HEALTH INSURANCE IN MEXICO – THINGS TO CONSIDER
Health insurance plans are available in Mexico City, Puerto Vallarta, Los Cabos, Playa del Carmen, San Miguel de Allende, and throughout Mexico. This article highlights important components of health insurance plans in Mexico and how to approach purchasing a health insurance.
How do I know which health plan in Mexico is right for me?
1. Coverage Area
Health plans will all offer a specific coverage area. Mexican plans may cover Mexico-only with limited coverage for travel-related medical emergencies outside of Mexico. International plans offer worldwide coverage. Expat plans may offer a choice of worldwide or worldwide excluding US 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 full coverage while traveling and continuity of care when you return to Mexico.
Most plans offer defined coverage areas. For instance, if the plan offers worldwide excluding US coverage, you won´t be able to request Mexico-only coverage.
Finally, health plans are priced based on multiple factors of which coverage area is only one. A reduced coverage area doesn´t necessarily translate into a big difference in price.
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.
Like with health plan coverage areas, benefits cannot be added or removed. For example, if the plan includes maternity coverage, you won´t be able to request a plan without it.
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, because once you choose a high deductible, you are stuck. Health insurance companies don´t allow members to lower their deductible in subsequent years.
4. Co-Insurance
Some 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 covered costs of medical care over the lifetime of your membership in the plan will be deducted from the lifetime sum.
6. $0 Deductible Benefits
Some health plans offer customers free health benefits with $0 deductible. Benefits are offered either as a result of a trigger event or after a specific waiting period (10 months, 12 months, 24 moths, or 36 months). Benefit amounts (what the company pays) for $0 deductible offerings vary by plan.
Some examples of $0 deductible benefits include:
Air Ambulance -Emergency transportation via air ambulance to the nearest medical facility when adequate medical treatment is unavailable locally, and the attending physician certifies that the transfer by any other means could result in loss of life, or limb.
Annual Check Ups - Preventative health check ups for primary insured, spouse, and dependent children.
Telemedicine - Access to a medical consultation via phone or video with a general medicine practitioner.
Accident Waiver - $0 deductible for serious accidents which result in a hospitalization event.
Deductible Elimination - $0 deductible for members who have had no medical or accident claims in 3 years.
Maternity - Deductible elimination for maternity costs.
Be sure to ask what $0 deductible benefits each plan may offer.
7. In-Network and Out-of-Network providers - In Mexico, doctors and clinics are not part of any established networks. In-network refers to hospitals for which no out-of-network charges apply. Out-of-network means that co-insurance or additional co-insurance applies at hospitals not on the in-network list.
Going to an out-of-network hospital in Mexico does not necessarily mean that there will be no coverage.
Mexican health plans are structured around specific in-network hospitals. Lower premium plans offer less and lower level hospital choices. Higher premium plans offer access to top Mexican hospitals. Most international and expat health plans, on the other hand, offer FREE CHOICE of hospitals.
With free choice, you can go to the hospital of your choice for your diagnosis or surgery needs.
Health insurance in Mexico has a number of moving parts and considerations. Knowing the above terms and each plan´s particular conditions, will enable you to make an informed purchase decision.
