Can I use my health insurance in Mexico?

health insurance in Mexico

When Googling “Can I use my health insurance in Mexico?”, you’ll find conflicting information. Some sites say yes while other sites say no. So, to answer the question “Can I use my health insurance in Mexico?” the answer is sometimes AND there are exceptions. These exceptions and more are covered in this very important article. In an interview with an Amexcare representative, they break down the misconceptions, the frustration and the real truth about foreign insurance in Mexico and why it’s so difficult to understand.

This article was updated in June of 2023.

How does health insurance in Mexico work with U.S. companies?

“Most U.S. domestic health plans provide limited coverage overseas and won’t cover prescriptions abroad,” says Margaret Wilson, M.D., chief medical officer of UnitedHealthcare Global, which is part of UnitedHealthcare, the largest health insurer in the U.S.

“Check your existing health plan. Coverage varies by health insurer and plan, so you must contact your carrier to get the details of your specific policy. In most cases, Medicare does not cover you outside the U.S., though some Medicare Advantage and Medigap plans offer worldwide emergency care.” says Cathryn Donaldson, a spokesperson for America’s Health Insurance Plans, a trade association.

Amexcare: Not surprisingly, your coverage will vary from insurance company and what type of policy you have. For example, a lot of people have Medicare. With Medicare, you are not covered in Mexico. However, you can purchase an advantage or supplement plan that will provide more coverage. A popular military insurance, Tricare, offers comprehensive coverage while VA insurance only covers VA related conditions.

Moreover, here is the ulimate challenge: if your U.S. insurance does not cover you here, you may want to get local insurance. It should be noted, if you have pre-existing conditions or are 65+ you may not qualify.

hospital recovery room overlooking a lush tropical landscape and health insurance in Mexico

How does healthcare work in Mexico?

Amexcare:  Mexico has both public and private healthcare systems. Each system has its own doctors, pharmacies, and healthcare plans. Both of these operate independent of each other. Most importantly, people are typically only allowed to use the services within their network. For example, if you are part of the public system (IMSS), you can use the private system but you will pay out of pocket. If you are part of the private sector then it’s not possible to qualify for the public sector. Thus, you are not able to use the public health system. It’s important to note that non-residents are not eligible for public health care in the IMSS system.

Notably, health care costs vary depending on several factors:

  • type of hospital
  • seriousness of the condition
  • location (big or mid-sized city, etc.)

For example:

  • In Mérida, an emergency room visit costs between $350 to $500 MXN or $15 to $25 US.
  • A general doctor consult costs approximately $500 MXN or $25 US.
  • While a specialist, think gynecologist or dermatologist, costs approximately $800 MXN or $40 US.
  • However, in other private hospitals (good ones), this amount can double or triple.

More than likely, patients have to pay for services rendered before leaving the hospital. Then, the patient is responsible for submitting the relevant paperwork and receipts for reimbursement to their insurance company. At times, an advance deposit is needed before getting treated or admitted to the hospital.

On rare occasions, some hospitals may require a Guarantee of Payment certificate from the insurance company. This serves as proof that the hospital won’t be out of pocket. With this situation, you’ll have to make advance arrangements and obtain permissions from both the hospital and the insurance company which may take time.

medical files organized alphabetically on a shelf for health insurance in Mexico

How does medical billing work in Mexico?

Amexcare:  Did you know that the only country in the world to do medical coding is the U.S.? Medical coding allows the insurance company to validate and verify what is and what is not covered under the patient’s plan.

If a visit to a clinic or hospital in Mexico is not properly coded, most U.S. insurance companies will not pay. Let me repeat, if a visit to a clinic or hospital in Mexico is not properly coded, most U.S. insurance companies will not pay.

Because hospitals in Mexico do not perform medical coding, they don’t understand how to convey this important information the patient. Proper medical coding is absolutely necessary so that the hospital can get paid.

Take this into account, most Medicare Advantage Plans will only accept claims if they are properly coded. Then, take the same example for multiple insurance companies. If a claim is not properly coded, the hospital is not paid.

Another important factor to keep in mind, some insurance companies and some hospitals do not accept claims. The patient is required to pay out of pocket and then submit the invoices for reimbursement. Therefore, because Mexico does NOT perform coding, an alternate solution must be put into place. The solution is Amexcare. Amexcare performs the medical coding and billing for many non-U.S. hospitals across various countries.

Who is Amexcare?

Amexcare:  Amexcare is an international medical coding and billing company that works with 100+ international, travel and expat insurance policies across the globe. We work for the hospitals helping with their claims to international insurance companies. Hence, the hospitals have the ability to accept patients with international insurance. This is a huge benefit to the three parties because hospitals in Mexico are NOT familiar with dealing with foreign insurance.

Notably, foreign insurance in Mexico is not as straight forward as national insurance. Therefore, Amexcare plays a valuable coordination role between the patient, the medical provider and the corresponding insurance company. This in turn results in the facilitation of all administrative and medical processes.

Amexcare Verifies Benefits

  • Verifying insurance benefits for patients
  • Collaborating with the respective medical provider or hospital
  • Coding the medical claim on behalf of the medical provider or hospital
  • Submitting the claim to the insurance company
  • Answering questions and concerns from the patient

Keep in mind – Amexcare is the BILLING company NOT the collections company. Over time, Amexcare has learned what insurance companies are reliable and not reliable. Most importantly, coverage is not the same in Mexico as in the U.S.

Sometimes the insurance only pays a portion of the claim and the patient has to pay the balance. At times, the patient may be able to make payment arrangements with the hospital.

What does Amexcare do for health insurance in Mexico?

Amexcare:  Amexcare offers complete claim management. They take care of all aspects related to foreign insurance claims on behalf of the hospital, including:

  • Compiling information and documentation related to the event, situation, issue, surgery, accident, etc.
  • Verifying policy coverage, benefits and limitations.
  • Obtaining the Guarantee of Payment or Authorization (from the hospital and/or insurance company).
  • Preparing claims according to insurance requirements.
  • Presenting claim to insurance company.
  • Following up with insurance.
  • Facilitating payment of claim from insurance companies to the hospitals.
  • Taking the role as the direct point of contact between the patient, the hospital and the insurance company.

medical insurance claim form with calculator, pen, and stethoscope

What does Amexcare not do?

Amexcare:  Amexcare is NOT responsible to pay claims or to reimburse clients. They only handle claims. Amexcare takes the role of facilitator between the insurance company and the hospital. This can be hard to understand at times. Why? People from the U.S. are used to dealing directly with the hospital for billing and insurance. Because hospitals do not perform medical coding, it is impossible to make an insurance claim. Therefore, Amexcare has an important role in ensuring verfication of benefits AND being an advocate for the patient, the hospital and the insurance company. In this way, each party receives maximum advantages with health insurance in Mexico.

How does Amexcare work in regard to health insurance in Mexico?

Amexcare:  As part of Amexcare’s foreign claim management services, we provide medical providers with essential information. In this way, they can make informed decisions about the health treatment of patients.

An example of some of the information we identify during our verification of benefits process:

  • Validity – Is the policy valid in the country where the treatment is taking place?
  • Benefits – What treatment is the patient entitled to?
  • Limitations – Limitations of the policy?
  • Deductible – What is the policy deductible? How much of this has been met?
  • Co-payment – Any co-payments required?
  • Co-insurance – What percentage of the billed amount is the patient required to pay?
  • Emergency vs Non-Emergency – Does the policy allow for elective surgeries?
  • Pharmacy Benefits – Is the patient entitled to any pharmacy benefits?
  • OOP – What is the Out of Pocket Maximum for the patient?
  • Medical history – Does the policy cover preexisting medical conditions?

It’s understandable that without a comprehensive overview of the coverage specifics, hospitals put themselves at risk of non-payment or partial payment from insurers.

Why is Amexcare extraordinarily beneficial?

Amexcare:  Amexcare provides Free Verification of Benefits (VOB). This helps individuals understand their policy coverage, benefits, limitations, conditions, deductible, co-payments, co-insurance, pre-existing conditions, out-of-pocket maximums, etc.

What we suggest is that individuals contact Amexcare directly in order to find out the specific details on whether or not their can use their health insurance in Mexico.

To verify benefits, send an email to:

1) Send a copy of your insurance card – front and back

2) AND a copy of an ID with date of birth such as a passport, driver’s license, FM2, FM3, etc.

We always recommend verifying benefits FIRST before an individual needs medical services. This way there are no surprises and the individual can make alternate healthcare arrangements if needed.

Once coverage is verified with insurance, an Amexcare representative will explain the insurance coverage and make recommendations for doctors and hospitals, if needed. Typically, the Amexcare representative shares their cell phone number to help the patient in case of emergencies.

health insurance in Mexico

Where is Amexcare located?

Amexcare:  Amexcare has two offices worldwide:

2028 E Ben White Blvd Austin. TX 78741. USA

Av. Ejercito Nacional 533, Granada, CDMX 11520. Mexico

What cities in Mexico does Amexcare cover?

Amexcare:  Amexcare works with hospitals in:

  • Aguascalientes
  • Ajijic
  • Celaya
  • Chapala
  • Culiacan
  • Ensenada
  • Guadalajara
  • Guanajuato
  • La Paz
  • Leon
  • Mazatlan
  • Mérida
  • Mexicali
  • Mexico City
  • Monterrey
  • Puebla
  • Queretaro
  • Reynosa
  • Saltillo
  • San Luis Potosi
  • San Miguel de Allende
  • Tijuana
  • Veracruz

Who does Amexcare work with for health insurance in Mexico?

Amexcare:  We work with many types of individuals, including:

  • Retirees – foreign nationals who reside permanently abroad
  • Snowbirds – foreign nationals who spend part of their time living abroad
  • Expatriates – temporary or permanent workers
  • Travelers – spending time abroad for leisure
  • National citizens who have foreign insurance policies (i.e. A Mexican national, who lives in Mexico part of their year, but possess a U.S. health insurance policy)

health insurance in Mexico

How does U.S. insurance work in Mexico?

“Check your existing health plan. Coverage varies by health insurer and plan, so you must contact your carrier to get the details of your specific policy. In most cases, Medicare does not cover you outside the U.S., though some Medicare Advantage and Medigap plans offer worldwide emergency care.” says Cathryn Donaldson, a spokesperson for America’s Health Insurance Plans, a trade association.

Amexcare:  Policies and coverage vary greatly. If your U.S. insurance does not cover you in Mexico, you may want to get local insurance. However, if you have pre-existing conditions or are 65+ you may not qualify. To answer the question is health insurance accepted in Mexico, the answer is sometimes AND there are exceptions.

Because Mexico is a huge retirement destination, there are many people on Medicare that come here. It makes sense that alot of people have Medicare. But with the regular Medicare plan, you are not covered in Mexico. With the Medicare Advantage or Supplement Plan, you are covered with some limitations. Additionally, Tricare (military insurance) covers an individual comprehensively. But VA insurance only covers VA related issues. Therefore, someone with VA insurance may want to return to the U.S. to a VA hospital.

What is a Per Diem Rate for Tricare patients?

Amexcare:  There’s one important thing I need to tell everyone about in regard to health insurance in Mexico. There are some hospitals paid by Tricare on a Per Diem Rate  when directly billed by the hospital (to Tricare). A daily rate capped for treatments, you MUST know if a hospital bills on a Per Diem Rate – VERY IMPORTANT!!!

This means, capped at a certain amount and responsible to pay the balance. Therefore, it is extremely important to know up front if the hospital you have chosen for treatment bills on this type of rate. Of course, Amexcare can tell you which hospitals bill this way. We keep the patient in mind and do not want any last minute surprises with health insurance in Mexico.

The diagnostic code can dictate the per diem rate.

Fortunately, there is a tool where you can find the Per Diem Rate here:

For North & South America, the rate for Panama is used on the Tricare Website. If there have more questions about this, an Amexcare representative will be happy to assist with health insurance in Mexico

U.S. Insurance Companies that pay, are slow to pay, or don’t pay when using health insurance in Mexico

Some insurances don’t pay or are slow to pay when their clients are in Mexico. Keep in mind, Amexcare lets you know upfront so there are no surprises. Here are some of the slow to pay or don’t pay insurance companies for review: 

  • Humana
  • Molina
  • VA – claims take too long (from 1 years to 2 years)
    NOTE: For VA – returning to the U.S. is the best option
  • Healthnet
  • Most Medicare supplement plans
  • Some Aetna Medicare plans

Great Insurance

  • Medicare Advantage plans
  • Blue Cross/Blue Shield Medicare Advantage
  • AARP Medicare Advantage
  • United Medicare Advantage

Commercial plans

  • Blue Cross/Blue Shield
  • Cigna
  • UHC

Final Thoughts on Can I use my health insurance in Mexico?

Personally, I think Mexico offers many health and health care benefits. Lower cost of living with high quality of life makes it worth it. Take into account, a vast and dynamic history, gorgeous scenery, incredible food, and warm communities. Additionally, the proximity to the U.S.  make Mexico a beloved destination for tourists and retirees. Foreigners living in Mexico can find anything they want from bustling cities to sleepy, oceanside towns.

Of course, reducing the cost of living, better medical care and insurance benefits are concerns for everyone. More often than not, individuals have a lack of understanding about their insurance policy. As you can see, Amexcare has the expertise and client care to alleviate stress and frustration for health insurance in Mexico.

Impressed with the depth and breadth of knowledge the Amexcare Representative shared, I sensed the passion for clients and the important facilitation by Amexcare. Remember, Amexcare can, “Assist you to receive medical services under your insurance plan, ensuring you receive the maximum health benefits allowed, while reducing the administrative burden of preparing and presenting insurance claims.”

What’s imperative to remember is this:
most clinics and hospitals in Mexico do not participate
in direct billing programs for international insurance.