ACA 2027: benchmark premiums up 13%, and Medicare rarely covers Mexico

November 5, 2026. Health plans on the Affordable Care Act (ACA) Marketplace are going up for the second year in a row: the average increase in benchmark silver premiums for 2027 is 13%, according to the analysis KFF published on October 30. Open enrollment began on November 1 in most states.

If you are an American living in Mérida, Cancún or San Miguel de Allende, the more important question is a different one: what protects you here if you get sick. As a rule, Medicare does not.

ACA premiums for 2027: 13% higher on average

KFF, the health policy research organization, reports that insurers proposed a median increase of 15% and that finalized benchmark silver premiums rise 13% on average. In states that use HealthCare.gov the increase is 11%; in states that run their own platform, 16%.

It follows a 26% jump from 2025 to 2026, the year the enhanced premium tax credits expired. KFF notes that most enrollees receive a subsidy, so not everyone will pay the full increase.

Medicare outside the United States: you usually pay

The official Medicare page is blunt: Medicare usually doesn't cover health care while you are outside the US, and in most cases you pay all costs. The exceptions are narrow, such as certain services on a cruise ship that is in a US port or no more than six hours away from one, or rare cases of hospital care abroad, for example when you are in the US and a foreign hospital is closer than a US one. If you live in Mexico, they usually don't apply.

Some Medigap supplement plans pay 80% of a foreign travel emergency, up to plan limits, according to the Medicare.gov comparison chart. The chart refers to emergencies while traveling; it does not mention check-ups or planned treatment, which is what someone living in Mexico needs.

And a hospital stay in the US is expensive. HealthCare.gov, the federal government's portal, puts the average cost of a three-day hospital stay at around $30,000, or 561,441 pesos at the Bank of Mexico FIX rate of November 5 (18.7147). Fixing a broken leg can cost up to $7,500.

What changes with a Mexican major medical policy

If you live in Mexico, you can buy major medical insurance (gastos médicos mayores) from a Mexican insurer, subject to each company's age and underwriting rules. These are the practical differences compared with relying on Medicare or travel insurance:

• You use it here, in hospitals here. According to Condusef, Mexico's financial consumer protection agency, depending on your policy the insurer can pay the hospital directly; if you pay first, you can ask for reimbursement. That is why it pays to check which hospitals are in the network, such as the ones across Mexico, by city, listed on our hospitals page.
• It can be tax deductible. Article 151, section VI, of Mexico's Income Tax Law lets individuals resident in the country deduct major medical premiums when the beneficiary is the taxpayer, their spouse or common-law partner, or their parents, grandparents, children or grandchildren. It applies if you are a Mexican tax resident who files an annual return, within the requirements and limits of the law.
• Coverage outside Mexico, if you need it. If you travel to the US often, there are international health insurance plans that also cover you abroad, depending on the area you choose.

Mexico has fine print too

Mexico is not immune to medical inflation. AMIS, the Mexican insurers' association, reported on October 14 that in the first quarter of 2026 the average major medical claim was 100,852 pesos (about $5,389), 17.8% more than in the same period of 2025. It is not the same measure as the HealthCare.gov figure, because it includes every kind of claim and not only hospital stays, but it gives a sense of scale.

Before you sign, check the deductible, which you pay before the insurer steps in, and the coinsurance, the share of the bill that stays with you. Condusef also reminds buyers to check exclusions and waiting periods for certain illnesses or treatments. And disclose your full medical history on the application: leaving something out can cost you the claim.

How 1SEGUROS can help

At 1SEGUROS, serving clients all over Mexico since 2001, we compare major medical plans from several insurers operating in Mexico and explain in English or Spanish what each one covers, which hospitals it includes and which clauses to read closely. If you only spend part of the year here, also look at travel insurance. Message us on WhatsApp at +52 999 316 7145.