Can I get health insurance in Mexico if I have a pre-existing condition?
By far, this is one of the top questions expats living in Mexico (or those looking to move here) have.
And we get it.
For some, it’s critical and can be a deal breaker before moving to Mexico full-time – or the reason you may need to move back to your passport country.
Here is everything you need to know about pre-existing conditions and obtaining health insurance while living in Mexico.
Understanding Pre-Existing Conditions and Expat Medical Insurance
A pre-existing condition is any health issue that you have prior to applying for health insurance.
Common pre-existing conditions include:
- Cardiovascular diseases, such as heart attacks or installed heart stents
- Chronic conditions like high cholesterol
- Various cancers, from more manageable types to those requiring extensive treatment (including those in remission)
- Conditions like diverticulitis, which often lead to automatic denials due to their extensive impact on overall health
Pre-Existing conditions can also include any previous accidents that caused injury, previously treated pain (back, hip, etc.), and even broken bones.
It’s important to be thorough about your medical history when applying for international health insurance.
Pre-Existing Conditions and Expat Medical Insurance
In the US, health insurance companies can’t refuse to cover you or charge you more just because you have a pre-existing condition.
But that’s not the case for private insurance companies that offer international health insurance for expats in Mexico.
If you have a pre-existing condition, insurers have the right to deny your application, exclude coverage for a specific pre-existing condition, place higher deductibles on previous medical conditions, or limit treatment related to that condition.
When you submit an application for a new policy, it will go through the underwriting process where it will then be determined if the pre-existing condition will be covered, denied, or require a higher deductible.
General Rules for Pre-Existing Conditions
When it comes to pre-existing conditions, insurance companies consider several factors, including…
- Current medical status
- Your level of activity and overall diet
- If you have a past cancer diagnosis and how long you have been in remission
They will also consider your daily habits such as alcohol intake and if you smoke or not.
From there they will either exclude that condition outright, offer an increase in deductible for that specific condition, or flatly deny your application.
There are some pre-existing conditions that are automatic denials so be sure to bring up any conditions you have with your broker.
Let’s say you’ve had high cholesterol for 10-15 years but have maintained stable levels through a healthy lifestyle and medication. The insurance company may exclude coverage for high cholesterol-related issues, but still offer coverage for other health concerns.
Or, they may outright deny coverage based on certain pre-existing conditions.
In the case of more serious conditions like breast cancer, insurers might offer a waiting period of 1-3 years before coverage kicks in for cancer-related treatments.
Alternatively, they may provide coverage with a higher deductible. Instead of a standard $5,000 deductible, they may require a $20,000 deductible for breast cancer-related claims.
When it comes to heart attacks, the timeline also matters.
If the heart attack occurred 10 years ago and you’re now relatively healthy, the insurer may make an exception.
But they will likely request current medical notes and updated medical information.
However, if the heart attack happened within the past 5 years, most insurers will probably deny coverage.
What Happens If I Don’t Disclose Pre-Existing Conditions?
If you fail to disclose a minor pre-existing condition, such as a previous back injury, the insurer may simply exclude coverage for anything back-related going forward.
However, if you omit a more significant condition, like stage zero melanoma cancer, the insurance company may cancel your policy entirely.
Honesty is always the best policy when applying for health insurance.
What If I Have a Minor Pre-Existing Condition?
Minor pre-existing conditions, such as a previously broken bone or minor orthopedic issues, may not result in a complete denial of coverage.
Instead, the insurer might exclude that specific condition from your policy or offer coverage with a higher deductible.
These exclusions can be temporary (1-3 years) or lifetime exclusions, depending on the insurer and the specific condition.
Steps to Take When Applying for Health Insurance with Pre-Existing Conditions
Be honest and thorough when completing the health history portion of your application.
Provide approximate dates, doctor or hospital names, and any relevant medical records.
If you’re unsure about specific details, such as the exact age you had your tonsils removed, disclose the information to the best of your knowledge.
Be prepared to submit medical records, especially for more significant pre-existing conditions.
Remember that each case is assessed individually, so provide as much context as possible.
Here’s an example of an application.
What to Do If You’re Denied Coverage
If your application is denied due to pre-existing conditions, most of the time, there isn’t much that can be done.
However, here are a few things you could do:
- Appeal the decision and provide additional information or context to the insurance company.
- Ask if they can offer coverage with a higher deductible or exclude the specific condition from your policy.
- If there is an exclusion period, you can wait it out and then resubmit all current medical records.
- Explore alternative options, such as travel insurance or medical evacuation coverage.
