Mexico: A Look at the Health Program that Replaced Seguro Popular

When Mexican President Andrés Manuel Obrador López Obrador — commonly referred to as AMLO –first announced over a year ago that he would be replacing Seguro Popular with something new, expats who relied on that program to meet their healthcare needs naturally became concerned.

At the time, it was unclear if foreigners would be eligible to participate in the new program, and if so, at what cost? Well, now we have some answers.

So Long Seguro Popular, Hello el INSABI

As of January 1st, 2020, Seguro Popular no longer exists. It has been replaced by el Instituto Nacional de Salud para el Bienestar , or el INSABI for short.

This is a substantial change in the law that extends free healthcare and medications to anyone not affiliated with one of the other Mexican social security health programs (IMSS, ISSSTE).

Here are some highlights:

It’s 100% free

The annual fees associated with Seguro Popular have been eliminated. Anyone who qualifies (see below) can obtain free healthcare and medications through el INSABI.

It’s much easier to qualify now

In the past, many foreigners have been denied continuing coverage under Seguro Popular for a variety of reasons. There are only three requirements now:

  1. Be a person located inside Mexico
  2. Not be part of the social security system (IMSS or ISSSTE)
  3. Present one of the following: Mexican Voter ID card, CURP or birth certificate

Only Mexican citizens and lawful residents will have a CURP, which is an alphanumeric identity code, but the federal health law (Artículo 77 bis 7) now states that if the person does not have a CURP, that a birth certificate will suffice.

There is no need to sign-up to participate

Under Seguro Popular, it was necessary to sign-up in order to receive benefits. All you have to do is present one of the documents listed in the previous section.

Let’s Wrap This Up

Since this new system has only been in place for less than 48 hours now, it’s impossible to know how this will work in the real world.

The good news is that as the law reads now, there is no requirement that a person has to be a citizen or even have Mexican residency to participate. The bad news is that could change in the near future as supporting regulations and internal agency policies are enacted.

We saw something like that happen in early 2018 when Mexico made substantial changes to the requirements to participate in Seguro Popular. They eliminated the sections of the procedural manual that allowed foreigners to participate at all.

The funny thing was that the new manual didn’t say foreigners couldn’t sign up, but it also didn’t say they could. The result was that many foreigners were turned down for coverage over the last year and a half or so.

Only time will tell how this will all work out. My advice for anyone whose move to Mexico hinges on being able to participate in the public healthcare system is to wait a little longer to see how this thing shakes out.

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Sources:

Diario de la Federación (la Ley General de Salud, La Ley de los Institutos Nacionales de Salud)
el Instituto Nacional de Salud para el Bienestar

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About the Author

Qroo Paul
Paul Kurtzweil (Q-Roo Paul) was a deputy sheriff in Florida for 25 years before retiring at the rank of lieutenant in 2015. He and his wife moved to Mexico looking to maximize their retirement income. They later started a blog called Two Expats Mexico (qroo.us) to share their experiences as well as information about the logistical and legal aspects of retiring south of the border.

42 Comments on "Mexico: A Look at the Health Program that Replaced Seguro Popular"

  1. Hi Paul! Any idea how one determines which health care locations would accept INSABI?

    • Just head down to the local health department locations and they can give you more info. They are often called centros de salud. That’s where you go for vaccinations and other basic health services.

  2. George Butler | January 2, 2020 at 10:59 am |

    You will usually end up paying another type of price by participating in a completely free system like that – – long waits, shortages of medicines, etc. The private Mexican health insurance programs are great deals at a fraction of the cost of US health insurance.

  3. Very interesting. I know that I received a CURP in order to apply for my Tarjeta Inapam. I am also a resident. Do either or those cards suffice for qualifying?

    • Their list of approved documents is very short: Mexican Voter ID Card, CURP (which is on the Voter ID card anyway), or a birth certificate. But bringing more is always better than less. Keep in mind this is a brand spanking new way of doing things and everyone involved is early in the learning curve.

  4. Sharon Lesley | January 2, 2020 at 11:38 am |

    We tried to join IMSS a year ago but they put so many obstacles in the way that we gave up. So now we will try the new scheme with our CURP. It’s a shame though, I would rather pay something towards health care.

  5. Thanks Paul!!

  6. It will be very interesting to see how it pans out. As a Residente permanente I look forward to this….thanks for the article Paul..

  7. I signed up for Seguro Popular just in case of catastrophic health issues. Everyday health care I pay out of pocket.

    Thanks for the info on the changes, Paul.

  8. Thanks Paul! Does the birth certificate have to mexican? Or is a USA birth certificate ok?

    • The law only says a birth certificate, it doesn’t specify. I suspect that there will be some clarification coming in the form of supporting regulations and procedures. Who knows how long that will take though? 🙂

  9. We were at a SP Centro de Salud in December and they wouldn’t let us see our usual doctor until we showed them our passport. Our Canadian passport seemed to make it all OK.

  10. https://m.arenapublica.com/…/el-insabi-mas-que-remplazo…

    On October 23, the Chamber of Deputies approved the creation of the Institute of Health for Welfare (INSABI), an agency that comes not only to replace Popular Insurance, but also to seek a truly universal public health system – and free – from the first day of next year.

    According to what the government said, with INSABI, members of the Popular Insurance will no longer have limitations and will have all the medical services that an IMSS or ISSSTE member receives, but free of charge.

    In the same way, all people who currently do not have access to any health system will have it, simply because they are within the national territory, which also includes foreigners. A kind of dream come true.

    For the general director of the Center for Economic and Budgetary Research (CIEP), Héctor Villarreal Páez, the creation of INSABI is one of the “greatest social reforms in the country’s history” that has implications for all Mexicans from different angles.

    First, it is intended to be the door for around 20 million people who currently do not have any type of medical service according to the National Council for Social Development Policy Evaluation (Coneval), have access to them and finally I came to a universal public health system.

    Second, as an institution, INSABI will be a health coordinator and administrator, since in order to create it, it will be necessary to centralize the state health systems. But all of the above entails several financial implications that have not yet been resolved – says Villarreal Páez – particularly in regard to the gratuity with which it is proposed to deliver these services; In addition, this modality encourages the permanence of informality.

    INSABI is more than the replacement of Popular Insurance.

    Financing, the great mystery of INSABI

    A good public health system is not cheap and Mexico has not been characterized by investing strongly and efficiently in it.

    According to the latest data from the World Bank, Mexico was the second country with the lowest expenditure among the members of the Organization for Economic Cooperation and Development (OECD) in 2016, with an investment of 5.4% in relation to its GDP; Turkey being the least investor, with an equivalent to 4.3% while the average spending in OECD countries is 8.8% of GDP, only counting health goods and services consumed during the year.

    After the original INSABI initiative was handed over to the Chamber of Deputies by the Morena bench, CIEP published the possible budgetary impacts that this institute could launch. Analysts at the center specializing in public finances concluded that providing a package of unlimited health services to 53.2 million people already benefited from the Popular Insurance and 22.5 million who do not have any type of health service, will cost around 792 thousand 620 million pesos (mdp), a figure equivalent to 3.2% of the GDP of 2019. As the saying goes, there is no free lunch, it has a cost.

    But that is not all. The previous amount, although it already takes into account the current health costs, demographic change and the incidence of diseases, the costs related to infrastructure, technological investment or the workforce must still be added, the latter estimated at 17 thousand 991 million pesos per year for the basification of all workers in the public health sector in the country, according to the organization.

    When questioning the matter to Héctor Villarreal, a doctor in economics and an expert in public finances and budget, about whether the country’s finances could allow an economic impact of such magnitude he commented: “It depends on what you want to achieve. It seems to me that Here is a political discussion with very good intentions, but with many utopian things, especially when talking about this gratuity of basically all services for all people … A public health system is expensive … and you can be very efficient in spending and very efficient with a very hard fight against corruption, but if we don’t talk about financing sources, the truth is that it ends in utopia. ”

    The centralization of the health system for the creation of insabi is not clear

    Will an INSABI be created without knowing its basic structure?

    The decree approved by the Chamber of Deputies still leaves the key details of the regulation to be published within 180 days following the official creation of the new institute.

    • Thanks for sharing that. I’m curious how this will affect IMSS in the long run. Those folks are still paying into their health system, many through employee contributions, and are not able to participate in this program. It looks, at least for the time being, that they really got the short end of the stick on this one.

  11. Notice paragraph 3 — … which also includes foreigners.

    • So, they created a healthcare system that can be used by foreigners without restriction? Hmmm, considering that they border a country where millions of people cannot afford medical care and those folks can enter Mexico at anytime without a visa, this seems like a really bad idea. They will have to tweak these requirements or the program will be bankrupt in no time flat.

  12. Patrick D Durkin | January 2, 2020 at 2:53 pm |

    Just curious how this affects you or do you have a private plan or just pay out of pocket?
    Thanks for all the great continuous information you offer, it helps my wife and I plan out our future.

    • We will continue to use the private system because it’s fast and the patient care is top-notch. The public facilities here are often crowded and long waits are common. I suspect that this program, as written, will only exacerbate that problem.

      We know a local bartender who slipped and broke his collar bone in a rain storm. He was taken to a public hospital for treatment and sat in the waiting room in a wet sheet for over two hours waiting before his friends drove him to a nearby private hospital. He was seen immediately upon arrival and treated. He said that although he had to pay for the treatment out-of-pocket, it was definitely worth it.

  13. So if there is no sign up, where do you present your CURP?

  14. Wow! I think this is really good news. Thank you for always keeping us up to date on the latest occurrences!

  15. Rick A Rezac | January 2, 2020 at 6:10 pm |

    So, no sign up for FOREIGNER, just keep a copy of BC on you in case of anything medical? And you can make use of, probably, Seguro facilities just with that for other things?

    • That’s how it looks for now. There are still a lot of unanswered questions how this will all work in actual practice.

  16. THERESA WITT | January 2, 2020 at 9:38 pm |

    This is a good beginning
    Of course details will be worked out as it presents itself in the process…
    .

  17. Gerald Andres | January 3, 2020 at 9:16 am |

    To somewhat change the subject. I am hearing a rumor that AMLO has set up some program to monitor Mexican Bank Cards usage. Possibly for tax purposes to help pay for this new medical program. Heard anything like that? Thanks, I enjoy your emails, very informative.

    • Supposedly, it’s to facilitate a program to get instant “facturas” (tax receipts). The information is used for tax purposes but it won’t have much impact on expats. You’re already taxed on the money you spend in the form of an IVA.

      It’s estimated that over 23% of Mexico’s GDP is made up of the “informal economy.” Those are the workers and businesses who operate under the table. Between those folks and the tax cheats using fictitious “facturas”, Mexico is missing out on a lot of income. AMLO has been working on improving that situation.

      Here’s an article about the debit/credit card link to the tax folks. If you’re Spanish isn’t great, you can run it through Google Translate:

      https://heraldodemexico.com.mx/mer-k-2/sat-factura-instantanea-tarjeta-credito-rfc-mitos-multas-impuestos-hacienda-como-funcionan-facturas/

  18. Will this plan include Baja Sur? We have a local clinic in Todos Santos. Would I just go there with my BC?

    • Yes, it is nationwide but it’s only been in existence for three days, so it’s anyone’s guess how they’re handling it at the local levels. Having lived in Mexico for almost 5 years, I know from experience that when policies or law change, it takes a long time to see the changes at the line level.

  19. @Paul. So in the past, you’ve mentioned the advantage of having permanent residency (perhaps temp also) in obtaining better rates for medical services. To clarify, that was n the *private* system for out of pocket expenses? I know it’s very early in the transition to the new system, but is perm/temp residency still important for lowering health care costs

    • Yes, that is in the private system and it will make it easier to use the public system because you will have a CURP (alphanumeric population identifier).

  20. Thank you Paul for sharing this great news. So for Mexican permanent residents with CURP, they can use public healthcare for free all over Mexico or only in the municipalities they live?

    I wonder if you will write a blog on Pros and Cons for Americans/Canadians becoming Mexican citizens?

    • According to the information I’ve gathered, you can use the facilities all over the country.

      As far as the citizenship thing goes, I actually have that on my list of possible topics.

  21. John McCloud | January 8, 2020 at 4:07 pm |

    I believe that the birth certificate referred to in the INSABI regulations is a Mexican birth certificate, not just any birth certificate. I acknowledge that the regulations do not spell this out, but I think the intent is fairly clear. At the moment anyone living in Mexico who can come up with his or her birth certificate could make a legal claim to the right to coverage, but I suspect that once someone attempts this, INSABI officials are going to change the wording to make it clear that foreign birth certificates do not count. I may be wrong, but I think not.

    • Some people think it will eventually state that in the supporting regulations that will eventually be written, others say that it won’t be limited because the president wanted everyone to have equal access. That would include the undocumented immigrants from Central America etc. I’m sure we’ll know one way or another before the end of the year.

  22. Mexican news is filled with reports of Mexicans who had SP and are now being charged hundreds to thousands for treatment. Yesterday, our illustrious president in his morning conference said it would take months to get things going. I hope people can afford to wait. Also, keep in mind that SP and now INSABI is not an equivalent of IMMS or ISSTE. It does not cover surgeries, chemo treatments, mostly walk-in doctors visits, broken bones, and the like. I won’t put much hope in the program. As an ex-pat I have always paid for IMSS and it too has it’s defects. Knowing what clinics, doctors and hospitals to use is key. Ajijic is one city with new facilities. I live outside of Monterrey and the hospitals in the city are dumps. The exceptions are the specialty hospitals for preemies, transplants, dialysis, and heart bypass. After a lifetime here, I have seen no major change for the better in public healthcare.

    • Thanks for sharing that. I’ve been reading those reports in the news too. We plan to stick to the private healthcare system.

  23. I wonder if we should apply and get this now as PR’s for 10 years in Q Roo? I wouldn’t not use this service at this point as the care and hospitals are not up to standard but hoping they will be in the future!

    • You don’t have to apply for it, it’s automatic. All you have to do is head to a level one or two public health facility like the Centros de Salud that are in most towns or IMSS Bienestar.

  24. Hmm, I do have a curp. I am thinking its best not to cheap out an go with IMSS as long as they dont disquaklify you for some sort of pre existing condition. I am thinking that something like skymed is also not a bad idea since I still have Canadian medicare (I make sure I spend 5 months a year in Canada)

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