Moving to Mexico comes with a lot of adjustments—new food, new neighborhoods, new ways of doing things… and yes, a new healthcare system. If you’re an expat trying to make sense of health insurance here, you’re not alone.
Understanding the fine print in a foreign language can be overwhelming, especially when terms don’t translate exactly or are used differently than in your home country. That’s why we created this bilingual glossary for expats: to help you decode the jargon, avoid costly misunderstandings, and feel more confident about your health coverage in Mexico.
Whether you already have insurance or you’re just starting to look, keep this glossary handy—it’ll make every policy, brochure, and doctor’s visit feel a lot less intimidating.
Bilingual Glossary for Expats: Health Insurance Terms You Should Know
Here’s a carefully selected list of common health insurance terms in English and Spanish, plus plain-English explanations and examples. We’ve divided them into categories to make things easier.
Costs & Payments
| Term (EN) 🇬🇧 | Término (ES) 🇲🇽 | What It Means |
|---|---|---|
| Premium | Prima | What you pay monthly or yearly to keep your insurance active. |
| Deductible | Deducible | The amount you must pay out of pocket before your insurance starts covering costs. Accidents pay no deductible |
| Co-insurance | Coaseguro | A percentage you continue paying after the deductible, usually up to a certain cap. |
| Out-of-pocket maximum | Tope de coaseguro | The total amount you’ll pay for a single claim (deductible + co-insurance) before your insurance covers 100%. |
| Copay | Copago | A fixed fee you pay for certain services (e.g., $150 pesos per doctor visit). |
🔎 Example:
Let’s say your deductible is $20,000 MXN. You get surgery that costs $200,000 MXN.
- First, you pay your deductible ($20k), then co-insurance kicks in.
- If your co-insurance is 10%, you’ll pay 10% of the remaining $180k = $18,000.
- The sum of these two (deductible + co-insurance) = $38,000.
- If your out-of-pocket max is $30,000, you’ll only pay that amount. Your insurer covers the rest.
Providers & Access
| Term (EN) 🇬🇧 | Término (ES) 🇲🇽 | What It Means |
|---|---|---|
| Hospital network | Red hospitalaria | The list of hospitals where your policy is accepted. Going outside the network usually means higher costs—or no coverage at all. |
| Preferred provider | Proveedor preferente | A doctor or hospital that gives you better rates or 100% coverage. |
| Out-of-network | Fuera de red | Medical services not covered by your policy—or only partially—because they’re not affiliated with your insurer. |
| Emergency room | Urgencias | Where you go in a true medical emergency. Usually covered, even outside the network, but terms may vary. |
| General practitioner (GP) | Médico general | A non-specialist doctor for basic checkups and referrals. |
Policy Conditions
| Term (EN) 🇬🇧 | Término (ES) 🇲🇽 | What It Means |
|---|---|---|
| Pre-existing condition | Enfermedad preexistente | Any illness or health issue you had before buying your plan. May be excluded or covered with a waiting period. |
| Surcharge | Extraprima | An extra fee added to your premium because the insurer sees you as a higher risk. |
| Waiting period | Periodo de espera | The time you must wait before certain benefits (like maternity or pre-existing conditions) are covered. |
| Insured Sum | Suma Asegurada | The maximum amount your insurance will pay per year or per incident. |
| Coverage limit | Límite de cobertura | Specific caps per illness, treatment, or category. Can be lower than your total sum insured. |
| Lifetime limit | Límite vitalicio | The total your insurer will ever pay during your entire life under the policy. Rare, but still exists. |
Special Coverage & Benefits
| Term (EN) 🇬🇧 | Término (ES) 🇲🇽 | What It Means |
|---|---|---|
| Major medical expenses | Gastos médicos mayores | Refers to insurance that covers serious or high-cost events like surgeries or cancer treatment. |
| Maternity coverage | Cobertura de maternidad | Includes prenatal visits, delivery, and sometimes newborn care—usually with a waiting period of 10 months. |
| Chronic condition | Enfermedad crónica | Ongoing illnesses like diabetes or hypertension. May require special declarations or add-ons. |
| Second medical opinion | Segunda opinión médica | A formal review of your diagnosis or treatment plan by another qualified doctor. Some plans include this. |
| Ambulance services | Ambulancia | Policies cover land ambulances, and some include air transport in emergencies. Check the fine print. |
What’s the Big Deal with These Terms?
These aren’t just abstract words in a policy—they define what’s covered, when, how much you pay, and what risks you’re actually protected against.
A common mistake expats make is assuming insurance in Mexico works just like in the U.S. or Europe. But the definitions—and even the priorities—can be very different here.
In Mexico, most local insurers work with a per event deductible. That means each medical incident—like getting COVID in February and a heart issue in August—would trigger the deductible separately. Two events = two deductibles.
But not all companies operate this way. Some international insurers, like Bupa, follow the U.S. model: a single annual deductible. If you meet it once, you’re covered for the rest of the year. Even better? All policies waive the deductible entirely for accidents.
Knowing these details can save you tens of thousands of pesos—and a lot of frustration.
Bonus: What Kind of Insurance Agent Are You Dealing With?
This one’s for the skeptical (smart!) expats. Did you know that insurance agents in Mexico have different licenses depending on what they’re allowed to sell?
Here’s a quick summary:
| License | What It Covers | Level |
|---|---|---|
| Provisional | Entry-level license, often for agents in training. They’re not fully certified yet. | Newbie |
| A1 | Life and health (individual only) | Basic |
| A2 | Auto, home, and other individual property | Basic |
| A (Complete) | A1 + A2 | Standard full license |
| B1 | Group life and health plans | Advanced |
| B2 | Group property, fleets, liability, etc. | Advanced |
| B (Complete) | B1 + B2 | Professional level |
| C | High-risk coverage (aircraft, stadiums, reinsurance) | Expert |
| F / G / M… | Specialized licenses (e.g., fianzas, livestock, etc.) | Niche |
📍 Pro tip: Always ask your agent for their cédula number and check it on the official CNSF agent registry.
If they only have a Provisional or A1 license and they’re pitching you “the best” coverage—or the price sounds too good to be true—you might want to ask some deeper questions. 🚩
Want to go deeper? Check out our full article: > How to Know if an Insurance Agent in Mexico Is Legit
Final Thoughts: Understanding Is Power
This bilingual glossary for expats isn’t just about definitions—it’s about making informed decisions and protecting your health (and wallet) in Mexico. Whether you’re choosing your first plan or switching providers, understanding these terms is the first step to doing it right.
And hey—if your current agent can’t explain these words clearly… maybe it’s time to find one who can.
Still figuring out what’s best for you? We break it all down here:
> Best Health Insurance for Expats in Mexico 2025 Guide
Ready to explore your health insurance options in Mexico?
At Donna, we specialize in helping expats find private health insurance plans—both national and international, with or without deductibles—tailored to your medical needs, lifestyle, and budget.
Whether you’re retiring in Mexico, working remotely, or just spending a few years under the sun, we’ll help you understand your options in plain English (or Spanish, if you prefer). No fluff. No pressure. Just honest guidance and clear answers.
If you’re ready to move forward, send us a message on WhatsApp or fill out this form—we’ll get back to you shortly.
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