Medicare Advantage in Mexico: What U.S. Expats and Local Providers Need to Know

With a growing U.S. retiree population in Puerto Vallarta and other cities in Mexico, confusion remains widespread about whether and how Medicare Advantage (Part C) can be used for medical care abroad. Many expats have been misinformed—sometimes by well-meaning advisors, other times by those with a financial incentive to sell private insurance.

This article sets the record straight based on federal law, Social Security Administration (SSA) guidelines, and real-world practice from local providers here in Mexico.

Quick Answer

If you’re a U.S. citizen enrolled in a Medicare Advantage plan, you can receive emergency and urgent care in Mexico—including Puerto Vallarta—as long as you maintain legal U.S. residence.

What the Law Says

Under 42 CFR §422.113, all Medicare Advantage plans must cover emergency and urgently needed services worldwide:

“An MA organization must provide enrollees access to urgently needed services and emergency services regardless of whether the services are obtained within or outside the MA plan’s service area.”

Residency vs. Physical Presence

There is no federal requirement that you live in the U.S. six months per year. What’s required is that you maintain legal residence in your plan’s U.S. service area.

According to the SSA, you can establish U.S. residency with at least two of the following:

• U.S. driver’s license or state ID
• Filing U.S. taxes (state or federal)
• Voting and receiving mail at a U.S. address
• Owning or leasing a residence in the service area
• Not notifying your insurer of a permanent move abroad

How Emergency Coverage Works in Puerto Vallarta

Medical providers such as Lakeside Medical Group have 15+ years of experience billing major U.S. Medicare Advantage insurers (Aetna, Humana, UHC) directly for emergency services.

For patients:

• Carry your Medicare Advantage ID card and U.S. ID
• Ensure your plan includes global emergency coverage (most do)
• Request itemized bills if paying upfront for reimbursement

For providers:

• CMS permits emergency claims from non-CMS-enrolled facilities
• Send full diagnosis and CPT codes to the patient’s MA insurer

Common Myths — Debunked

Local Example: Lakeside Medical Group

Lakeside Medical Group operates in Puerto Vallarta, Guadalajara, and Chapala. They handle emergency billing for Medicare Advantage members and often provide care with no upfront cost.

Final Takeaways

• Yes – you can use your Medicare Advantage plan in Mexico for emergencies
• Maintain legal U.S. residency (not physical presence)
• You do not need to buy private insurance unless you want routine care abroad
• Inform providers about emergency billing options

Sources & References

• CMS - Centers for Medicare & Medicaid Services
• MA Organization - Medicare Advantage Organization
• 42 CFR §422.113 – CMS Regulation
• CMS Medicare Managed Care Manual – Chapter 4
• SSA Legal Residency Policy
• Lakeside Medical Group (Puerto Vallarta)

If you or your provider would like a printable version of this article or the official Medicare Advantage guide for Mexico, please contact This email address is being protected from spambots. You need JavaScript enabled to view it..