Medical Coverage

Medical coverage available in Chapala, Ajijic and nearby Guadalajara

There are many different options for covering medical expenses here in Mexico.  Anytime you start talking about coverage for medical expenses, there are always qualifiers.

IMSS the Mexican Medicare

Many people have heard about IMSS, which is often likened to “Mexican Medicare”. IMSS offers a very inexpensive annual medical coverage that is similar to HMOs in the United States. Applicants must take a physical and complete extensive health questionnaires. Acceptance is NOT assured. If an applicant is accepted, the premium varies depending on age as does the annual premium. Essentially, there is before and after age 65.

The first year on IMSS only a minimum of basic services are covered. Anything needed beyond these basic services must be paid out-of-pocket.  Enrollees are assigned to a clinic where they receive their medical care. Most of these are staffed by doctors, nurses and technicians who do not speak English. Applicants who are not fluent in Spanish usually bring a translator. Normally appointments are not made,  the clinic waits on people on a “first-come, first-served basis”. The quality of care is very good, however. The second year there are a few more services available, and the third year, all care is covered 100%, including everything from a flu shot to a quadruple bypass.

The people who do not qualify for IMSS still have other options available to them. Medical care in Mexico is excellent and inexpensive. Many people keep their US or Canadian insurance in force and use it for services when they return to their country of origin. They visit one of the many local clinics or doctors’ offices and pay for treatment. Major tests or surgeries are saved for when they return home. For Canadians in particular, being out of Canada 6 months out of the year, still allows you to keep your health care benefits.

International Insurance, Medicare, Tricare and more

Some purchase international health insurance. There are several vendors locally or on the Internet who can discuss the types of options available.

Mexico is home to well over a million US Veterans. Their needs are met in several ways. Currently there is one clinic at Lakeside that takes TRICARE, the health care program serving active duty service members, National Guard and Reserve members, retirees, families and survivors worldwide. Medijic also takes CHAMPUS, The Civilian Health and Medical Program of the Uniformed Services (in the United States). CHAMPUS is a federally-funded health program that provides beneficiaries with medical care supplemental to that available in military and Public Health Service (PHS) facilities. All CHAMPUS beneficiaries move over to Medicare at age 65. For disabled veterans there is the Foreign Medical Program (FMP). If you are a member of any of these insurance programs, Medijic will provide direct billing. Medijic also takes many other forms of health insurance, including direct billing for some Canadians.

Medical care in Mexico is inexpensive

The cost of medical care is surprisingly low. One hospital in Guadalajara charged $1,000 pesos for a routine mammogram and bone scan. That’s $75 USD at today’s exchange rates. CT scans run around $2,750 pesos ($215 USD) depending on the area that is being scanned. A colonoscopy runs from $4,000 – $5,500 pesos ($310 – $430), depending on where these exams are performed and whether any polyps are removed. Many tests can be performed Lakeside while others need to be done in Guadalajara. There are many clinics, labs, and hospitals in Guadalajara, and with the right leg work, any test will be done quickly and competently, and you will carry your results out with you when you leave.

Hospitals in nearby Guadalajara are Incredible & World Class

Hospitals in Guadaljara vary in size and services, they are only a 45 minute drive from Ajijic or Lakeside in general. There are many hospitals that cater to ex-pats. I speak from personal experience. Shortly after our arrival in Mexico, my husband became very ill and ultimately had brain surgery at San Javier Hospital in Guadlajara. Our USA insurance covered everything but our deductible, which we paid directly to the hospital. The service at the hospital was incredible.  Although the nurses spoke Spanish and we did not, we managed to communicate. Admission took only a couple of minutes.  They had valet parking and from curb to bed took less than 15 minutes. My husband had a private room, complete with a private bathroom that would put many 5-star hotels to shame.

In Mexico they understand that family helps improve the patient’s recovery, so we found there was a 7-foot couch in the room where I could stay with my husband. They even brought me clean sheets and a pillow. I was also given a box of chocolates for chosing their hospital. Room service was available for my food needs. There was also a restaurant, gift shop, and ATM available. We could watch TV or DVDs. Those were the creature comforts. The important thing was the excellent medical care from the team of doctors and the successful surgery that saved my husband’s life. This is only one of several world-class hospitals available in Guadalajara.

Check out the San Javier Hospital here: www.sanjavier.com.mx/

There is one hospital in Guadalajara for people who cannot pay. It is the Hospital Civil. This hospital is different in that they provide care, but the patient must bring in clothing, personal toiletries, and a family member or friend who will take the place of the nursing staff. While they do have nurses, they do not do personal care.

Mexico full-time and opt-out of Medicare

Another important thing to note is that things can change quickly in Mexico. Many changes have happened in the past four years. New hospitals have opened, and old hospitals have been renovated. More clinics have appeared, and new services are constantly being offered. Many ex-pats decide to stay in Mexico full-time and opt-out of their Medicare since it is not currently accepted here. They feel confident enough of the services in Mexico to put their money into savings and self-insure.

One expat was diagnosed with breast cancer in her first year of IMSS coverage. She had the surgery done in Guadalajara at the Hospital Del Carmen and put it on her credit card; she’s been paying it off monthly instead of paying a monthly insurance premium.

Other Options

Some resourceful residents have also found coverage with a program called Seguros Popular. Since this is a government program that was initially set up for indigent Mexican Indians, people should be careful relying on this program as their sole source of insurance.

Deciding which choice to make in how to handle your medical and health requirements while living in Mexico depends on your personal life decisions. Talk it over with each other. You will find the way that works best for your budget and your personal needs.

Salud! To your health.
By Victoria Schmidt, Access Team writer