Hello! We are Cross Border Wealth Advisors and are determined to help people simplify their financial lives when retiring abroad by offering financial solutions for wealth and portfolio management and tax preparation. I’m Victor Gersten, and I’m an expat myself. I’m a Certified Financial Planner and an Enrolled Agent with 14 years of experience in the financial services industry in San Diego, Ca. Furthermore, as an expat living in Spain, I have helped many expats to retire financially by sorting out the complicated legal, tax or investment questions that most expats have.
One of the things that expats have been asking me the most when they are planning on moving to Mexico is how Medicare works. This post will cover certain things you need to know about Medicare in Mexico, how it works, what it covers, and who qualifies for it cause our purpose is for you to be as informed as possible before deciding to retire abroad.
Mexico is a hit among tourists and expats, perhaps because of its laid-back culture and relaxed atmosphere, especially from a healthcare perspective. Many expats talk about going to the doctor for only USD 40 without insurance or getting surgery for only a few hundred dollars. But that doesn’t mean a serious emergency in Mexico can’t cost you thousands of dollars.
As a U.S. citizen or resident, you can apply for Medicare if you are 65 or older. Whether you have pre-existing conditions or not is irrelevant. Some other people may qualify for Medicare coverage because of specific medical conditions. In the event you didn’t apply and didn’t get coverage, there is a late enrollment fee you’ll have to pay later. Your penalty fee depends on how long you went without coverage after 65 and which plan you chose. It’s also important to remember that if you plan to live in Mexico, you will be covered by a Medicare Advantage plan worldwide.
There are public health insurance programs in Mexico, such as the INSABI or IMSS, but you may not want to go to one of these hospitals in an emergency. The wait times can be quite long since it’s a public hospital. You’ll probably want to see a specialist immediately in an emergency regarding your health. Therefore, you should consider enrolling in a Medicare Advantage plan that covers you in Mexico.
Medicare Advantage, also known as plan C, is a supplemental plan to Medicare parts A and B that covers you in case of emergencies anywhere in the world. Medicare Advantage plans are run through private health insurance companies and are private health insurance plans accepted by Medicare.
It’s important to note that not all Medicare Advantage plans are the same. If you live full-time in Mexico, some insurance plans won’t cover you, and some won’t cover certain “emergencies.”
How To Make a Claim Using Medicare?
In most cases, you’ll need to pay the Mexican hospital out of pocket and then file a Medicare Advantage claim afterward. When you’re dealing with a serious emergency, knowing how to navigate this process can be the last thing on your mind. It can save you frustration and confusion at a Mexican hospital if you know what to expect in advance.
Why Hire a Medicare Advantage Broker?
It is important to find a Medicare broker who deeply understands what Medicare Advantage policies cover while abroad. Most people aren’t aware that Medicare Advantage policies do not cover you in Mexico if you have been away from the U.S. for more than 60 days.
But you must note Medicare Advantage will only cover emergencies in Mexico. Cancer and other chronic diseases that are not considered emergencies of life or death, for example, are not covered. That is why many people enroll in Medicare Advantage when they move to Mexico. They can see a doctor in Mexico for under $50 without insurance for small things like a stomach bug or a common cold. But when it comes to a serious issue where surgery may be needed, such as a broken leg, the right Medicare Advantage policy will cover those costs.
However, having the right person help you choose a policy will help you not only ensure you get the coverage you need but will also avoid confusion when it comes actually to using your Medicare Advantage policy in Mexico.
Does Mexico Have Universal Healthcare?
Yes, since the introduction of the INSABI scheme in January 2020, Mexico has had universal healthcare for all its citizens and expats.
Who Exactly Needs Expat Health Insurance in Mexico?
Everyone who lives in Mexico as a legal long-term resident, either working, accompanying a family member, or retired, will have to enroll in a health insurance scheme.
On the other hand, you can simply use your international travel insurance if you are in Mexico under one of the following scenarios:
- You are in Mexico under a visitor’s permit (FMM)
- You will stay in the country for less than 180 days during which time you will not work.
Mexico Health Insurance Options for Expats
Expats in Mexico have the following health insurance options:
- Public health insurance (IMSS). All employed expats are enrolled under the IMSS scheme. Additional private health insurance is optional.
- Private health insurance:
- Local: You buy private health insurance for a local company in Mexico, but you will not be covered if you decide to go back to the US for a visit or if you travel abroad.
- International: You can compare and purchase Mexico health insurance online from Insubuy or International Citizens Insurance. Depending on the policy, you are covered in Mexico, the US, and worldwide.
Private Health Insurance for Expats in Mexico
You can buy private health insurance through international health insurance companies or insurance brokers such as Insubuy or International Citizens Insurance which allow you to compare plans from different companies online to choose what best suits your needs.
Many US expats in Mexico combine public and private health insurance because private insurance gives you coverage in private clinics and hospitals, as well as the opportunity to choose your healthcare provider.
Private hospitals in Mexico have shorter waiting times, better infrastructure, better care, and usually more English-speaking doctors, which are helpful for expats.
Although healthcare in Mexican private hospitals is only about half as expensive as it is in the United States, it can still be too much to pay out-of-pocket, so a good private health insurance policy is a must.
What Does Expat Health Insurance in Mexico Cover?
Public health insurance in Mexico covers:
- Accidents and emergencies in the first year of coverage.
- Surgeries and other health conditions, starting from the second year.
- Medication (only when prescribed by your doctor).
- Part of your salary if you cannot work due to an illness or accident for up to 52 weeks.
Private health insurance for expats offers coverage for the following:
- In-patient and out-patient medical treatment.
- Dental and vision treatment.
- Mental health care.
- Pre-existing health conditions.
- Evacuation or repatriation.
- Travel health insurance.
- Coverage in private hospitals, which have a higher quality of care and where the doctors are more likely to speak English, makes for easier communication.
Remember: If you are enrolled only in the public health insurance scheme, there are specific doctors and clinics which you can visit, depending on the locale. This means you cannot choose your doctor, and you cannot be treated in private clinics or hospitals. Otherwise, you pay from your pocket.
Can I Use My US Health Insurance in Mexico?
No, in most cases, you will not be able to use the health insurance you have in the US for treatment in Mexico. Your American health insurance policy, such as Medicare, will not extend outside the borders.
Even if you have an insurance policy with international coverage, you still have to pay out-of-pocket initially, before being reimbursed back in the US. Or, if you have expat health insurance in Mexico but have continued your insurance policy in the US as well, you may use the latter for evacuation to the States for treatment. Still, there is usually a time cap on this.
How Much Does Health Insurance for Expats in Mexico Cost?
If you subscribe to the IMSS health insurance scheme, the cost of Mexican health insurance ranges from MXN 4,650 (appx. USD 218) per year to MXN 12,750 (appx. USD 590) per year.
Cost of private health insurance in Mexico
When it comes to private health insurance for Mexico expats, the cost will depend on the specific company you purchase from, your age, medical history, the amount of coverage you choose, and the policy you subscribe to.
If you regularly travel to the US, you should choose a policy with worldwide coverage, including the USA. However, this will raise the price of your premium, considering the high cost of healthcare, but it is better than facing those prices without health insurance.
If you do not intend to go back to the USA, then you can choose a policy that does not include the US, thus paying lower monthly/annual premiums.
These are some of the many aspects that we consider when creating a financial plan. When working with CBWA, we ensure that we analyze your situation completely to find all the financial gaps and opportunities that will help you live a happy and healthy life in Mexico.