Medicare in Mexico: Eligibility for Americans While Living Abroad
Americans living in Mexico are not eligible to be medically insured by Medicare. Medicare is a health insurance scheme for U.S. residents who are living in the United States or its approved territories. However, there are three scenarios that may qualify U.S. expats in Mexico for Medicare coverage.
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Are you a senior expatriate living in Mexico? Are you wondering if your Medicare coverage in the U.S. will work in Mexico?
This article will explain all about what Medicare is, what makes an American eligible for Medicare coverage, and the rules about Medicare coverage in Mexico and abroad.
There are a few exceptions to the no Medicare coverage out of the U.S. rule, and we will explain those below. We’ll also explain the Mexico insurance options U.S. expats over 65 do have when residing in Mexico.
If you have more questions after finishing this article, talk to one of our experts on insurance in Mexico for American citizens. They can direct you to the best options available so you have medical coverage for all your health needs. You can also start comparing insurance policies by yourself today!
Can Senior American Citizens Use Medicare in Mexico?
American residents over the age of 65 cannot use Medicare to cover their medical care provided in Mexico. This is because the United States does not provide coverage outside of the United States and its approved territories. The areas where Medicare coverage is accepted include:
- The 50 United States of America
- The District of Columbia
- Puerto Rico
- The U.S. Virgin Islands
- Guam
- American Samoa
- The Northern Mariana Islands
If you plan to travel outside of the United States to Mexico only for a period of time, you can keep your Medicare coverage in place while you travel and it will remain active when you return to U.S. soil.
During this time, you will not have any coverage for care or medical services administered outside the approved U.S. borders.
This Medicare policy is the same for U.S. expats in Thailand who want to use Medicare.
What is U.S. Medicare Coverage?
Medicare is a U.S. federal health insurance program designed for U.S. residents age 65 or older, certain younger people with disabilities, and individuals with End-Stage Renal Disease. Medicare offers three main services: hospital insurance, medical insurance, and prescription drug coverage.
Let’s break down the three parts of Medicare coverage for you:
- Part A – Hospital Insurance: Medicare covers inpatient hospital stays, treatment services administered in a nursing facility, hospice care, and some other home health care.
- Part B – Medical Insurance: Medicare also covers certain doctor services, outpatient care, medical supplies, and preventative healthcare services.
- Part D – Prescription Drug Coverage: Medicare assists in the coverage of prescription drugs and vaccinations.
Exceptions When Medicare is Accepted Outside of the US
There are three situations when Medicare may approve coverage for medical care or supplies offered outside of the United States and its territories. In these scenarios, Medicare will only pay for Medicare-covered services that you get in a foreign hospital (Part A services).
Part B medical services may or may not be covered, and Part D prescription drugs will not be covered.
The three situations that are Medicare exceptions are:
- If you’re in the U.S. and you have a medical emergency and the closest hospital that can treat you is a foreign hospital.
- If you are traveling from one U.S. state through Canada to another U.S. state (such as Alaska) without unreasonable delay and you have a medical emergency and the closest hospital that can treat you is in Canada.
- If you live in the U.S. and the foreign hospital is closer to your home than a U.S. hospital, regardless of whether or not you have a medical emergency.
Because Mexico shares a border with the United States, it is plausible that as U.S. residents live in Mexico and/or travel through Mexico, and/or live on the border of Mexico they may qualify for Medicare coverage for care given in a Mexican hospital.
Each claim will be considered on a case-by-case basis, and you can only receive coverage for the Medicare-covered services previously agreed upon in your personal Medicare plan. (For example, if you don’t have Part B services, they will not be covered in one of these scenarios).
What is Covered in Mexico by Medicare in These Situations
Medicare may cover Part A and Part B medical services if a U.S. citizen qualifies for Medicare outside of the U.S. in one of the three approved scenarios. Part A services include inpatient hospital care when a patient has been admitted. As soon as you’re discharged, coverage will end.
Part B services that are covered may include emergency and non-emergency ambulance and doctor services that you get before and during your covered inpatient hospital stay. Any services administered after your formal discharge from the hospital will not be covered.
Part D services (prescription drugs) are not covered by Medicare outside of the U.S.
What the Patient Pays When Covered by Medicare in Mexico
Patients who are approved for Medicare coverage in a foreign hospital in Mexico will be expected to pay their usual coinsurance or copayments and deductibles. This should be no different than what you’d pay in a U.S. hospital.
The foreign hospital should submit a claim to Medicare for you to get covered, though they may not. If they don’t, you’ll be expected to pay the full bill for your services. You can contact the foreign hospital and request them to make the claim, or in a rare circumstance, you can contact Medicare directly.
Read here about the process of submitting a foreign claim to Medicare. Claims must be submitted within 12 months of the date of care.
More Health Insurance Options for U.S. Seniors in Mexico
U.S. seniors and expats living in Mexico can choose to get public health insurance through government schemes or private insurance through a private insurance provider. Public insurance can be more affordable, but it may have more benefit limits. Private insurance offers more comprehensive coverage.
Public Health Insurance in Mexico for Expats
U.S. expats living in Mexico have two public health insurance options: the INSABI scheme and the IMSS scheme. Both are available to Mexican citizens and foreign expats alike, and their key differences depend on whether or not you are employed. The INSABI scheme provides universal healthcare for all.
- INSABI Scheme
This is the Instituto de Salud para el Bienestar, meaning “The Institute of Health for Wellbeing,” and it is available to unemployed Mexicans and others who cannot afford to enroll voluntarily. This universal scheme covers healthcare services and care free of charge.
- IMSS Scheme
This is the Instituto Mexicano del Seguro Social, meaning “The Institute of Social Security.” This scheme offers medical insurance for Mexican and expatriate employees working for private companies.
Senior expats over the age of 65 will likely no longer be employed, disqualifying them from the IMSS scheme. This leaves you the option to enroll in the INSABI scheme or purchase private health insurance (as discussed below).
If you are hoping to find a job, consider these top 5 jobs for Americans in Mexico.
Private Health Insurance in Mexico for Retiree Expats
Private health insurance in Mexico is a strong option for retiree expats seeking comprehensive medical coverage. A private health insurance plan is offered by an insurance company of your choosing, and the plan can include extensive benefits for inpatient, outpatient, emergency, and geriatric care.
A private health insurance plan typically provides more extensive benefits, particularly outpatient and drug prescription benefits, than a public health insurance plan. They may be more expensive, but they can grant you access to the more sophisticated, up-to-date medical facilities in your region.
Top Insurance Providers for Senior Expats Living in Mexico
Among the very top private insurance providers for senior expats in Mexico are Allianz Care, Cigna Global, NOW Health International, VUMI, AXA, BUPA, GeoBlue, Passport Card, Global Benefits Group, and Best Doctors Insurance. Retirees in Mexico will highly want to consider these providers.
Here is a brief introduction to some of these top international insurance companies in Mexico for expats and some of their unique benefits for the elderly:
- Allianz Care: They offer three core expat medical coverage plans: Care, Care Plus, and Care Pro. All of these plans include coverage for nursing at home, rehabilitation treatment, and oncology. They also have an Expat Assistance Program (EAP) with unique elderly care services and more.
- Cigna Global: Cigna has four expat health insurance plans: Silver, Gold, Platinum, and Close Care. Cigna’s Gold and higher plans include coverage for home nursing, palliative care, cancer care, and more. Outpatient benefits include hormone replacement therapy, hearing aids, 60+ care, and more.
- NOW Health International: NOW Health offers a WorldCare plan with four policy options and SimpleCare with three policy options. Among NOW’s plans include coverage for rehabilitation, menopause hormone replacement therapy, and inpatient and outpatient care.
- AXA: AXA offers five expat health insurance coverage levels: Foundation, Standard, Comprehensive, Prestige, and Prestige Plus. You can choose your level of coverage, with benefits for inpatient and outpatient care, cancer care, chronic conditions, medical evacuation and repatriation, and more.
- BUPA: The medical insurance plans offered to expats from BUPA are Major Medical, Select, Premier, and Elite. Some of their benefits include medical evacuation and repatriation, health checks, inpatient and outpatient care, and dental care.
You can read more about the full list of 10 top international insurance companies for expats in Mexico here.
Why Should I Use a Broker to Get Expat Health Insurance?
It can be very beneficial for expats to use a broker to purchase their health insurance because a broker knows the local market, has expert experience in the international insurance industry, and focuses on serving you (rather than earning money for any one single insurance company).
If you’ve never heard of what an insurance broker is or how they can help expats, you won’t want to miss our article that breaks it all down for you.
Using a broker can not only save you money, but they can simplify the insurance process by doing your research and analysis for you, negotiating with the provider on your behalf, and walking you through the process from start to finish, answering any questions you may have.
Your broker will become your next best friend! Reach out to Pacific Prime today to see how we can help you get the best insurance for your time in Mexico.
Frequently Asked Questions
Can an American expat use Medicare in Mexico?
American expatriates living in Mexico cannot use Medicare because it is a United States insurance scheme designed only for residents in the U.S. and its approved territories. U.S. expats will need to either enroll in one of Mexico’s public health schemes or purchase private health insurance.
Does your Medicare plan end if you move abroad?
Americans with Medicare can live abroad for a time without ending their Medicare plan. Your U.S. Medicare coverage will continue while you are out of the country, but it will not cover care and treatments you receive outside of the United States. You’ll need international coverage for that.
Conclusion
In this article, we’ve learned all about how Medicare does not cover healthcare expenses for Americans living in Mexico unless you find yourself in one of the 3 situations that are approved exceptions. Every situation will be assessed on a case-by-case basis.
Seniors who are planning to move to Mexico from the U.S. or who are already living in Mexico should have a much better idea of their health insurance options. Expats in Mexico can begin comparing health insurance plans and quotes immediately so they can find the best plan for their needs.
Talk to Pacific Prime insurance broker online or by calling 1-800-868-1451.
If you found value in this article, you’ll also want to read our blog posts Moving to Mexico from France and Taxes in Mexico for Canadians and Driver’s License Requirements in Mexico for Americans.
Serena earned her Bachelor’s Degree in Psychology from the University of British Columbia, Canada. As such, she is an avid advocate of mental health and is fascinated by all things psychology (especially if it’s cognitive psychology!).
Her previous work experience includes teaching toddlers to read, writing for a travel/wellness online magazine, and then a business news blog. These combined experiences give her the skills and insights she needs to explain complex ideas in a succinct way. Being the daughter of an immigrant and a traveler herself, she is passionate about educating expats and digital nomads on travel and international health insurance.
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