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This email address is being protected from spambots. You need JavaScript enabled to view it.About Mexico Insura...
Melanie Lansing of Mexico Insurance Advisors – Best Places In The World To Retire User Account
health insurance in Mexico – Best Places In The World To Retire – International LivingCost of Health Insurance in Mexico
 
Quotes and rates listed on this blog are based on the date they were posted.
 
The best way to find out about rates is to contact an agent / agency.
 
Be sure to find a bilingual agent / agency who represents Mexican, International and Expat Health insurance companies (the more options, the better!).
 
Know the following before you call:
 
1. What coverage area do I need? (Mexico-only; worldwide; worldwide excluding the US)
2. What can I afford to pay for annual health insurance?
3. What deductible can I afford each year?
4. Which health benefits are most important to me?
5. What pre-existing conditions do I have (medications & surgeries)?
 
Once you find a bilingual / bicultural agent in Mexico, ask the following:
 
1. Which companies offer the most competitive rates?
2. Which companies have a good track record of paying claims & in a timely fashion?
3. How does health insurance work in Mexico? (It is not the same as in the US & Canada).
4. What plan(s) are most people buying & why?
5. How are pre-existing conditions covered?
 
See my post from June 12th, 2016 for more information on costs of health insurance in Mexico.
 
 
 
 
 
This email address is being protected from spambots. You need JavaScript enabled to view it.About Travel MedEvac
Cathie LoCicero of Travel MedEvac – Best Places In The World To Retire User Account
Cathie Smith Insurance logo – Best Places In The World To Retire – International LivingThe cost of health insurance in Mexico is determined by how old you are, what sex you are, if you have any pre-existing conditions, and where you live. Off the top of my head, I can't give a rate because the cost of a policy is an individual thing. 
 
Health insurance in Mexico works like any other insurance policy. First of all, these are major medical policies, which means the insurance policy would cover hospitalization, surgeries, and things like that. Some may have office visit programs, but most of the insurance policies are major medical.
 
Prescriptions generally are on your own. The medications needed in hospitalization would be covered under a section of your insurance policy. For month-by-month ongoing maintenance medications like the ones you take for blood pressure or cholesterol control, these things you pay out of your own pocket in Mexico, although these medications are a fraction of what they would cost if you were to buy them yourself in the US.
 
The office visits generally are on your own, too, although there are certain policies that cover office visits under certain conditions. For example, you may be covered for illness office visits. You may also be afforded one wellness physical examination every year. There are several different types of health insurance that you can get.
 
You may want something with a low deductible so that when you go to the hospital you only pay US $500 deductible. Other people might want what we would consider catastrophic policies and say, "Anything under $25,000 I'll pay for myself; just give me a low premium. If the hospitalization cost goes beyond that, I want it all covered." 
 
There are different types of policies for different types of budgets and needs. I know that's very vague, but there are just so many different situations that I can't be tossing numbers out because there are a lot of different things that come into consideration. What I will tell you is that the cost of health insurance in Mexico is much less than what you would pay in the United States for an insurance policy. 
 
There are some policies where if you are an American and at the same time a Mexican resident and you want coverage when you are traveling in the United States or coverage if you need something that cannot be done in Mexico and would have to be done in the United States, you can pay an additional premium for that. You could only get that type of policy if you truly are a Mexican resident. If you want that program, you must not have any coverage in the United States for the first six months living in Mexico because we have to comply with the American law on that. 
 
The Affordable Care Act of America or what people call "ObamaCare" states that you can only have a policy like what I just mentioned if you truly do live outside of the United States. That's a big advantage for Americans to not have to pay a penalty in the United States because they are not buying Affordable Care Act insurance packages.
 
(Cathie Smith Insurance logo, pictured.)
Peter F Gordon, MD of Lake Medical Group – Best Places In The World To Retire User Account
Dr. Peter Gordon with his staff, Puerto Vallarta, Mexico – Best Places In The World To Retire – International LivingThere are many options for health insurance in Mexico. And the costs vary depending on what you choose.
 
There are national health insurance companies that cover major medical conditions, ambulances and hospital expenses but they usually do not cover outpatient costs like office visits or laboratory testing. Their premiums are less than in other countries, but they typically do not insure someone over age 60 to 65.
 
We work with some independent insurance brokers who also offer international and travelers’ insurance. They too cover the major-medical expenses, there is no limit for age, and they are usually very reasonably priced.
 
Mexico has a national health care system called IMSS and foreigners who have a resident visa are eligible to apply. This has a yearly cost of about 300 to 400 dollars and covers everything: office visits, hospital, laboratory testing, even medications. On some occasions applicants are not accepted for pre-existing health problems or the coverage is slowly integrated over a few years. Also, like many other national systems they are over-utilized, understaffed, and lacking resources. Typically, what I see are patients who sign up for IMSS and use it only for the major health problems like hospitalizations, where they have excellent facilities and physicians. Then for the routine things they see me and use the private diagnostic services, which are fairly inexpensive, anyway.
 
Lastly, in our office we offer a service that works with a patient’s existing medical insurance. We have contracts with over 350 international medical insurance companies. The policy is reviewed and if it qualifies, the patient is able to see a physician in their office for $100 pesos (around US $5), have a hospitalization for $500 pesos (around US $25) total, no deductibles, no co-insurances, and no sign-up fee or additional cost. 
 
(Dr. Peter F. Gordon MD with his staff, Puerto Vallarta, Mexico.)
Ron Surles – Best Places In The World To Retire User Account
IMMS , Mexico – Best Places In The World To Retire – International LivingWe are retired here in Mazatlán now 12 years and have had IMMS 7 years and it has worked fine for us.  We make a appointment each month after our last visit.
 
We get about 90%of our meds for free. For the remaining, we go to a pharmacy where most have a doctor you can visit for 39 pesos (about US $2).   The doctor will  write you a prescription and you fill it there for about 1/3 of USA or less.
 
My wife just had a gastric bypass for no cost by her surgeon who Is one of the best in Mexico, but also does IMMS.  He has his own clinic where we go for follow ups. We pay 300 pesos / visit (about US $15).  She just had to have to go in for an emergency in which she was  three days there in a private room with excellent, 24 hour a day care, and our bill was only 5,700 pesos (about US $275).
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Andre Bellon of Bellon Insurance Agents – Best Places In The World To Retire User Account
Graphic for Bellon Insurance Agents, Ajijic, Mexico – Best Places In The World To Retire – International LivingThe cost of health insurance in Mexico depends on the age of the recipient, and the type of plan that they want to carry. It also depends on the type of deductible that they’re going to get. The average of the policies that we sell here have the 35,000 pesos deductible (about US $1,900), and the premium is worth around 30,000 pesos -40,000 pesos per year (around $1,600 to $2,150). These are for people who are 60 years old or more - that’s what it costs for them. If you’re younger, the premium is going to be much cheaper.
 
For example, for a person who’s 6 years old, the policy will cost around 10,000 pesos per year ($540). For a person who’s 60 years old, the policy will cost around 30,000 pesos.
 
IMSS is a Mexican government program, but it’s in bankruptcy. It’s a service that is going to disappear. Let me put it this way: for each peso that they get, the administration gets 80%, while the rest is for the equipment, the maintenance of the hospitals, and medications. That makes it impossible for any structure, or any business, to keep on going. 
 
The problem is it’s the government, and they have been trying to keep it alive for a long time. There are some people predicting that by 2020, IMSS is going to disappear because they cannot keep on with that track. 
 
Seguro Popular was born because of that problem- the administration is so strong that they cannot change anything, so they made a different entity, a different plan, so that the money does not go to IMSS, and instead goes to Seguro Popular- with a different administration and a different structure.
 
In my personal opinion, both of these options are better than nothing. For example, under IMSS, if you need a surgery for a hernia, you’re going to have to wait for 3 months to be attended to. In contrast, if you have a private insurance company and you go to a hospital, you will be attended to immediately. There have been cases where a person had an emergency situation when using a government healthcare system, and they received him, and instead of giving the patient a room, they will put him in the hallway. That’s how IMSS works. 
 
Seguro Popular does not have hospitals. They receive you, they give you appointments, and if you need surgery, they’ll take you to a private hospital. The government will be the one to pay for that, but that takes a long time for them to schedule. 
 
That’s the reason I say it’s better than nothing. The IMSS was actually a great idea- it’s not a bad thing. There are a lot of people in Mexico who do not have the chance of getting any healthcare coverage, so IMSS is really good for them. For the people who have income, however, IMSS is not recommended.
 
Most of the people here in Ajijic get IMSS because it’s the number one insurance, and it’s cheap. You just have to pay 4,000 pesos (around $215), and you’re in. That’s it. You can be a temporary resident and get it as well. There’s no pre-existing condition issue with IMSS. With a health insurance policy, you have to go through a test, and if you have a pre-existing illness, they might reject you, or give you an exclusion.
 
In my opinion, have IMSS if it’s not possible for you to get a private insurance. You can have both, but there’s no need to. IMSS will cover you, and, for example, maybe in 3-4 months you will have your hernia surgery. With the private insurance policy that you’re getting, your situation will depend on your deductible. If your deductible is too high, the insurance company’s not going to pay for much, or anything. You can get your surgery done with IMSS and they will not charge you for that, but in the private hospital, you will have to pay for your deductible before the insurance company pays for any charges above that. 
 
A hernia surgery in Mexico costs around 100,000 pesos (about $5,400). There are places where it can cost 30,000 pesos– 40,000 pesos. It depends where you go. The insurance will pay 30,000 pesos or the 100,000 pesos if it’s needed, depending on the plan that you have. If you go to a cheaper place, and you have a high deductible, you’re going to have to pay everything, because the insurance company is not going to pay the bill if the bill is lower than your deductible. 
 
Seguro Popular is an insurance policy, whereas IMSS are government-run healthcare facilities, although Seguro Popular is also run by the government. The doctors in IMSS are not government employees. This is very important. The best doctors with the most difficult specialties work in IMSS. They’re private doctors working part time, but they dedicate time to provide that kind of service. It may be because they are obliged to do it, or because they want to do it. They’re really good doctors, and IMSS has magnificent equipment. The problem is the administration- how they’re going to provide the service to you. That’s the problem with IMSS.
 
The administration controls which doctors go into IMSS. They also control which medication to buy. For example, you are given two options for your medications.
 
(Graphic for Bellon Insurance Agents, Ajijic, Mexico, pictured.)
Marvin Golden of Lake Chapala Real Estate – Best Places In The World To Retire User Account
IMSS Hospital, Mexico – Best Places In The World To Retire – International LivingOur health insurance here in Mexico is with BUPA. It covers us in Mexico and out of Mexico. The cost for us is about US $1,700 each per year, with a $5,000 deductible.
 
When you break your arm or knee and you need surgery here in Mexico, it’s not going to cost anywhere near that, so the point of the insurance for us is to protect us for a catastrophic event like car accidents or a major disease like cancer that could wipe us out. That’s why we took the higher deductible, which gave us a lower premium. You have to be under 75 years old to have our insurance.
 
One of the problems is you join the plan for a couple of years and then they start bouncing the rates up. Then you go to another plan, so you’re always looking for something that will cover you to age 80. For us, we pay $1,700 per year and we’ve never used it.
 
We were covered here under the Mexico IMSS for a long time, which is often free, but they don’t necessarily have the drugs and the best staff. For example, one of our staff had a couple of babies and when her baby gets sick, she’d have to be there at 6 AM, take a number, and wait her turn. At 1 PM, they’d say, “Sorry we’re done for the day. You’ll have to come back tomorrow.”
 
Sometimes, they don’t have good coverage. They might not have the drugs and sometimes they don’t have the equipment, and often they do not speak English. So we told her, “Just go to the doctor. We know it’s going to cost around $20 but we will happily pay for it.” You go in, get looked after, and the kid is okay. Don’t bother with IMSS, even though it is free. So as we get older and as we are traveling more, we wanted to have better coverage, better quality care, and coverage for out of the country, which is why we got a private plan.
 
When you’re in Mexico, even if you have insurance, the cost to see a private doctor is so low that you can just pay out of pocket, even if you have the “no charge” IMSS insurance, which you can get as a temporary resident.  It may be great in certain circumstances but in normal circumstances, the wait is so long and so inconvenient that you might as well just pay $20 and see a private doctor. If you go to the hospital under IMSS coverage, traditionally you would have somebody sleep on the floor beside you to look after you, so it gets a little rough.
 
(An IMSS Hospital, Mexico, pictured.)
This email address is being protected from spambots. You need JavaScript enabled to view it.About Mexico Insura...
Melanie Lansing of Mexico Insurance Advisors – Best Places In The World To Retire User Account
Mexico Insurance Advisors logo – Best Places In The World To Retire – International LivingHealth insurance in Mexico is based on age and sex and the type of plan and specific benefits. There are basic plans and high-end plans. The most affordable and comprehensive full-cover health insurance plans we sell are designed specifically for expats by Worldwide Expatriate Association (WEA). The WEA plans include everything from in-patient to out-patient care, doctor´s visits, medication, chiropractic care, diagnostic tests, and wellness benefits. The two coverage options are worldwide & worldwide excluding the US coverage. 

For individuals between 30-50 years old the average cost is between US $55 and $75 a month. 

For individuals between 60-70 years old the average cost is between US $120 and $200 a month. 

The benefits are similar to what you would get with a United Health or a Kaiser Plan in the United States.

I explain to customers that health insurance costs (annual premiums) are just one factor to consider when purchasing health insurance. 

It is also important to find a local agent to represent them, someone who:
  1. Is fully bilingual / bicultural.
  2. Offers assistance with claims processing.
  3. Acts as your advocate when communicating with Mexican doctors, hospitals & clinics. 
  4. Provides resources & referrals to Mexican doctors, specialists, and hospitals.
  5. Is knowledgeable of the Mexico Market, specifically: 
  • Which are the best hospitals, clinics & doctors in your area.
  • How your health insurance works at the local hospitals.
  • How health insurance is different in Mexico than in the US & Canada. 
Other factors to consider include:
  1. Health Benefits- What medical & hospitalization services are covered and up to what amounts?
  2. Payment Responsibility - What is the co-insurance and /or co-pay amount(s)?   Will the health insurance company pay hospitals directly?
Language barriers are another consideration to factor. Mexican insurance companies such as GNP as well as International Health Insurance companies registered in Mexico, provide all of their policy paperwork and customer service in Spanish. WEA and other offshore health insurance companies offer solutions in English.

Age is also an important element to consider when first applying for health insurance. Mexican health insurance plans have younger enrollment age restrictions: 64, 65, and 70 years old.  Expat, international and offshore health insurance plans allow individuals to apply before they turn 75. Of course, once accepted into a plan, most guarantee lifetime renewability. 

Those individuals who are 75 or older would eligible for Plan Seguro, the one private health insurance in Mexico without age restrictions. Unfortunately, the cost of Plan Seguro is quite high and often unaffordable for those on a fixed income. I always recommend that people over 75 look into signing up with the Mexican Public Health Plans; either Seguro Popular or IMSS (Instituto Mexicano del Seguro Social), both government run. 

Getting back to WEA’s affordable Expat health insurance plans… For a 60-year old couple (male and female), the cost would be $120 USD a month each.  This plan would cover them anywhere in the world except the US. It would also include a $1,000 annual deductible. With a higher deductible, the premium would be even lower. 

Some of the unique advantages of WEA´s Expat Health Insurance are:
  1. Free choice of doctors, hospitals & clinics in the world (no networks except with the plan that includes the US).
  2. Prompt & Direct payment to hospitals.
  3. 40% to 60% less costly than Mexican and other international health plans 
  4. No co-insurance (except in the US)
  5. Only one co-pay, for emergency medical services received at a hospital or clinic. 
Acquiring private health insurance in Mexico is a matter of choice of plan, price, and benefits. What makes Mexico Insurance Advisors different is our commitment to assist our customers beyond the initial sale of the policy. We become our customers´advocates and source for resources and referrals in the medical community. When we first meet, we educate our customers on how insurance works in Mexico & how to be prepared for medical emergencies. Because we are brokers, we are able to offer customers plans from over ten different Mexican, international, and offshore health insurance companies. 

Some customers choose to purchase a Best Doctor´s plan, the highest rated health insurance plan on the market. Others go with the WEA Expat plan because of its affordability & comprehensive benefits.  All health plan choices are made based on the customer´s choice and personal needs.

**These are approximate prices. Things change all the time but this gives you a rough idea of the cost of health insurance in Mexico. 
 
Michael Keller of Guardian Insurance Mexico – Best Places In The World To Retire User Account
Novomar Insurance logo – Best Places In The World To Retire – International LivingThe cost of health insurance in Mexico varies based on several factors. Age is the main one. If you are 65 and older, the premium is higher. If you are under the age of 65, you will find that the health insurance policies down here in Mexico are a lot cheaper than those in the States.
 
The cost also varies depending on the insurance company and the deductible amount that you choose. Usually, there is a US $250 annual deductible per person up to US $10,000 annual deductible per person. Most people pick US $1,000 to US $2,500 for their annual deductible, which keeps their annual premium between US $800 and US $1,200 per person, depending on their age. Many of the companies that we work with have no network in Mexico so you can go wherever you want.  If an insurance company does have a network, and you go to a facility out of network, you will have to pay the co-pay. If you stay in-network, there is no copay. You just have to reach your deductible once per person per year.
 
When you go to a clinic, hospital, or any provider that is in-network, you need to pay first whatever deductible that you choose upfront. Maybe you could go because you have an ear infection that only costs US $200 for you to be treated.  In this case, you keep the receipt and that US $200 adds towards your US $1,000 deductible. So as your medical bills throughout the year add up, once you reach the deductible that you choose, your insurance company takes over and pays for everything.
 
As far as submitting paperwork and doing claims, it depends on the company that you work with. With some companies down here in Mexico, it’s a long, drawn out process and there is a claims process that you have to be a part of. You have to save all your facturas, which are receipts, you have to contact the insurance provider, you have to contact the facility and set everything up. A lot of the companies want you to call ahead of time to notify them that you are going to file a claim, and that you’re on your way to the hospital even in an emergency. Some companies, like the one that we work with called PanAmerican, are among the elite companies around the world and you don’t have to do any of that. You just have to show your insurance card when you’re admitted to the facility and they take care of all the paperwork, the claims, and everything. You don’t have to call them upfront. They will do everything for you.  If you are not in-network, you are still covered but you just have to pay your deductible plus the co-pay, which sometimes costs around 10% or 20% of the medical fees.
 
The biggest concern of most people who get insurance down here is the network. Most people get a policy where they know that they are going to have the hospitals that they want in the network in their area. And a lot of the companies that we work with, especially in the Vallarta area, have most of the major hospitals that are frequented by expats in their network. So most people don’t have to worry about going out of network, at least in the Vallarta area. Normally, how it works is that the insurance company will always try to make the payment even if the facility is out of network, no matter where you are. It’s really up to the facility if they want to accept the insurance or not. Obviously, most of them want to take the insurance because then they know for sure that they are going to get paid because if the person is paying out of pocket, they are not sure if they are going to get paid or not and you can’t legally hold someone in the hospital and force them to pay. Patients are free to go by their own will; they can’t be forced to stay at a hospital until they pay. So most facilities, when they know that someone has insurance, will accept the patient and they will look to the insurance company to get their payments.
 
There were some instances here in Mexico that I’ve heard of where some of the hospitals have tried to hold people. The same happened to one of our clients who switched over from a different company that wasn’t paying the claim. I guess the hospital had two big body guards standing by the door and they made the patient give them a credit card before he could leave but that was because he wasn’t educated ahead of time, knowing that down here in Mexico they can’t do that.
 
The cost differential between the same type of insurance you’d have in the US compared to what you’d have in Mexico is very large. One of the bigger policies that I wrote for a client was a US $12,000 annual premium per year for two people.  When I talked to the client over lunch, he said that this amount was about half of what he was paying in the US for him and his wife. This was for very good coverage.
 
(Novamar Insurance Mexico logo, pictured.)
This email address is being protected from spambots. You need JavaScript enabled to view it.About I Go Yucatan
Alfonso Galindo of I Go Yucatan – Best Places In The World To Retire User Account
annual motorcycle rally in Rocky Point, Mexico – Best Places In The World To Retire – International LivingIf you’re a legal resident in Mexico, you qualify for a national healthcare insurance, which is about US $380 per year for an average retiree, 55 to 65 years old. This would be for the public healthcare system, which is no less or no better than any private clinic because every single doctor working in the national healthcare system also owns his own office and also works at not just one but probably 2 or 3 other private high end clinics. So a lot of these doctors have their state job, which guarantees their pension. They usually have their private doctor’s office in addition to working in a hospital or two.
 
Personally, I am in the public healthcare system, which I consider my catastrophic coverage. If my healthcare problem is just run-of-the-mill, I go to the private clinics and pay out of pocket.  I did go to the public system when I had my motorcycle accident and I broke my collarbone in two places and broke two ribs. The bill for my care was zero.  It can take a long time to get a follow up appointment in the public healthcare system in Mexico, so, being that it was only $24 to see a private orthopedic doctor, I chose to pay $24 and go see a private orthopedic physician to follow up on my care. I paid $24 for my orthopedic, I paid $15 for the private X-ray in addition to the one I had in the hospital, and for my brace, so all together my out of pocket expense was about $40 for two broken ribs and a collar bone broken in two places. 
 
I am comfortable going to the public clinic because I know that those doctors are the same doctors that attend patients in the most expensive private hospital, so it doesn’t make a lot of sense for me to pay money for one when I can get it for free at the other.  
 
Here’s a story to illustrate the point.  Dr. Fern, in Tijuana, had a very rich Mexican come in to see him.  Dr. Fern is a cardiologist.  The rich man come for certain x-rays.  Dr. Fern told his patient, “I’m going to take care of you” but his patient said, “No, no, I’m going to La Jolla in San Diego where they’re going to operate on me.” And his doctor told him, “You know it’s going to be much more expensive for the same healthcare that I would give you here.” “No, no,” said the man, “I’m going to La Jolla to get my treatment there”.  So the man goes through his treatment, and everything goes well.  He’s in the room after his open-heart surgery, and lo and behold, his doctor from Tijuana is the same one who operated on him in La Jolla. The man asked, “What are you doing here?” and his doctor said, “I operated on you. I told you that you would get the same exact healthcare.” The difference was $180,000 in San Diego and $21,000 in Tijuana. 
 
A hip replacement in the US would run you, if you were lucky, $40,000; I believe that hip replacements average $60,000 to $80,000 now in the US. Here, not just Merida, in general across Mexico, a hip replacement can run you $8,000 to $12,000, if you decided to go to a private hospital.  If you used the public system, it would cost close to nothing. Personally, if I needed a hip replacement, I would go to the public system.
 
(Participants in the annual motorcycle rally in Rocky Point ( Puerto Peñasco), Mexico, pictured.)

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