What is the coinsurance in a major medical insurance policy in Mexico?
- Sáas Consultores
- 1 day ago
- 2 min read
Coinsurance in a major medical insurance policy in Mexico is the percentage that the insured must pay on covered medical expenses once the deductible has been met. It’s a way to share the financial responsibility between you and the insurance company.
Coinsurance applies only to the covered expenses that exceed the deductible. Most policies in Mexico include a maximum limit, which caps the total amount you’ll have to pay under this concept.
How is it calculated?
The total amount of medical expenses is determined.
The deductible is subtracted.
Coinsurance is applied to the remaining amount (e.g., 10%).
If the result exceeds the established limit, you only pay up to that cap.
Example
Carlos, age 50, underwent spinal surgery that generated $300,000 MXN in medical expenses.
His policy includes a $20,000 MXN deductible and 10% coinsurance with a cap of $30,000 MXN.
Covered expenses after deductible: $280,000 MXN
10% coinsurance: $28,000 MXN → Carlos pays this
The insurance company pays: $252,000 MXN
Without a coinsurance cap, Carlos could have paid more if the total expenses had been higher.
Recommendations
Review your policy’s general conditions to verify whether coinsurance has a cap, what that cap is, and whether any procedures or coverages apply a different coinsurance percentage or limit.
Using doctors and hospitals within the insurer’s preferred network may help reduce the coinsurance cap you are responsible for.
Keep in mind that a lower coinsurance percentage typically increases the cost of the premium.
Compare plans with different coinsurance percentages to make an informed decision.
Consider purchasing additional coverages that reduce coinsurance in certain situations, such as direct payment arrangements.
At Sáas, we have a team of consultants who can guide you through the process of contracting and using your policy.
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