How does the state health insurance system work?

In addition to the Seguro Popular, the government’s health initiative, the Institute of Social Security also runs a health insurance policy for employees. This is known as the Instituto Mexicano del Seguro Social (IMSS), and both employees and employers pay monthly contributions into the system.

The third part of IMSS funding comes from the federal government and it also runs its own network of primary care providers and hospitals. As an employed expat, you are likely to fall under this kind of coverage. If you are not employed, you may still be able to register with the scheme by making a voluntary monthly contribution. It is not a legal requirement to have insurance, but it is advisable.

Government employees (around 9 million people) are covered by the Institute for Social Security and Services for State Workers (Instituto de Seguridad y Servicios de los Trabajadores del Estado, or ISSSTE).

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Who is eligible for state healthcare?

As above, if you are employed, you will be eligible for the IMSS. However, you will need to have residency status: you will need to apply for this if you are planning to be resident in Mexico for more than 180 days.

If you will be living in the country for less than 180 days and will not be generating income, you will not be eligible for either form of national coverage. In that case, you will need to take out private health insurance.

Note that some hospitals will not accept private international cover: check with the hospital and your provider before you are admitted, if possible. Hospitals will require payment at the time of treatment.


How do you apply to join the state health insurance system?

Your employer should register you with the IMSS. Some expats and retirees choose voluntary registration with the IMSS, which you can do at your local office. You will need:

  • passport
  • FM3 or FM2 visa
  • birth certificate (translated into Spanish by a certified translator)
  • your CURP (Unique Population Registration Number)
  • proof of your legal address
  • marriage certificate (if applicable)
  • 4 (2.5x3 cm) black and white photos
  • Check that the local office is English-speaking. You can pay the registration fee by bank transfer; check, too, that your bank is a participant in the scheme and has the relevant account details. You will then receive a carnet and an appointment with your local GP within the next month. You will need to take your documentation to your first appointment at your GP’s surgery, and you will then be issued with an ADIMSS card.

    If you are registered with the Seguro Popular you will be issued with a family healthcard, which you must take with you to all appointments.


What is covered by the state health insurance system?

If you are registered with the IMSS, your first year of coverage will only cover basic medical treatment. You will not be covered for pre-existing conditions. In the second year of coverage, you will also be entitled to:

  • surgical treatment
  • medical supplies
  • prescription drugs
  • hospital visits

You will need to obtain a factura, or receipt, after accessing any treatment and you will then need to return this to your insurance company in order to be reimbursed.

You will be emailed a factura for prescription medication and will also be given one at your doctor’s surgery: you must return both copies to your insurance provider in order to be reimbursed.

To be covered for maternity care, you will need to have taken out coverage at least 10 months before your baby is due to be born. You will not be able to sign up once you are pregnant, so if there is any chance that you might get pregnant, you will need to make sure you have coverage well in advance.

You will be asked to make an upfront payment for primary care; for example, 350-500 pesos (US$18 -25) for a GP visit. It is approximately the same for a visit to the emergency room. Inpatient services are around $100 per night.


Are retirees covered by state medical insurance?

If you are planning to retire to Mexico, you can either take out comprehensive private cover or top up cover, but you should also be eligible to register with the Seguro Popular. Your home country’s insurance coverage may cover you for living in Mexico, but check with your provider that this is the case.


Are students covered by state medical insurance?

You will only be covered by the IMSS if you are working, otherwise you will need to take out private cover. There are many private policies which are specifically designed for international students. Consult with your educational provider to see if they recommend any specific private cover.


Will your family be covered by your insurance?

Your family will be covered by your insurance if you are registered with the Seguro Popular and have a family health card, and they will also be covered under the IMSS scheme.


Is dental treatment covered by state health insurance?

You are likely to have to pay out of pocket for dental care, but it is relatively inexpensive, particularly when compared to the United States: around US$28 to have your teeth cleaned, $25-50 for a check up and $40-50 for a filling. Crowns will cost around $400 – 500.


What are the contribution rates for state health insurance?

The Seguro Popular is free for the 20% of the population who are on very low incomes. Otherwise, your contributions will be calculated according to your income, and will depend on the kind of insurance for which you are registered. For the IMSS, your premium will be in the region of US$400 – 500 per year (around $400 per month). Your employer will also have to make contributions into the scheme on your behalf.

If you are covered under the Seguro Popular, your premiums are calculated according to a sliding scale and are dependent on your income, and also on factors such as property ownership and whether you have children. You are likely to have to pay around $500 per annum per household.


Why buy private health insurance?

Public healthcare in Mexico is overstretched and underfunded, with long waiting times, so for additional peace of mind you may opt for private health insurance. You may also do so if for any reason you are not covered by the public sector or want access to more sophisticated facilities.

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What is covered by private health insurance?

Private insurance will cover a full range of both primary and secondary care, along with any elective treatments such as cosmetic surgery.


How much does private health insurance cost?

This will depend on factors such as your age and any pre-existing conditions, and the kind of package you opt for: a more expensive insurance package will give you access to a more extensive range of treatment and facilities.

Since so many variables have an effect on the cost of international private medical insurance in Mexico, it is very difficult to give accurate estimates without knowing the full details of the coverage required.

However, as a very rough guide, using a standard profile of a 40-year-old British male with no deductibles, no co-insurance, a middle tier plan, all modules included and worldwide coverage excluding the US, a ballpark price of around £4,000/$5,000 might be expected. Were coverage to be expanded to include the US, then the premium could increase to almost double that amount. However, some expats have quoted a lower average cost for Mexico, approximately US$1,700 per year, with a deductible of US$5,000, depending on the provider.


Which companies offer private health insurance?

Many of the large international health providers cover Mexico, including:

  • Cigna Global
  • GNP Seguros
  • Pacific Prime
  • Royal and Sun Alliance
  • MetLife


Glossary of health insurance terms

 (IMSS) – employees’ health insurance scheme

Seguro Popular - Popular Health Insurance scheme