How does the healthcare system work in Mexico, and what travel insurance, health insurance or expat insurance do you need?

How does the healthcare system work in Mexico?

What is the quality of healthcare in Mexico?

• The Mexican government has one of the lowest per capita health care expenditures of all countries affiliated with the OECD (Organization for Economic Cooperation and Development).
• Health care in Mexico is often relatively (much) cheaper than what we are used to in Europe or the United States.
• Emergency care, on the other hand, can sometimes be surprisingly expensive, especially for expats without local or international health insurance.
• A large proportion of Mexican doctors and specialists receive their training in the United States or Europe, an additional advantage is that they naturally speak reasonable to good English.
• If you are looking for English-speaking medical staff, you will find them -of course- in the larger cities and in regions where many expats traditionally reside; think of Lake Chapala, Puerto Vallarta, San Miguel de Allende and Mérida. The hospitals and clinics with the best reputation can be found in Mexico's largest cities. In addition to Mexico City, you can think of Ecatepec, Monterrey and Guadalajara. In a number of popular tourist regions of Mexico (such as Yucatan, Acapulco, Cabo San Lucas, Baja California and of course all larger Mexican cities) the costs of healthcare for foreigners are considerably higher than in the less visited regions.
• Please note that you pay in advance for a lot of healthcare in Mexico.
• Many hospitals and clinics in Mexico do not invoice their care directly to (international) insurers.
• So you often pay in advance, in 'cash' (/pin/credit card), and then declare it yourself. Preferably check with your international insurer in advance how invoices should be drawn up and whether other conditions apply, so that you can be sure that the Mexican invoice you submit will also be accepted.
• 'Pay in advance' here means in any case 'before you leave the hospital'. But sometimes you even have to make a 'deposit', before any care is provided at all.
• In some cases, a 'document with payment guarantee' from your international insurer is also accepted. Please note that this can mean a lot of paperwork at a time when you are not feeling 'at your best'.

How does the public healthcare system work in Mexico?

• The public health care system is called IMSS, Instituto Mexicano del Seguro Social, which stands for 'Mexican Social Security Institute'.
• As an expat, you may be eligible for IMSS if you live there and (officially) work there. The employee contribution, which is directly deducted from your salary by your employer, is around US$500 per year (as an indication; the amount is of course subject to fluctuations).
• You must have contributed (financially) to IMSS for at least 4 weeks before you can use it. After these first 4 weeks, you are covered for hospital costs, first aid, operations and medication. If you become so ill that you can no longer work, IMSS will pay healthcare costs in proportion to a percentage of your salary, up to a maximum of 52 weeks.
• Many expats with a temporary or permanent residence visa use IMSS. Non-residents, retired expats, freelancers or long-term travelers are generally not eligible. Please note that under IMSS, some patients will be given higher priority than you as an expat. This depends very much on the package you have taken out.
• It is common for certain existing medical conditions to be excluded from coverage under IMSS.
• The application process for IMSS can be challenging. There are regional or local IMSS offices in many regions, where you can submit forms (in Spanish) and formal documents. Bring an interpreter/translator if you do not speak Spanish well to very well.
• The IMSS coverage is quite basic; it is definitely advisable to insure yourself as an expat (plus any partner and children) with an international health insurance. If you live in Mexico outside of the large or medium-sized cities, keep in mind that the care and facilities offered in public hospitals are really at 'basic level'. Always check the latest status, but IMSS generally does not cover eye care, dental care, voluntary care (such as plastic surgery), fertility treatments or care for damage you have caused yourself.
• If you are not eligible for IMSS, due to lack of financial resources or because of existing conditions (such as cancer, diabetes, cardiovascular disease or addictions), there is the Seguro Popular program. In Mexico, this includes all unemployed and homeless people. You will also come across the terms IMSS-Opportunidades and/or Instituto de Salud para el Bienestar, INSABI.
• For foreigners who live and work in Mexico for a longer period of time, public health care is therefore not always accessible. Keep in mind that Mexico's public hospitals can be very busy. In many places, there is no English-speaking doctor or nurse available. And the waiting times for non-urgent matters can sometimes be very long.

How does the private healthcare system work in Mexico?

• The vast majority of Mexicans use one of the public healthcare programs. Only about 5-10% of Mexicans choose private healthcare; "lack of financial resources" is the main reason for this.
• Many expats in Mexico do choose private healthcare. Facilities in private hospitals and clinics are generally better and the chance that you will encounter an English-speaking employee is much greater.
• In Mexico you will find better conditions in private clinics in larger cities such as Mexico City, Iztapalapa, Guadalajara and in various medium-sized cities spread across the country.
• The quality of the care provided, especially in private clinics, is, in general, good to very good (of course there are regional differences). Many expats report back that they are 'satisfied' with the care provided.
• The costs of private healthcare in Mexico are lower than costs in the USA, for example, but of course considerably higher than the costs of comparable interventions under public healthcare. It is known that some Mexicans living/staying in the USA prefer to travel back to Mexico for certain treatments to use private healthcare there. Convenience, affordability and efficiency are the main reasons for these 'medical returns'.

How is the general practitioner arranged in Mexico?

• If you participate in the IMSS system, you will be linked to a local clinic and a general practitioner, the so-called GP/médico general.
• This GP is your first point of contact, performs regular check-ups (if you request them) and writes prescriptions.
• Please note that, depending on how busy it is, it can sometimes take one to several days before you can see your GP. At some GPs, the appointment system works according to the "first come, first served" principle. That is why you often see a queue forming very early in the morning at the Mexican GP to schedule an appointment, which then actually takes place either the same day or in the days after.
• If you are insured through the private healthcare system, or through an international health insurance, you often have more freedom of choice in terms of doctor or practitioner.
• Always check in advance with your expat insurance (except for emergency aid) with which private hospitals agreements have been made, so that you can be sure that the care provided by a specialist/hospital will also be reimbursed.

How is the dentist arranged in Mexico?

• In general, there are good dentists ('dentistas') in the larger and medium-sized cities in Mexico, who follow international standards, and for a very reasonable price.
• In consultation with your international dental insurance, do your research on which practice you choose: some dentists are more specialized in orthodontic or preventive care for children and adults, while others focus on special dental care for older patients. If you are unsure about a particular procedure, ask for a second opinion or a price indication from another provider.
• Because Mexico has a lot of "medical tourism", especially around dental care, you will find dentists who speak good English in many places.
• Compared to the USA, treatments with a dentist in Mexico are up to 80% cheaper. The quality does vary greatly, so try to do your research beforehand.

How is pregnancy care arranged in Mexico?

• Children are generally very welcome in Mexico; pregnancy is 'a celebration'.
• According to tradition, care for pregnancy was often only sought after the first trimester; you still encounter this in Mexico.
• In any case, cultural traditions play a major role during the period of pregnancy; including 'keeping the body temperature in balance' (so avoiding both cold and heat) and stopping work early. A pregnant woman is encouraged to exercise a lot and it is normal for the entire family to be involved with the pregnant woman for comfort, tips and practical advice.
• Hospitals/clinics specifically focused on pregnancy, both under public and private care, can be found in the larger Mexican cities. In non-urban areas, this care is provided in a general hospital.
• If you give birth to your child in the hospital, the number of days you stay in the hospital after the birth varies greatly; partly depending on the medical circumstances. Traditional midwives use a number of techniques around childbirth:
• hydrotherapy: Temazcal (sauna) or Vapor (steam bath) with specific herbs,
• medicinal plants, by eating them, or via massage or herbal bath,
• sobada: a therapeutic massage, for example to influence the position of the baby in the womb,
• summoning protective spirits, intended to deal with worries during pregnancy or to summon strength around childbirth,
• injecting or administering fluids, for example via a needle or IV, to induce labor,
• wearing red clothing, to ward off the 'evil eye' around childbirth.
• In Mexico, the family is very present around pregnancy, birth and the first baby period. Strangely enough, there are few festivities after the birth - outside the immediate family. The more a newborn is 'admired' by strange eyes, the greater the chance of illness, so the superstition goes.
• If you expect to give birth in Mexico, make sure you have good obstetrics coverage in your international health insurance policy. In Mexico (and Guatemala) the rebozo is very well known; an elongated wrap made of woven cotton that you can use as a belly band or baby carrier. The massage techniques with the rebozo can help with pelvic complaints, back pain and hard bellies. The muscles are gently loosened by shaking and rocking with the cloth.

How are pharmacies in Mexico? 

• If you want to replenish your travel pharmacy while on the road, many types of medicines are available at pharmacies (farmacias) in Mexico.
• Mexico has a (worldwide quite unique) system of Segunda Clase and Primera Clase pharmacies.
• Segunda clase pharmacies can be found really everywhere; certainly in the larger cities but also far beyond. It is important to know that these pharmacies are not allowed to sell registered medicines. For example, you can find antibiotics, cholesterol medication and allergy medicines there, but no medicines that have a higher risk of abuse.
• The Primera Clase pharmacies, which are less well spread throughout the country, do not have these restrictions. Here you will find everything for which you get a prescription from your doctor, including pain medication and other medicines that can lead to addiction.

How safe or unsafe is a trip or stay in Mexico?

What should you pay attention to in terms of safety in Mexico?

• Crime levels in Mexico are high. Crime in Mexico ranges from relatively harmless (such as pickpockets) to violent robberies and sometimes even rape and murder.
• It is not wise to go to busy tourist places, with large amounts of money or adorned with jewelry. Pickpockets are active in busy places.
• The border area between Mexico and the United States is notorious. So are multiple border cities crime is high due to rival drug gangs among themselves and between drug gangs and the government. They usually do not target foreigners, but you run a great risk of ending up in the wrong place at the wrong time.
• There are multiple states in Mexico which are notorious for mutual violence between criminal (drug) gangs. In these states you sometimes find tourist hotspots; make sure you are aware of the latest situation.
• In various cities in Mexico you can end up in political demonstrations, fights or violence by drug gangs. Check the updated safety instructions. As long as you stay in the tourist areas, there is usually not much going on.
• Robberies sometimes also take place on buses to popular tourist destinations.
• In the urban areas of Mexico (including the capital Mexico City) kidnappings occur - often short ones. The victim is then forced to withdraw money from an ATM. A kidnapping usually lasts about 24 hours: the kidnapper can then withdraw money several times.
• If you are staying in Mexico for a longer period of time, there is a chance that you will encounter earthquakes or tropical storms. For the former, you can follow the sources 'Servicio Sismológico Nacional' (information in Spanish) and 'USGS Earthquake Hazards Program' (information in English). For storms and hurricanes, 'National Hurricane Center' (information in English) and 'Tropical Storm Risk' are good starting sources.

What should you look out for in terms of diseases in Mexico?

• Expats generally experience Mexico as a country with a high quality of life: climate, beaches, nature, delicious and varied food, friendly people, low cost of living.
• Tropical diseases are indeed present in parts of the country. Checking vaccinations before you leave is highly recommended. Also consider hepatitis B and rabies for a longer stay.
• Always drink bottled water in Mexico, which is cheap and available everywhere.
• Keep in mind that it often takes longer in Mexico before 'something is arranged'. Prepare yourself for that and start on time; that will save a lot of stress.
• Mexico is also a fairly 'loud' and 'noisy' country. Especially in the big cities and busy tourist places there is always noise. If you are staying in Mexico for a longer period of time, seek out the peace and quiet of nature or the Mexican countryside in good time.
• Check well before departure for which medicines you need a declaration to be allowed to take a first dose to Mexico. Always take the original packaging with you and think about arranging a medication declaration in good time. For each medicine you use, write down the international name of the active substance and try to find out before you leave whether your medicine is also available in Mexico, where and how.

What should you pay attention to when it comes to traffic in Mexico?

• Do not travel by road after sunset, especially not in remote areas.
• Also be on your guard during the day: that is when robberies occur.
• Stay on the main roads as much as possible.
• In Mexico, you will encounter checkpoints on some main roads. The army, the migration service or the police can thoroughly search your car at these locations. Cooperate.
• If you are traveling by car, be extra alert at intersections. Stationary traffic can be a target for armed robbers.

What work and travel insurance policies are suitable for short and long stays in Mexico?

• Is the trip to Mexico and your return sufficiently covered? Are you sufficiently covered before, during and after your activities? Which insurance best suits your trip and your activity? Read more about insurances for abroad on JoHoinsurances.org.

What emigration and expat insurance can you take out for Mexico if you are going to live there for a while?

• It is not a legal requirement for expats to have health insurance, but it is highly recommended. In some circumstances, you may qualify for the local IMSS health system, but it is still advisable to insure yourself with an international health insurance.
• Some areas in Mexico are considered dangerous. Depending on current events, these areas may be outside the coverage area of ​​your insurance company. Make sure you are up to date with information regarding the coverage areas of your specific health insurance.
• Make sure your insurance covers medical evacuation as well as coverage in neighboring countries. Read more about insurances for abroad on Expatinsurances.org.