International Annual Private Health Insurance vs. Mexican Annual Private Health Insurance: Which One is Right for You?
by Michael Keller, M&M Insurance MX
This article was provided by Michael Keller of M&M Insurance MX. If you have questions about any of the information in the article, or would like a customized insurance quote, please contact him directly. Contact info is provided at the end of this article.
Thinking about purchasing private health insurance to cover you while you are in Mexico? If you have a home in La Paz and, like many expats, spend several months a year here, or you have taken the leap to live here full time as a temporary or permanent resident, chances are you have questions about how to obtain health insurance. Even if you are in good health, accidents happen, and it’s good to know what your options are before you need to visit a local hospital or see a doctor. Of course, you do not have to purchase private health insurance to obtain health care in La Paz. Mexico does offer options to those with resident status for public health insurance, while many visitors opt to simply pay cash for minor visits, and purchase travel insurance to cover catastrophic care. To review your options, see our article on Health Care Options in La Paz here.
Private Health Insurance Options
Annual private health insurance policies from Mexican providers are constructed very differently than policies from international providers. It is very important to understand the significant differences in the way these plans work, before deciding on an option.
Many people think that Mexican policies, like the ones offered through AXA, GNP, Seguros Monterey, Mapfre, Plan Seguro, etc., are going to be less expensive because they are offered by Mexican providers, and because many have the option to have coverage only in Mexico, versus internationally. However, that is usually not the case, and Mexican policies have a very similar premium compared to the international policies. The Mexican policies usually can be modified more in terms of coverage, so there are ways to get a low premium, but it is typically by sacrificing coverage or putting the burden more on you if you need to use your policy.
With Mexican plans, the deductibles are applied to lifetime per accident/illness, not per year. This means if you have multiple unrelated medical incidents within a policy year, you would have to meet the full deductible each time, regardless of whether they occur in the same year. But for long-term chronic illnesses, you just meet the deductible one time for that illness, for the life of the policy.
With the international providers, the deductibles are applied per year. All expenses for any accidents/illnesses are applied towards that one deductible, and once you reach that, anything else is covered that year. The deductible then resets to the full amount at the renewal.
Almost all Mexican policies also have a coinsurance: an additional amount you need to pay on top of the deductible. What the coinsurance is applied to can vary by company. It can be applied to all medical expenses, only hospitalization expenses, only out-of-network expenses, etc. It will almost always work as a percentage, and many companies will also have a “coinsurance max” as well.
With the international policies, there is rarely any type of coinsurance, and if there is, it is for minor coverages, and specified directly on the benefits chart. Some international policies will have a small coinsurance for ICU treatment as well.
All policies, whether Mexican or international, are going to have a specified medical network that you need to be treated within in order to be covered in full. The Mexican providers are more strict with their medical networks, and do have specific hospitals/clinics/labs where you need to go to be treated. With the international providers, in general, their networks are pretty open, and they will not restrict or reduce coverage for going “out-of-network”.
On the other hand, because Mexican providers have operations in Mexico, they usually have better relationships with hospitals, are more widely accepted by major hospitals, and have more direct payment agreements with hospitals. The international providers are not based in Mexico, so although they do have a lot of direct payment agreements in place as well, they are not as widely accepted and can sometimes be price-gouged by the hospital.
The Mexican policies also normally have tiered medical networks, meaning you can pay for a higher medical network level to get a better selection of hospitals. With the international providers, it is more of an open nationwide network.
All policies, whether Mexican or international, all require some waiting period before the policy goes into effect. If you contract one of the stated illnesses/diseases within the waiting period, it is seen as a preexisting condition and not covered by the policy. Almost all Mexican and international policies will cover accidents from day one.
With the international providers, usually “all illnesses/diseases” are grouped into one waiting period. That can be as short as 30 days or up to 180 days, depending on the provider. With Mexican providers the waiting period is tiered, and it varies by provider. It could be, for example, 6 months for knee, spine, eye and feet issues, and kidney stones; one year for prostate, gynecological, hernias, joints, etc.; two years for cancer, mammary tumors, organ transplants, nose and sinus issues; etc.
The biggest difference here is that Mexican policies will always require a factura (official invoice) for any and all claims expenses, no matter how big or small the claim amount. And making sure you get a factura for every expense can be tedious. The international providers do not require facturas for claims expenses.
For direct payments, it can vary by company, whether Mexican or international. A reputable Mexican provider will usually have an easier time making a direct payment, including for emergency expenses, than an international plan will, because they are based in Mexico. But there are international plans that send guarantee of payment letters to hospitals within 24 hours of being notified, which is very fast.
For reimbursements, with the international providers, depending on the company, it can take one to four months. With the Mexican providers it is usually more like 4+ minimum. And their claims processes are MUCH more strict, where everything needs to be submitted exactly as asked, or it will not proceed.
Also keep in mind that, with the Mexican providers, all legal documents are in Spanish. We do provide courtesy translations of a lot of documents, but not all documents, including general terms and conditions, which are usually over 100 pages.
What Will My Insurance Cost?
With standard international providers, such as VUMI, premiums for individuals age 30-64 range from a very reasonable $800 USD to $3,000 USD per person per year depending on age and deductible. At age 65+, premiums basically double, ranging from $7,000 to $9,000+ USD per year in premium per person, starting at age 65 and then increasing from there. Other providers in this category come and go, such as Redbridge, Morgan White, BMI, etc., so choose carefully. There are a few international catastrophic coverage policies out there for people age 65+ that do not provide as much coverage, that are also available ranging from $1,700-$3,000 USD per year in premium per person, depending on the deductible.
Mexican policies range from high end providers such as GNP, AXA, Atlas, Bupa, etc., to lower cost providers such as Plan Seguro, Mapfre, HDI, etc. Almost all Mexican providers have an age limit of 65 (aside from Plan Seguro, which has no age limit). That means if you do not apply before turning 65, you are no longer eligible. The higher-end policies for individuals age 30-64 range from $25,000 MXN to $60,000 MXN per person per year. The lower-cost policies range from $15,000 MXN to $40,000 MXN per person per year. And the Mexican plans have a lot more ways to modify the coverage, including the deductible, the sum insured, the coinsurance, hospital level, etc. That means your premium can fluctuate a lot depending on those choices.
With Plan Seguro, for individuals age 65+, depending on a variety of factors, costs can be anywhere from $50,000 MXN to $100,000 MXN per year per person. But I have even quoted and covered some people 75+, and was able to get their premiums down in the $50,000-$80,000 MXN range.
The elite, international, best policies on the market (GeoBlue, Cigna, Bupa, Best Doctors, Aetna, etc.) for people age 30-65, with a deductible of $2,000 USD-$10,000 USD, the premium per person could be anywhere from $6,000 USD per year to $15,000 USD per year. These are the top tier plans, which include full US coverage. However, these are also the companies that are the most flexible about providing coverage for major medical conditions. So depending on your health situation and age, individuals, if they can afford it, have to get one of these plans to cover their preexisting conditions. For people age 65+, the costs of these plans can climb dramatically. Expect to pay $10,000 USD premium minimum, per person, with a $5,000-$10,000 USD annual deductible.
If you have questions, or would like a personalized quote for private health insurance options, please contact:
US: 708 966 7095
MX: 322 331 0595