air evacuation included in your policy, which will take you to the nearest facility for treatment, but not to your home country as true medical evacuation policy does. This is something separate that you can purchase on top of your medical plan and put it together for full coverage.



So that's it, I hope these questions are helpful to you again, beyond the lookout for future videos, where I really expand on all of these questions, and if you have another question that's not answered here, don't forget to let me know and I will get more information out soon.