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How Healthcare Works in Mexico

How Healthcare Works in Mexico

Navigating a new country’s healthcare system is never easy. Below, we list the current structure of the Mexican health system, as well as explain how to access both the public and private health sectors and their advantages and disadvantages. Here's how the local Mexican healthcare system works:

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Mexico Health Care Facts

• Both public and private healthcare systems have their own doctors, pharmacies, physicians, and healthcare These operate inindependent networks.People are usually only allowed to use the services within their network.

• Health care costs vary depending on several factors, such as the hospital, the seriousness of the condition, and the location, among others. To give you an idea, for an emergency room visit you can expect to pay a basic sum of between 350 and 500 MXN (15 and 25 USD).

• A doctor’s consultation will cost you approximately the same as a trip to the emergency room — around 400 MXN (18 USD).

• Mexican pharmacies are divided into two categories: primera clase and segunda clase. On the one hand, segunda clase pharmacies are easy to find, both in big cities and small towns, but be aware that they cannot sell prescription medication. (e.g. psychiatric meds). On the other hand, _primera clase_pharmacies are fewer in numbers, but you will be able to get any type of drug that has been prescribed to you.

• The best hospitals in the country are in Mexico City, Monterrey, and Guadalajara. In the case of any major medical issue, it is best to seek treatment in any of these locations.
   

Does Mexico have Free Public Healthcare?

Mexico’s healthcare system is composed of a mixture of private, public, and employer-funded healthcare schemes. The country began its efforts to provide full healthcare coverage back in 2004, with a program called Seguro Popular. This was designed to make various preventative treatments affordable to those who could not otherwise access them. From January 2020, this program was replaced by the Instituto de Salud para el Bienestar (INSABI).

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Now, people without social security will receive free medical care and medicine without restrictions, and they will no longer need to enroll or pay any type of fee. The INSABI is a government agency that provides medical services to people who are not covered by the Mexican Social Security Institute (Instituto Mexicano del Seguro Social, IMSS) or the Institute for Social Security and Services for State Workers (Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, ISSSTE).

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What does Public Healthcare Cover in Mexico?

The country’s healthcare system has resources available at three different levels:

• The first level is the INSABI. This program focuses on care for those who are not covered by either the IMSS or ISSSTE.

• The mid-level is the public sector national healthcare programs, which are the IMSS and ISSSTE. Expats who are employed in Mexico are eligible for IMSS coverage, but, if you are self-employed, for instance, you could also choose to enroll voluntarily and pay contributions directly into the system.

• The top-level is comprised by private clinics and hospitals. These last two levels are the most applicable to expats.
   

As in most places in the world, the private system offers more modern facilities compared to the government-operated ones. If you’re an expat who is covered through the IMSS, you may wat to look into purchasing supplemental insurance. This is particularly useful if you will reside in a more rural area where the available public care facilities are very basic.

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In regard to coverage in the public system, know that you must have contributed to the IMSS scheme for at least 4 weeks before you are entitled to receive benefits. After this period, you are covered for hospital expenses, primary care, secondary care, surgery, and medication. In the case of an illness or accident that prevents you from working, the IMSS will pay you a percentage of your salary for up to 52 weeks.

The primary role of INSABI is to provide quality healthcare to everyone residing in Mexico who is not covered by the employment-based systems. This covers the following:

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• Free primary (e.g. General Practitioner or nurse) and secondary (e.g. specialist doctor) healthcare. Tertiary care (i.e. highly specialized treatments) is subject to fees.

• All conditions, without exceptions.

• Catastrophic and life-threatening diseases such as cancer and HIV are covered.

• Medications and supplies required for the treatments.
   

With that said, there are discrepancies between what the government is promising and what is actually materializing. There are reports that suggest that, in some hospitals, medications and medical supplies (e.g. gauze, ointments) are not readily available and patients must pay out of pocket.

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Please note that the Mexican public hospitals and healthcare facilities are overcrowded. Expats should consider acquiring private health insurance. Private hospitals in Mexico are also equipped with the latest technology, you will get more personalized treatment, and have shorter wait times.

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How does Healthcare Work in Mexico?

The Instituto Mexicano de Seguro Social (IMSS) provides healthcare services for both Mexican citizens and expats legally residing in the country. People enrolled in the IMSS program receive full coverage, including prescriptions. To find out if you will qualify for the program, check the IMSS site.

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The funds for this program come from the Federal government, employer payroll taxes, employee payroll taxes, and individual contributions from people who are not in formal employment.

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Below are two enrollment paths.

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• Any person (Mexican national or foreign resident) who is formally employed in the country pays their employee IMSS contributions. It is possible to have other private health insurance to complement it.

• There is an option to voluntarily enroll, which is open to people who are not in formal employment and others who want to enroll on a voluntary basis. Expats who hold either Temporary or Permanent residency status and are not formally employed (e.g. retirees) may apply. Please note that people who are enrolled in the IMSS via an employer get priority over those who enroll voluntarily.

Expats who wish to enroll voluntarily must have legal residency status. In order to qualify, you must either be a Residente Temporal (temporary resident) or Residente Permanente (permanent resident). Foreigners with FMM visitor permits (Forma Migratoria Múltiple) do not qualify.

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The ISSSTE (Mexican Civil Service Social Security and Services Institute) is a federal government organization, which partly administers Mexico’s healthcare and social security systems. It assists federal workers in cases of disability, old age, high-risk jobs, and death. The IMSS and ISSSTE provide health care for 55-60% of Mexico’s population. The INSABI covers people who do not qualify for either the ISSSTE or IMSS programs.

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Mexico Health Care Costs

For the IMSS, the costs depend on your age and there are some restrictions and limitations. You can check tables with rates at the Mexican government site. Just to give you an idea, a person in their forties currently pays around 7,000 MXN per year (320 USD), a person in their fifties pays about 8,500  MXM (385 USD); a person in their sixties around 12,300 MXN (560 USD).

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The IMSS does not cover some pre-existing conditions, such as malignant tumors, congenital diseases, chronic degenerative diseases, addictions, mental illness, and HIV. If you have any of these conditions, you will not be able enroll in the IMSS insurance program. The IMSS covers other specific pre-existing conditions on deferment, which means that you will be subjected to specific waiting periods before you can seekhealthcare services within the program.

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Mexico Healthcare System Pros and Cons

A good way of explaining the Mexican healthcare system is by shedding light on its benefits and disadvantages. We have compiled this list to help you better understand the situations you will be face in your new home.

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Advantages

• Public Healthcare is affordable. Note that the older you get, the more you pay. But, even if you are a retiree, it will still be more affordable than in many developed countries in the world, including the US. Just to give you an example, a retired couple will pay around 2,200 MXN (100 USD) a month for health insurance for both of them.

• Many Mexican doctors and dentists undertake at least part of their training in the US and continue to go to the US or Europe for ongoing training. This means that they speak English, making it easier for expats to communicate with medical staff.

• If you opt for private medical insurance, or get supplemental insurance, you will have access to top facilities, equipped with the latest technology.

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Disadvantages

• Care is provided by various social security institutes that are not inter This means that,in certain situations (e.g. losing your job), the continuity of your care may be disrupted. As the institutions have developed independently, decisions differ on medication and treatment options.

• Public health services do not have reciprocal agreements with other countries. This means that foreign programs such as US Medicare are not available in Mexico. Therefore, both visitors and foreign residents who are not enrolled in the public programs must make private health care arrangements.

• The quality of care across the country is not well-balanced; the best care is centralized in the big cities. For example, it’s will be a very different experience to receive care in Mexico City, where there are 2.4 beds available for every 1,000 inhabitants, than anywhere in the Chiapas State, where there are only 2 beds every 2,000 people.
   

An Overview of Private Health Insurance in Mexico

How does health insurance work in Mexico? If you decide to take out health insurance or supplement public care with a private policy, you will want to understand the ins and outs of the private system. If health coverage is not offered to you as part of your employee benefits package, and you can afford it, you might want to consider it, as it will allow you to choose the level of care you get, and how and when it is provided.

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In Mexico, private hospitals and specialist clinics have much shorter waiting lists and better infrastructure. Most expats who can afford private medical insurance will take out a plan. Private plans will cover your specific needs and provide you with direct access to private doctors, clinics and hospitals in the country. Policies are tailored to your individual situation, and premiums will depend on factors such as your age, level of coverage, and the deductible you agree to pay in the event of a claim.

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Do you Need Health Insurance in Mexico?

In Mexico, you will have good private and public health insurance options. Public health care is usually provided by the IMSS through employment or voluntary enrollment. The INSABI provides health care to individuals who are not covered by IMSS or who do not have private insurance.

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Bear in mind that healthcare services are mainly provided in Spanish and may not be available in English. Even though many Mexicans also speak English, particularly employees in the medical system, you should not assume that you will be seen by English speaking staff. Luckily, most private insurance providers include telephone support for their clients. They may help you find a local translator, or even provide the interpretation directly over the phone.

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Types of Health Insurance Plans

In Mexico, access to public health care is cheap. The main downfall is that as most public healthcare systems, the demand is higher than the offer, so the system is overcrowded. For this reason, many expats choose to either get private insurance or supplemental coverage.

Mexico has various trusted providers. If you decide to invest in private health insurance, it is essential for you to do serious research on what each provider covers and weigh that against your specific health needs. Look into the local hospitals in the area where you will reside and find out if they accept coverage from the provider you are considering.

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Some private health insurance companies popular among expats:

• GNP Seguros

• Royal and Sun Alliance

• Metlife

• Cigna

• IMG Global Medical
   

Health Insurance Coverage

Just like Mexico’s public healthcare system, its private counterpart covers a wide variety of conditions, procedures, and medical needs. You will need to make sure you find a private healthcare plan that covers all your requirements. Generally, you will be able to take out either a personal or family insurance package, and premiums will depend on the level of coverage, age, pre-existing medical conditions, and lifestyle (e.g. smoking, alcohol consumption).

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International health insurance companies provide different levels of medical insurance coverage. You will need to consider the services you will realistically need or use, which will depend on your overall health, among other factors. Moreover, there are many supplements that can provide you full coverage, including dental care, maternity, cancer treatments, mental health conditions, and even medical evacuation and expatriation costs.

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We are aware that all the different types of insurance, levels of coverage, pricing, and benefits may be confusing and overwhelming. A good option is to seek an expert to guide you through the process, and advise you on health insurance, protection, and wellbeing services. As part of our settling in services, you will find this type of assistance and more; taking on all the complexities of an international relocation on your own can be an unnecessarily stressful experience.

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Health Insurance in Mexico: Average Cost

Are you wondering how to get health insurance in Mexico and how much it is? When you have a clearer idea of your needs and requirements, you can find many comparison sites online, which will help you make an informed decision based on your specific needs. The costs will vary depending on the type of medical insurance, level of cover, the number of family members covered, among other factors. Just as an estimate, the average cost is around 38,000 MXN (1,700 USD) a year, with a deductible of approximately 11,000 MXN (5,000 USD).

How to Submit a Claim Your Insurance Company

The specifics on submitting a claim vary depending on your provider. However, one necessary step for all insurance companies is to request and keep your receipt, which is called a factura. For prescription drugs, thefactura is both emailed and given to you at the register. Please note that you must have both to get a reimbursement.

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How to Find a Family Doctor

If you enroll in the IMSS, you will be assigned to both a local clinic and a family doctor or GP (médico general). This doctor will be your first point of contact. With them you will be able to attend regular check-ups and obtain prescriptions for the medications you require. If you wish to choose a doctor, then you will have to take the private health route where you will have the freedom to decide which doctors you want and have more treatment options.
 

How to Find Specialists

If you need treatment for something more specific, only your assigned doctor can refer you to an IMSS medical specialist. As already mentioned, if you want to freely decide who will be your GP, or specialist, you will have to attend private healthcare facilities. Be aware that the IMSS does not cover eye care, dental care, elective surgeries (e.g. plastic surgeries), infertility treatments, or treatments for self-inflicted injuries.
 

How to Find a Dentist

Medical tourism in Mexico is huge, especially in dentistry. For this reason, many Mexican dentists speak English. There is a lot on offer, good and bad, so make sure you properly research and go to a licensed dentist. You can certainly find quality, highly trained dentists in Mexico. To offer you some perspective, here is a price comparison for some treatments in the US vs Mexico. Across the board, dental care is approximately 80% cheaper than in the US.
 

US**: Average Cost** Mexico**: Average Cost** Dental Crown 26,500 MXN (1,200 USD) 5,500 (250 USD) Full Dentures 12,000 MXN (5,000 USD) 15,400 MXN (700 USD) Teeth Cleaning 2,700 MXN (120 USD) 1000 MXN (45 USD)
 

Average Wait Time to See a Doctor in Mexico

Even if you are enrolled in the private system, you may have to wait a couple of days to see a GP.  To see a specialist, you may have to wait a week. However, wait times within the private system are minor in contrast to the public system.

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In the public network, to get a GP appointment you have to follow a drop-in scheduling system. People start forming a line very early in the morning to get an appointment and may be seen that same morning or get scheduled for the afternoon. The average wait time for surgical procedures is around 14 weeks. The average wait time for diagnostic procedures is around 11 weeks.

(c) https://www.internations.org/mexico-expats/guide/healthcare