OBJECTIVES: Few data has been published in Mexico related to direct smoking costs from the consumer perspective. To estimate lost income and pocket costs related to smoking diseases from the perspective of Mexican families METHODS: The analysis incorporated patients with public, private and no-health insurance from 18-65 years. Through Mexican literature review, medical costs and prevalence of 3 major diseases associated with tobacco consumption were identified: acute myocardial infarction (AMI), chronic obstructive pulmonary disease (COPD) and lung cancer (LC) as well as absenteeism associated to each disease. Average income was extracted from 2012 national income survey. Scenarios evaluated were: 1) Publicly health-insured patients: from the 4th day of disability, the Instituto Mexicano del Seguro Social covers 60% of wages, 2) Private health-insured: economical loss of private beneficiaries is a 20% co-pay plus daily average income lost. 3) No-health-insurance: Medical costs and absenteeism represent the economical loss. Costs are expressed in 2014 USD (1USD=13MXN). Morbidity cases were extracted from published data by National Institute of Public Health and used to calculate a weighted average of economical losses for each scenario. RESULTS: The distribution of people with smoking-related disease (AMI, COPD and LC) was 25.0%, 65.4% and 9.6%, respectively. Patients in scenario 1) 2) and 3) spend/lose an average of $446.6, $8,448.2 and $37,384.95 per year, respectively (medical costs are the drivers of the economic resources lost by not-insured population). Average illness expense derived from tobacco consumption regarding the proportion of people in each scenario was $13,917 yearly (local per capita GDP is $9,749).  Regardless of health-insurance status, LC is the most expensive disease ($39,564.26), followed by AMI and COPD ($14,337.06 and $10,109.32, respectively). CONCLUSIONS: The study showed that in the long run smokers incur significant economic losses even if they have medical insurance. Costs increases to people that do not have any insurance.