Health Insurance in Mexico – Things to Consider

Health insurance plans are available in Puerto Vallarta, Los Cabos, Playa del Carmen, San Miguel de Allende, and throughout Mexico. Although many people focus on cost and the bottom line; there are many other variables which are as important or even more important than the price.

The first question you should ask is; "Which health plan in Mexico is right for me?

Here is a list of important considerations.

1.      Coverage Area

Health plans will all offer a specific coverage area. Mexican plans may cover Mexico-only with limited coverage for travel-related emergencies outside of Mexico.  International plans, on the other hand, will offer worldwide coverage.

Which plan you choose will depend on which countries you plan to visit outside of Mexico. For individuals who travel back to Canada or the US, international plans may be the best choice, because they offer continuity of care if any diagnosis or medical emergency were to occur outside of Mexico. What this means, for instance, is that if you are injured while visiting relatives in the US, you will be able to return to Mexico for any follow-up care or treatment. If your plan does not include the US, you will not be able to return to Mexico for follow-up care.

2.      Health Benefits

Health insurance plans cover everything from doctor´s visits and medications to hospitalizations medical emergencies, and pre-planned inpatient / outpatient surgeries.  The advantage to having private health insurance in Mexico is knowing that you will be covered for unexpected medical expenses.  The cost of doctors´ visits and simple medical procedures can seem very affordable to Americans and Canadians in Mexico.  However, many fail to realize the high cost of medical emergencies and care for chronic medical conditions.  Purchasing health insurance in Mexico is a way to protect your retirement nest egg as well as your dream of living in Mexico.

3.      Deductibles

Deductibles refer to the amount you pay out-of-pocket before the health insurance company will begin paying for medical costs. Annual premiums or rates will vary based on the annual deductible amount you choose. Generally, the higher the deductible, the lower the annual premium.

Which deductible is best?

I usually recommend that individuals choose a lower deductible to start, however the deductible you elect will depend on the out-of-pocket expenses you can afford. Opting for a high deductible or in other words, a plan that will cover only major medical emergencies, may not be the best choice, since they don´t consider that once you choose a high deductible, your chances of changing to a lower deductible once you have received a diagnosis or received care, are slim.

4.      Co-Insurance

Many Mexican & some international health insurance plans include co-insurance as a way to lower annual premiums. Co-insurance refers to the percentage of the medical bill the insured is responsible for paying. The most common co-insurance rates are 5%, 10%, 15% and 20%.

Here is how it works.. With a $100,000 peso medical bill and 10% co-insurance, the insured would be expected to cover $10,000 pesos of the total bill. This amount is assessed on all medical bills and is charged separately from the deductible.

5.      Maximum Benefit Amount

The maximum benefit amount refers to the total dollar / peso amount the health plan commits to paying. Health plans either include an annual or a lifetime maximum dollar / peso amount. With an annual maximum benefit amount, if your plan covers $100,000 pesos and your maximum benefit is 5 million pesos; you will have 5 million pesos to use during each policy year and the amount will replenish at your renewal date. If on the other hand, you have a plan with a lifetime amount, all of the costs of medical care over the lifetime of your membership in the plan will be deducted from the lifetime sum.

Health insurance in Mexico has a number of considerations.  Knowing the above terms and how they work, will enable you to make an informed purchase decision.