How to find the Baja health insurance and care that’s right for you.
By Fern Corraini
Let’s face it: we’re all a little worried about getting sick these days. Most of our health concerns revolve around COVID-19, and we seem to have pushed the threat of other illnesses/accidents into the background.
Whether you’re a full-time resident or a seasonal visitor, you have probably wondered at some point: What would you do if you got sick or injured in La Paz? To help answer that question, we’ve assembled some current information that will clarify your health care options and choose a level of protection that’s right for you.
The most basic option is a quick visit to Dr. Similares, a small clinic attached to a Similares’ farmacia (pharmacy). A private consultation costs around 50 pesos ($2 or $3 US). The doctor will be a fully licensed GP, quite often just out of medical school. This is a great system if your condition is neither life threatening nor complex…such as a bladder infection, manta ray bite, strep throat, vitamin B12 injection, etc. There are several Dr. Similares located throughout La Paz. Click here for locations and business hours.
Option #2: INSABI (replacing Seguro Popular)
INSABI stands for El Instituto Nacional de Salud para el Bienestar – The National Health Institute for Wellness. Like its predecessor, Seguro Popular, INSABI is a program providing basic health care. Unlike Seguro Popular, INSABI is free. Eligibility is based on two very simple qualifiers:
- You must be a temporary or permanent resident of Mexico (not here on a tourist visa), and;
- You do not have access to any other social security programs such as IMSS (corporate health insurance for employees) or ISSSTE (health insurance for government employees).
“People will no longer need to go to a module, join and receive a policy, nor will they have to pay annual fees to be cared for in medical units as was the case previously,” reported the Ministry of Health. “The registration documents for the old system will no longer be valid.”
July, 2020 Update: Please be aware of the current situation of the INSABI program in Baja California Sur. On January 1, 2020 the federal government launched INSABI to replace Segura Popular, but it didn’t go smoothly. The rollout was confusing and problem-ridden. Thirteen Mexican states did not join the new program and kept Segura Popular. Baja California Sur agreed to join the program, and on January 31, 2020 Seguro Popular was officially dissolved, and INSABI was launched on February 1. Before the transition could be properly planned and introduced, COVID-19 arrived. It sapped resources and personnel, leaving INSABI a bit uncertain in BCS at present (July 2020). It’s predicted to stay that way for some time.
Option #3: IMSS
An employed Mexican citizen is eligible for a higher level of medical care called IMSS (pronounced “eems”), a system funded equally by the employee, the employer and the federal Mexican government. Expats are also eligible for IMSS if they meet the medical criteria and pay an annual fee. The main hospitals in La Paz for this level of care are the Hospital IMSS on Calle 5 de Febrero, and the IMSS specialist hospital on Calle Mujíca.
To apply for IMSS coverage, take your documents and photos to the IMSS intake center in the Soriana mall on Abasolo in La Paz. Required documents include:
- Passport plus 2 copies
- Residente Temporal or Residente Permanente visa, plus 2 copies
- 2 copies of your marriage license, if applicable
- 2 copies of your CURP card
- 2 copies of your most recent CFE or phone bill in your name
- 3 passport/visa photographs
- Application form disclosing any pre-existing conditions
This entire package will be reviewed, and you will be given a basic medical exam, after which you will be accepted or rejected. The entire process will take about a month.
If you are accepted by IMSS, you will have medical coverage for as long as you pay your annual fee. Once accepted, you cannot be disqualified. Obviously, you want to get this insurance while you are still healthy. However, even with all the necessary paperwork and without prior conditions, IMSS can still deny your coverage without a given reason. Pre-existing conditions that may disqualify you include cancer, diabetes, organ disease, stroke, heart attack, drug or alcohol dependency, HIV, and obesity.
The annual cost for IMSS is based on age:
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- 30-39 years 5,850 pesos
- 40-49 years 8,100 pesos
- 50-59 years 8,450 pesos
- 60-69 years 12,250 pesos
- 70-79 years 12,700 pesos
- 80+ years 12,750 pesos
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Option #4: Private Health Care
This option can be viewed as a “Pay As You Go” system. As medical costs here in Mexico are relatively inexpensive, private health care is often the route that expats take.
There are 4 private hospitals in La Paz:
Fidepaz Hospital (the Purple Hospital) https://www.hospitalfidepaz.com/en/
Medical Center (the White Hospital) http://medicalcenterlapaz.com/Secciones/inicio
Sanitorio María Luisa de la Peña (the Nuns’ Hospital) address: Lic. Manuel Torres Iglesias 515 y Ramirez
Military Hospital address: Centro Comercial ISSSTE, Forjadores and 8 de Octubre
These hospitals vary in size, services offered, languages spoken, amenities and cost. Some have their own doctors and specialists, in-house labs/x-rays/ultrasound, ambulance service, operating theaters, etc. They accept cash but also work with private insurance companies directly for payment.
Specialists such as neurologists, orthopedic doctors and cardiologists often work as in-house hospital specialists but have private practices as well.
Option #5: Private Insurance
Private medical insurance can be purchased that covers you in Mexico only or you can purchase a policy that includes international coverage. These commercial products come in all sizes and costs, with different benefits, deductibles, exclusions, conditions and qualifications. Your coverage will be determined by your age, current state of health, pre-existing conditions, health habits and your budget. It’s important that you choose a company with 24 hour customer care – in English if you require it.
There are many brokers selling Mexican health insurance, but be warned: due diligence is required as many are unlicensed and nefarious. A Mexican policy will be in Spanish, might specify exactly what doctors and hospitals you must use and may not insure you if you’re over 65 years of age. Clients must pay the bill upfront and then submit the factura to the insurance company for reimbursement.
Another main difference between Mexican and International insurance is how deductibles work. In a Mexico Only policy, deductibles are usually assessed by disease or injury, while International insurance generally has a set deductible that doesn’t change.
Be aware that many insurance companies are not accepting new clients right now due to the COVID-19 pandemic.
Here are just a few of the many companies/brokers offering private insurance:
- AXA https://axa.mx/seguro-de-gastos-medicos-mayores/inicio
- AETNA https://www.aetnainternational.com/en/individuals/mexico.html
- Cigna https://www.cignaglobal.com/
- Best Doctors https://bestdoctorsinsurance.com/
- IMG https://www.imglobal.com/international-health-insurance
- WEA Global Health Insurance https://westcoastri.com/wea-global-health-insurance/
- VUMI https://www.weexpats.com/vumi-insurance/
- Guardian Insurance MX https://guardianinsurancemx.com/mexico-medical-insurance/
What About Travel Insurance?
If you are here on a short trip only, you can purchase travel medical insurance for the length of your trip. Remember that “travel medical insurance” only covers accidents and emergencies. It is intended to be used for the short term, and does not cover other health issues nor is it renewable.
Have Questions?
For more information about health care options in La Paz, visit any of the links in this article. Or, contact us at info@bajaliferealty.com and we’ll be happy to connect you with the right sources.
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