AMIS Takes a Medical Expense Insurance Reform to Congress as Medical Inflation Keeps Climbing

The industry is seeking rules to expand coverage—especially for older adults—without jeopardizing solvency in an environment of rising hospital costs.

The Mexican Association of Insurance Institutions (AMIS) introduced a proposal to Mexico’s Chamber of Deputies for a comprehensive reform of the medical expense insurance market, aiming to address an issue that has been putting pressure on households, hospitals, and insurers alike: the sustained rise in the cost of private healthcare well above headline inflation. The initiative proposes changes to improve consumer information, adapt products to the needs of an aging population, and increase transparency across the care delivery chain, without undermining the system’s technical viability.

The industry’s diagnosis starts from two realities happening at the same time. On the one hand, demand for healthcare services rises as the population ages and the incidence of chronic conditions increases; on the other, private medicine becomes more expensive due to factors such as technological innovation, more complex procedures, input costs, and pressure on physician fees and hospital capacity. In that context, AMIS said private medical costs are growing between 14% and 16% per year—dynamics that, if automatically passed through to premiums, reduce affordability and raise the risk that policyholders will drop coverage.

In 2024, according to figures presented by the association, the sector handled nearly 3 million claims and paid around 117 billion pesos, with a loss ratio of 74%. AMIS emphasized to lawmakers that the line’s net profit—close to 4 billion pesos—came mainly from the investment returns on reserves, rather than from “extraordinary margins” in underwriting results, a point meant to temper the public debate around pricing and profitability.

The proposal comes at a time when Mexico’s economy is sending mixed signals: gradual disinflation compared with recent years, but still with pressure in services; a labor market that has shown resilience, though with uneven performance across sectors; and households facing higher costs in essential categories. In this setting, medical expense insurance acts as a financial buffer for middle- and upper-income families, but it is also a product highly sensitive to price shocks, because keeping coverage depends on the ability to pay over a lifetime.

Older adults: the breaking point between access and sustainability

One of the proposal’s central focuses is the older-adult segment, where a significant share of complaints about premium increases, restrictions, and changes in terms is concentrated. AMIS is proposing products designed specifically for this stage of life, with clear coverages and rules, as well as savings mechanisms to help “smooth” the cost of insurance in old age. The logic is to act before the insured reaches ages when medical risk spikes, because when premiums jump sharply, the likelihood of dropping the policy rises—leaving people exposed to catastrophic expenses precisely when they most need protection.

The legislative discussion also opens a window to revisit incentives: how to improve the design of deductibles and coinsurance, how to make products more comparable across companies, and how to better align coordination with hospitals and doctors to reduce disputes over billing and authorizations. In economic terms, any reform that tries to contain premiums without addressing underlying medical inflation tends to push pressures onto another part of the system; that is why the industry insists that transparency and operational efficiency—including cost traceability—must be part of the same package.

Currently, more than 14 million Mexicans have medical expense insurance, according to AMIS, and the line channels more than 117 billion pesos a year into private care. From a macro perspective, that flow functions as financing for private infrastructure and services and, at the same time, as a partial substitute for out-of-pocket household spending. However, coverage remains limited relative to the size of the population and highly concentrated by income level and formal employment, making the debate over how to expand access without creating distortions or weakening solvency especially relevant.

In the near term, the outcome will depend on how Congress balances consumer protection, contractual certainty, and actuarial viability. If the reform moves forward on technical grounds, it could improve product comparability, reduce friction in claims, and create clearer options for older people. If rules are tightened without addressing the structural rise in medical costs, the risk is that supply becomes more expensive or more restricted, reducing insurance penetration in a country where pressure on healthcare spending will continue to grow.

In short, AMIS’s proposal puts a long-term economic challenge on the table: how to finance higher-cost medical care in an aging society, preventing insurance from becoming unaffordable and without shifting risks in opaque ways among users, hospitals, and insurers.