Mexico's major medical insurance reform: a cap on increases and portability

November 13, 2026. The reform that seeks to curb increases in major medical insurance could be debated in Congress before the end of the year, according to El Economista. The Mexican Association of Insurance Institutions (AMIS) has been in talks with lawmakers to change it, and the insurance sector hopes the cap on premium increases will be left out.

If you live in Mexico and have major medical insurance, especially if you are already over 60, this debate is worth following.

What the bill proposes

The bill was filed by congressman Yericó Abramo Masso, of the PRI party, and published in the Gaceta Parlamentaria on February 12, 2025. It amends and adds to Article 200 of the Insurance and Surety Institutions Law (Ley de Instituciones de Seguros y de Fianzas) with these points:

• A cap on increases. Premium adjustments would take into account age, claims history and inflation as measured by INEGI, Mexico's statistics agency, but could never exceed the previous year's inflation plus 5 percent.
• A fund for later years. Policies for people under 60 would include a percentage for a fund that offsets increases after that age. People who turn 60 with 20 or more years of coverage would have that fund set out in their contract so they stay within the cap.
• Medicines included. Major medical insurance would have to cover medicines and medical supplies.
• Portability. Portability of seniority would have to be guaranteed so you can switch from one insurer to another.
• Out-of-network doctors. Insurers would have fee schedules to pay doctors outside their network, with amounts that are competitive in the medical market.
• Itemized products. Insurers would have to offer all their products with a full breakdown, so you can make an informed decision.

So far it is only a bill, not law, and the text that is voted on may be different. According to Expansión, in September the congressman said the committee report was to be voted on last April 28, but the insurance sector asked for more time. The same outlet reported that the proposal under discussion also includes requiring private hospitals to publish their rates every year and removing VAT from older adults' major medical policies.

What insurers say

José Antonio Barreiro, director of Health and Major Medical Insurance at AMIS, told El Economista that price controls are not a good measure in any sector or any market, and that limiting prices without measures to counter the increases would unbalance the sector and have an adverse effect. He attributed the increases to the cost of hospital services, doctors' fees, private medical infrastructure, technology and new treatments, and cited claims growing 16%, premiums rising 9% and private medical inflation expected to end the year close to 14%.

Industry figures show thin margins. According to Expansión, citing a Swiss Re Institute report, the combined ratio for major medical insurance was 99.1% in the first half of 2026: out of every 100 pesos in premiums, about 99.10 went to claims and technical costs. The consultancy WTW expects medical inflation in Mexico to fall from 17.8% in 2026 to 12.8% in 2027.

AMIS also has its own proposal. In February it put forward products for older adults with clear coverage and rules, savings plans to soften the impact of premiums in later life and more transparency across the care chain, according to Expansión.

Why it matters if you live in Mexico

Increases driven by age and the cost of care are not unique to Mexico. In Germany, for example, private health insurance premiums will also go up in January for many policyholders, although it is a different system, as we reported in our November 12 article. Here, Congress is debating rules designed for older policyholders, and insurers themselves are proposing products and savings plans for that stage of life.

What to do while it is decided

1. Don't let your policy lapse while you wait for the reform. Portability of seniority is a proposal, not a rule in force. Before switching insurers, ask for written confirmation that they will recognize your seniority and the waiting periods you have already completed.
2. If your renewal goes up a lot, adjust before you cancel. According to Fitch, when premiums rise policyholders choose more limited coverage or raise their deductibles and coinsurance. Check what you give up with each change, as we explained in our article on the Fitch report.
3. Read your policy's general conditions. Look at what they say about medicines, the hospital network and out-of-network doctors, the points the reform seeks to change.

Your major medical insurance with 1SEGUROS

At 1SEGUROS, in Mérida and with more than 30 years of experience, we compare national and international major medical insurance from several insurers and review with you the renewal, deductible, coinsurance and the seniority they recognize before you decide. We help you in Spanish or English. Message us on WhatsApp at +52 999 316 7145.