The "free" collision insurance that comes with Amex (and probably other) cards is secondary insurance, meaning you have to file with your main insurer at home first and they'll pay what's left. But their Premium insurance ($25 USD per rental - not per day) is primary, so it's better. And it's valid in Mexico, so you can decline collision with the rental company. If you do, they grumble and put a $2,500 USD hold on your credit card (maybe more these days). If there's accident, they will collect from the money they put on hold and you settle up with Amex later. That's fine, and we did it for years.
Liability coverage is another story. US liability coverage is NOT valid in Mexico, and the coverage they are required to give you by the government is inadequate to protect you if you are in an accident and someone gets hurt. Supplemental liability coverage (usually about $20 USD a day) gets you $3 million pesos of coverage and is worth it imo.
But none of that is the problem we've had lately. Most of the big rental brands have been taken over by the same crooked franchisee. We've rented a hundred times and we know the ropes well, but these guys are relentless. They bait and switch on cars and rates and play games with insurance and exchange rates and everything else because they have you captive at the counter. Terrible experience, especially for first-time tourists. I want to deal with someone else.
We used Autosel in January and it went well. They had a package price and wouldn't let us do the Amex Premium insurance trick. The total price was on the high side, but it wasn't crazy and it was easy and honest and complete and we were very happy with it. I will never go back to the franchise operators again!