Obtaining Mexican Social Security (IMSS) Health Insurance

articles Living, Working, Retiring

Robert & Curtis Page MD

Expats living in Mexico have other considerations and better economic choices not commonly shared with the short-term traveler.

First, there is no need for evacuation to a home country. Second, because many expats have developed a working understanding of Spanish and a comfort level with Mexican culture, they can often find lower costs for just about everything including health care. With the right research, health care is extremely affordable in Mexico with or without health insurance. Many comprehensive private insurance policies are very affordable.

The Mexican government, through the Mexican Institute of Social Security (IMSS for its Mexican initials), provides affordable health insurance for all residents of Mexico regardless of nationality.

There are varying opinions on the quality and user friendliness of the IMSS system. But the following interesting health-care statistics might help you decide what is best for you.

  • Although less than 3 percent of the Mexican population possesses a private medical insurance policy, 52 percent of the country’s total medical expenditures are for private medical services.
  • In fact, more than 25 percent of Mexicans with IMSS insurance pay for their medical expenditures out of pocket.
  • As a general rule, Mexicans tend to prefer private health care to the state-run system.

With this information at hand, we recommend that individuals or families living in Mexico purchase an affordable, Mexican private health plan. We have listed various carriers, with comparative analysis in our Mexico: Health and Safety Travel Guide (2nd Edition, March 2007).

IMSS insurance is available to all foreigners residing in Mexico, with exclusions or limitations based on pre-existing illness as detailed below. For some reason, however, the insurance can only be applied for during certain times of the year: January, July, August, and most of February. You pay the inexpensive annual fee (approximately $250 USD per year) in one lump sum at the time of application.

How to Apply for IMSS

The application process may be daunting, so expect bureaucratic delays. If things go smoothly, you have lost nothing. To avoid any potential hassles, we recommend that you ask for an agent who will complete the legwork for you for about $50 to 75 USD.

Once approved, applicants are assigned a primary care physician who must certify the health of the individual via a general examination. Your appointment also enters you into the IMSS database, which will enable you to receive care if you become ill in another part of the country. You will also be required to fill out a health questionnaire disclosing any pre-existing conditions. Your coverage will activate six to nine months after approval but, once accepted, you will be covered for life, as long as you continue with your yearly premiums. To apply you will need:

  • Two photocopies of your current passport and immigration documentation
  • Copies of either your FM-T, FM-2 or FM-3 (tourist/expatriate visas)
  • Duplicate copies of your marriage license (if applicable)
  • Two copies of a most recent utility or telephone bill in your name or a renter’s lease agreement in your name
  • Three passport-type photographs

Exclusion Criteria and Insurance Limitations

As a foreigner applying for IMSS, you may not receive treatment for pre-existing illness for the term of your coverage. These exclusions do not include treatment for any other illness that is acquired during your stay in Mexico. Pre-existing illness is defined as:

  • Malignant tumors (cancer)
  • Chronic degenerative disease such as that which is seen with long-standing diabetes, liver disease (cirrhosis, hepatitis, etc.), kidney disease (renal failure or renal insufficiency), heart disease (previous heart attack, arrhythmia, or valvular disease), lung disease (chronic bronchitis, emphysema, etc.), neurologic disease (multiple), cerebrovascular disease (stroke or TIA), peripheral vascular disease, and many others.
  • Drug or alcohol dependency
  • Psychiatric illness
  • HIV positive status or history of AIDS
  • History of traumatic or muscular injury that continues to require treatment

Further, you can not receive medical care benefits for the following conditions:

  • Benign breast tumors in the first six months after acceptance
  • Births in the first ten months after acceptance

In the first year after acceptance, you also cannot receive the following surgical procedures:

  • Lithotripsy for kidney stones
  • Surgery for gynecologic conditions except for cancer
  • Surgery for vein disorders
  • Surgical procedures for the sinuses, nose, hemorrhoids, rectal fistulas, tonsils and adenoids, hernias (except for herniated spinal discs), and other operations that are also considered “elective,” or voluntary, rather than required

In the first two years after acceptance you cannot receive surgery for orthopedic conditions. In addition, your IMSS insurance will not cover the following:

  • Aesthetic or plastic surgery
  • Eyeglasses
  • Contact lenses
  • Hearing aids
  • The surgical correction of astigmatism
  • Lasik surgery or the equivalent
  • Treatment of self-inflicted injury
  • Preventive care
  • Treatments for behavioral or psychiatric disturbances
  • Dental care (except for extractions), or
  • Infertility treatments
Published or Updated on: April 1, 2008 by Robert & Curtis Page MD © 2008
Share This:

Leave a Reply

Your email address will not be published. Required fields are marked *