Does Medicare Work in Mexico? - Hella Health (2024)

Mexico is a common destination for American holidaymakers and retirees but does Medicare work in this country? The answer is no, Medicare does not cover your medical expenses in Mexico except in a few exceptional circ*mstances.

Can you use Medicare in Mexico?

If you are an older American aged 65 or older, you are eligible for Medicare coverage. You may also be a beneficiary of Medicare due to an eligible disability or illness. However, it is important to keep in mind that your Medicare coverage is only valid if you are a U.S resident residing within the country.

You cannot use Medicare in Mexico because Medicare coverage does not pay for health care or supplies you get outside the U.S. This means if you are traveling in Mexico or residing there permanently, your Medicare benefits will not remain in effect. However, there are a few exceptions where you may get Medicare coverage in Mexico.

When does Medicare cover health services in Mexico?

If you receive health services in Mexico, Medicare will only cover you in the following circ*mstances:

· Your US doctor admits you to a Mexican hospital for treatment;

· You have a medical emergency, and a Mexican hospital is closer than the nearest hospital in the U.S;

· You receive treatment at a Mexican hospital that is closer to your home than the nearest U.S. hospital that can treat your particular condition.

It is important to note that in these situations, Medicare will only cover the Medicare-approved services that are indicated in your plan.

Medicare Part A will cover inpatient care at a Mexican hospital if it has been deemed medically necessary, while Part B will cover costs like ambulance charges and doctor services. You will still be required to cover the applicable coinsurance and deductibles.

Medicare will not cover any prescription drugs bought outside of the U.S, even if you qualify for Medicare coverage in Mexico under the exceptions.

Does Medicare cover emergency care in Mexico?

If you are on Original Medicare, your plan will cover emergency care in Mexico only in the following circ*mstances:

· You have a medical emergency, and the nearest hospital is in Mexico;

· If you are on a cruise and the ship is more than 6 hours from a U.S port, and Mexico is the closest country.

Other Medicare plans like Medicare Part C and Medigap plans may cover medical emergencies in Mexico, but this will depend on your specific plan and provider.

Keep in mind that hospitals in Mexico are not required to file Medicare claims on your behalf, so if you receive treatment, you will need to file the Medicare claim yourself.

Which Medicare plans cover you in Mexico?

If you are on Original Medicare, your Part A and Part B coverage benefits only apply while you reside in the U.S, except in a few exceptional circ*mstances. However, if you want to be covered while traveling or residing in Mexico, you can opt for the following Medicare plans.

Medicare Advantage

Medicare Part C or Medicare Advantage plans are offered by private insurance companies as alternatives to original Medicare. Part C plans typically include coverage for medical expenses in foreign countries, including Mexico. However, coverage may vary depending on the provider, so verify with your insurer before travel.

Medigap

Medicare supplement plans Or Medigap plans are sold by private insurers to supplement Original Medicare. Medigap plans C, D, E, F, G, H, I, J, M, and N will cover emergency medical expenses in Mexico and other foreign countries.

However, Medigap will only cover services that are not covered by Original Medicare, and you will be required to pay a deductible of $250. Medigap plans limit coverage for foreign emergency Medicare to $50,000 per lifetime.

Medicare alternatives when in Mexico

Medicare coverage in Mexico is only available in limited circ*mstances. This means it is important to consider alternative health insurance while residing or traveling in Mexico.

Travel insurance

Purchasing travel insurance will help you get medical coverage for the duration of your travel in Mexico. Check with your provider for covered services and applicable limits before travel to understand what your travel insurance will cover.

Private medical insurance

If you permanently reside in Mexico, private medical insurance will offer you the coverage you need. Get a quote from providers in Mexico based on your healthcare needs and profile to ensure you have sufficient coverage.

IMSS coverage

IMSS healthcare is a government healthcare system in Mexico that is open to both foreign residents and Mexican nationals. If you have legal residency status in Mexico, you can voluntarily enroll for IMSS coverage. You can also be enrolled by your employer if you are formally employed in Mexico.