Lake Chapala Ajijic Mexico Information

Mexican Medical Insurance IMSS

IMSS–Instituto Mexicano del Seguro Social

What is it? IMSS stands for Instituto Mexicano del Seguro Social. It’s about as close to socialized medical coverage as you can get. Many working people qualify for IMSS and many employers make a contribution toward the IMSS coverage. Mexico has allowed retirees and other visiting residents to buy the IMSS coverage. They base the cost on what the payment would be if you were working full time at minimum wages. This year I believe I paid around $3,180 pesos. It goes up slightly each year. (Update note, see current rates below. The way they charge is now based on a different system per person instead of per family.)

What do you get? IMSS gives you complete coverage including prescription meds except for certain preexisting conditions that have varying time periods before they are covered. This is an excellent article that explains the preexisting conditions: http://www.mexconnect.com/mex_/dt/dtimssregs.html

When you apply for IMSS, you fill out a questionnaire and you answer general health questions and health history questions. There are some preexisting conditions that would prevent you from coverage by IMSS. The official IMSS government site is at: http://www.imss.gob.mx/

My opinion/suggestion: Buy the best medical coverage your budget will allow. My budget wouldn’t allow for more than IMSS, so that’s why I went that route. But I would highly recommend that if you have IMSS coverage, also pay to get a second opinion for any important issues and/or research as much as you can for yourself on the internet. I’ve had IMSS coverage since 1999 or 2000 mainly as a major medical fallback. I’ve ended up using it also for periodic “runny nose” doctor’s visits. I think they do a fine job with run-of-the-mill ailments, but two major concerns I’ve had were misdiagnosed and due to the second opinions, I was able to get the proper treatment. Saying that, I’m sure if I were to have a heart attack tomorrow, I’d be glad I was covered with IMSS and I’m sure my treatment would be good enough to offset the cost I would have to put out if I weren’t covered.

Words of warning for newbies to IMSS coverage: This is NOT medical care like you’re used to up north. (Which is good and bad.) Your first clue is when you are asked for a urine sample and they hand you a small mayonnaise jar (sans label) with a big “M” on the red lid (McCormick). I’m sure they are sterilized, but still it is different than the sterile cups up north that come complete with instructions for a “clean catch” and include a handy wipe, all sealed in plastic.

I would not recommend IMSS for those who speak no Spanish. Even though I’ve had a few doctors in the emergency room who speak some English, almost everything else from getting your appointment, to speaking with your family doctor, to picking up prescriptions is in Spanish. Most staff have been very helpful, but there have been a few that showed their impatience with my stuttering Spanish. If you can afford coverage at Sharp, I understand they have more English speaking personnel. But if your budget demands you choose IMSS, either enroll in a Spanish class, or be sure to take along a friend who can translate for you.

The system is similar to HMOs in the US (and I assume to the socialized system in Canada) where the starting point for everything is the family doctor. If the problem is something the family doctor can’t handle, he approves your visit to a specialist. The IMSS specialist clinic is halfway between Ley 1 and Ley 2. Your first time there, you need to stand in line to create your patient file. After that, you don’t need to fetch it yourself. If they have an appointment for you, they’ll have the file there and waiting. But be prepared the first time. Obtaining your turn in line is like doing battle at the market or getting stamps at the post office; you have to elbow your way to the front.

My first brush with IMSS care was during an elevated blood pressure crisis that took me to four emergency room visits, two of them being all-night stays. The last trip there, their treatment was making me worse. It was after paying for a specialist visit to a cardiologist that he diagnosed that my blood levels were low in potassium and prescribed a potassium supplement that I paid for out-of-pocket, but it solved the problem.

A couple of interesting observations: Many of the IMSS doctors are also in private practice and many also work at Sharp. So it doesn’t necessarily mean that because you have cheap insurance, you’re getting substandard doctors. It’s true that their hands are sometimes tied because of what IMSS will cover. For example, I’ve had a few doctors tell me that there are better blood pressure meds, but there are only certain ones within the approved IMSS line-up.

Also, within IMSS, like most of Mexican culture, it does make a difference in who you know. On my second emergency room visit, I developed a friendship with a surgeon who was on duty but who wanted to practice his English. After treating him and his wife to breakfast and after invitations to their home for breakfast, I had a friend who gave me his cell number, home number, consultation office number, etc. During my last blood pressure/irregular heart beat crisis, he was happy to come to my home, assist as he could and phone a cardiologist friend who saw me later that day and immediately brought me back to normal. I gladly paid 250 pesos for the visit. But he pointed out that he was also an IMSS doctor, and should I need additional cardiology care, just request him through my friend (the IMSS surgeon) and he would phone my IMSS family doctor to make the necessary arrangements to make sure I got the paperwork in place to get to him.
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