Deductible and coinsurance: what they are and how much you pay
These are the two words that confuse people most when buying major medical insurance (in Mexico, "gastos médicos mayores"). Understanding them helps you choose well and avoid surprises when you use your policy.
The deductible: the first part you pay
The deductible is a fixed amount you pay at the start of each condition, before the insurance starts paying. It works much like the deductible on car insurance.
If your deductible is 20,000 pesos and your surgery costs 150,000, you cover the first 20,000 and the insurance takes care of the rest (minus the coinsurance, which we cover below).
You pay it once per condition, not every time you see the doctor for the same issue. If you have surgery and later need follow-up visits for that same cause, you usually don't pay the deductible again.
Coinsurance: a shared percentage
After the deductible, many policies ask you to cover a percentage of what's left. That percentage is the coinsurance; it's usually between 10 and 20%.
Most policies set a coinsurance cap: the maximum amount you would pay per condition. This matters because, with an expensive illness, the cap is what protects your wallet.
A complete example
Illustrative example
- Total cost of care: 150,000 pesos
- Deductible: 20,000 pesos (you pay this)
- That leaves 130,000. Coinsurance of 10%: 13,000 pesos (you pay this)
- You pay 33,000 pesos and the insurance pays 117,000.
Amounts and percentages vary by insurance company and by the plan you choose.
High or low deductible?
A higher deductible makes your policy cheaper each year, but you pay more when you use it. A lower one costs more each year, but protects you sooner.
- Higher deductible if you want protection against serious events and can cover mid-sized expenses on your own.
- Lower deductible if you'd rather pay a bit more each year and spend less out of pocket when something unexpected happens.
There's no single answer: it depends on your savings, your age and your family. That's exactly the part worth reviewing calmly before you buy.