Wednesday, June 19, 2024

IMSS for the expat: it’s a viable and affordable option

If you are living in Mexico and work full time for a Mexican company, chances are that you have IMSS (Instituto Mexicano del Seguro Social) coverage. But what about the rest of us?

IMSS is Mexico’s answer to socialized medicine. As a contract worker for both Mexican and American schools, I did not qualify, or so I thought. Most expats grapple over the question, private insurance or IMSS?

IMSS is both a viable and an affordable option. It is also tried and true. You can find an IMSS clinic within blocks of your home and even while traveling. The initial process is complicated but the savings makes it worth it.

At 50, my annual premium was US $571 and there are no costs beyond that, such as copays or prescriptions. My daughter was a dependent at no additional cost until she turned 16. Had she been enrolled in a Mexican school; the coverage would have continued for free. Since she was not, I was able to purchase her coverage for $300 annually.

The initial process of getting set up can be frustrating but using the insurance is not. There is an app where you can find your clinic and sub-delegation based on your postal code. First you must create a trámite which can be done on the website. This is not difficult if you speak a reasonable amount of Spanish. If you don’t, you will need to find a Spanish speaker to help. You should choose incorporación voluntaria on the site. This will produce your trámite and allow you to print invoices.

I would highly recommend paying for a year at a time. It is possible to pay monthly but that requires you to go to the bank every month. There is no option to pay online. If you are one day late, they will cancel it and you have to start from scratch. Sadly, I learned that lesson the hard way.

Next, take the invoices to the bank and pay them. Any bank should be able to process these transactions. However, if you do not go to your bank, you will need to bring cash. My daughter has a long last name that the system could not handle so IMSS had to print the invoice. This required me to pull cash from an ATM and go to a specific bank near the sub-delegation.

Now here is where it gets tricky. If you are missing a single document when you make your initial trip to your sub-delegation, you will be turned away. There will probably be zero English speakers on staff. They have tried to turn me away due to lack of documents. I knew I had them all which resulted in a friendly disagreement that was ultimately resolved.

If you want to complete the transaction, do not appear frustrated or angry. If you do, you can expect no help. If you are patient and friendly, you will have a better experience.

This is what you will need (original and copies):

  • Residente temporal or permanante
  • Your trámite
  • Invoices with proof of payment (receipts) attached
  • Two photographs infantil (you can have these made at any passport photo shop)
  • Birth certificate
  • A Mexican social security number (de seguridad social). Hopefully you have this. If not, it will require a trip to another office. IMSS will give you the information for the location.
  • Proof of residence – a bill such as CFE or gas that is less than three months old.
IMSS smartphone app
IMSS has a smartphone app to help users locate the nearest clinic among other services.

If you are missing any of these items, you will be turned away until you have them. The processing of paperwork will take some time so bring a book. There also may be a lineup. Some sub-delegations will give you a card for an appointment for another day and others will see you the same day. It is a crap shoot.

Never go on Monday if you can avoid it. Once you have accomplished all of that, congratulations! Go have a drink and some tacos. The hard part is over.

Once your paperwork has been processed, now you need to go to your clinic where they will give you a book that works like an insurance card. They will need one of the photos infantil for the book. There may be a lineup but this doesn’t take any time at all. Depending on your clinic, they may want to do a quick physical and record the results in your book. If not, you should book an appointment which is easily done on their app.

IMSS is great for preventative medicine, vaccinations, and prescriptions. They also have dental care. I have been told it is really great in emergencies but thankfully have no experience with that. After recovering from COVID last year, I went to IMSS to see how it impacted my health. They did a full blood screening, chest x-ray, and even a mammogram while I was there.

That being said, IMSS is not always the best solution. Last May, I required an invasive surgery and decided to go to a private hospital. I found a specialist on the Doctoralia app who spoke English and was able to pay cash for a procedure that required anesthesia and an overnight stay. The total cost was $3,000. I also lost a crown and rather than going to IMMS, because I deemed it an emergency, I just walked around to a few dentists before I found one who replaced it for $25.

There are also some preexisting conditions — malignant tumors, chronic degenerative diseases and congenital diseases, for example — that are not covered by IMSS.

Ultimately, my advice would be to avoid private insurance in Mexico unless you are wealthy. It is outrageously expensive and I don’t trust that it would be available when needed.

IMSS was founded in 1943 and clinics are present everywhere in Mexico. Sometimes you may want to go private and pay cash but IMSS will be there when you really need it.

Jennifer Trujillo is an English and Spanish professor from Texas living in Mexico City.

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