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Mexico's health care lures Americans

By Chris Hawley, USA TODAY

September 1, 2009

MEXICO CITY — It sounds almost too good to be true: a health care plan with no limits, no deductibles, free medicines, tests, X-rays, eyeglasses, even dental work — all for a flat fee of $250 or less a year.

To get it, you just have to move to Mexico.

As the United States debates an overhaul of its health care system, thousands of American retirees in Mexico have quietly found a solution of their own, signing up for the health care plan run by the Mexican Social Security Institute.

The system has flaws, the facilities aren't cutting-edge, and the deal may not last long because the Mexican government said in a recent report that it is "notorious" for losing money. But for now, retirees say they're getting a bargain.

"It was one of the primary reasons I moved here," said Judy Harvey of Prescott Valley , who now lives in Alamos, Sonora . "I couldn't afford health care in the United States . … To me, this is the best system that there is."

It's unclear how many Americans use IMSS, but with between 40,000 and 80,000 U.S. retirees living in Mexico , the number probably runs "well into the thousands," said David Warner, a public policy professor at the University of Texas .

"They take very good care of us," said Jessica Moyal, 59, of Hollywood , Fla. , who now lives in San Miguel de Allende, Mexico , a popular retirement enclave for Americans.

The IMSS plan is primarily designed to support Mexican taxpayers who have been paying into the system for decades, and officials say they don't want to be overrun by bargain-hunting foreigners.

"If they started flooding down here for this, it wouldn't be sustainable," said Javier Lopez Ortiz, IMSS director in San Miguel de Allende.

Pre-existing conditions aren't covered for the first two years, and some newer medicines and implants are not free. IMSS hospitals don't have frills such as televisions or in-room phones, and they often require patients to bring family members to help with bathing and other non-medical tasks. Most doctors and nurses speak only Spanish, and Mexico 's overloaded court system doesn't provide much recourse if something goes wrong.

But the medical care doesn't cost a dime after paying the annual fee, and it is usually good, retirees and health experts say. Warner said most American retirees enroll in IMSS as a form of cheap insurance against medical emergencies, while using private doctors or traveling back to the USA for less urgent care. Medicare, the U.S. insurance plan for retirees, cannot be used outside the United States .

Program prompts relocation

The program has helped people such as Ron and Jemmy Miller of Shawano, Wis. They decided to retire early, but knew affording health care was going to be a problem.

Ron was a self-employed contractor, and Jemmy was a loan officer at a bank. At ages 61 and 52, respectively, they were too young to qualify for Medicare, but too old to risk not having health insurance.

"We knew that we couldn't retire without Medicare," Jemmy Miller said. "We're pretty much in Mexico now because we can't afford health care in the States."

The couple learned about IMSS from Mexico guidebooks and the Internet. They moved to the central city of Irapuato in 2006, got residency visas as foreign retirees, and then enrolled in IMSS.

The IMSS system is similar to an HMO in the United States , Jemmy Miller said. Patients are assigned a primary care physician and given a passport-size ID booklet that includes records of appointments. The doctor can refer patients to specialists, a bigger hospital or one of the IMSS specialty hospitals in cities such as Guadalajara or Mexico City .

In 2007, Ron Miller got appendicitis and had emergency surgery at the local IMSS hospital. He was in the hospital for about a week and had a double room to himself. The food was good, the nurses were attentive, and doctors stopped by three or four times a day to check on him, he said. At the end of it all, there was no bill, just an entry in the ID booklet.

The Millers may soon move back to the United States , but Jemmy Miller said they want to try to maintain the IMSS coverage. "If something big really comes up, we'd probably come back to Mexico ," she said.

Different levels of care offered

IMSS is one of several public health systems in Mexico , each with its own network of hospitals and clinics. The program, which was founded in 1943, is funded by a combination of payroll deductions, employer contributions and government funds. It covers 50.8 million workers.

IMSS facilities are a step up from the state hospitals, but not as advanced as Mexico's private hospitals, which are often world-class, said Curtis Page, a Tempe, Ariz., doctor and co-author of a book about health care in Mexico.

Most patients seem grateful nonetheless. When Michael Kirkpatrick, 63, of Austin , fell off his motorcycle near his home in San Miguel de Allende, IMSS surgeons gave him a stainless-steel artificial hip.

There was no physical rehabilitation after the surgery, just a checkup a few weeks later.

"There was not the kind of follow-through and therapy that you would expect if you were doing this in the first world," Kirkpatrick said. "But it was satisfactory. The hip feels good."

Bob Story, 75, of St. Louis , had prostate-reduction surgery at an IMSS hospital in Mazatlán and discovered that patients were expected to bring their own pillows. It was a small price to pay, he said, for a surgery that would have cost thousands of dollars back home.

"I would say it's better than any health plan I've had in the States," he said.

Hawley is Latin America correspondent for USA TODAY and The Arizona Republic

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I am on IMSS and a USA citizen. I have used IMSS extensively and rate it a 9 on a scale of 10. I am treated at Ocho de Julio, Washington Street, and Centro hospitals. I am the only gringo I have ever seen at any hospital. The Mexican protocols at IMSS bedevil a Mexican so good luck to any gringo seeking treatment.

Anyone having enrolled in IMSS has reached level 1.

Bueno Suerte

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I've always found it very interesting and generous that the Mexican Government will allow foreigners to be part of the IMSS system and get all their "late in life" medical issues looked after almost for free. Its a shame that people like Ron and Jemmy Miller could spoil that for everyone by moving back to the United States and trying to abuse IMSS by hanging on to it while not residing in Mexico. I sure hope they don't find a way to do that. If every American who couldn't afford health care came down here and pulled that stunt, IMSS would go broke for sure. They should be ashamed of themselves for trying to take advantage of the Mexican Government's generosity in this way.

According to the article eyeglasses and dentistry are also covered by IMSS. I was unaware of this. Is that true or just the reporter's error? Does anyone know?

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I've always found it very interesting and generous that the Mexican Government will allow foreigners to be part of the IMSS system and get all their "late in life" medical issues looked after almost for free. Its a shame that people like Ron and Jemmy Miller could spoil that for everyone by moving back to the United States and trying to abuse IMSS by hanging on to it while not residing in Mexico. I sure hope they don't find a way to do that. If every American who couldn't afford health care came down here and pulled that stunt, IMSS would go broke for sure. They should be ashamed of themselves for trying to take advantage of the Mexican Government's generosity in this way.

According to the article eyeglasses and dentistry are also covered by IMSS. I was unaware of this. Is that true or just the reporter's error? Does anyone know?

I can't imagine how Mr. & Mrs. Miller would be able to keep their IMSS if they move back to the States since one of the prerequisites for having IMSS is that one must have an active FM3 or FM2. We all know that renewing usually involves either multiple trips to the Municipo Palacio in Chapala or dealing with a local expediter--one can't just run in and out and have it renewed. They also would have to have proof that the are living here--recent utility bills, etc. All this would be a lot to have to pull off!

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I now look at IMSS differently and see how those who retired early and have no Medicare would move to Mexico. The savings in health insurance alone would more than pay for rent for a couple plus many other expenses.

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Availability of IMSS was a big factor in our decision to move here. My husband is on Medicare, but I won't be eligible to another 15 years. I wanted to retire early, but refused to take the risk of possibly losing everything we had in the states over a medical emergency. Paying out of pocket for insurance there would have made it financially unaffordable.

My husband uses IMSS to get his medications. I still have not had a reason to go there for myself. But I can say that it is not a walk in the park dealing with the Chapala clinic... Still, it works for our purposes and as an emergency fall-back. I have to say, articles like this make me nervous. It's just advertising to get more Americans into an already overloaded system. It's not as great as they make it out to be, and seems to always be on the verge of "bankruptcy". More "medical refugees" from the States could just ruin it for all of us.

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It bothers me that people move into this country and get on IMSS, a system that is supposed to be there for the purpose of helping less fortunate Mexicans. I feel that it is pretty similar to Mexicans who move to the U.S. and then start collecting welfare. I suppose you could argue the two balance each other out or you could conclude that two wrongs don't make a right.

Private insurance here is pretty cheap, particularly for younger people. I wonder if it isn't a more moral choice to buy this and leave the slim resources of IMSS for the impoverished Mexicans who surely need it more than any of us do.

It really surprises me that Mexico hasn't put a citizenship requirement on this program.

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It bothers me that people move into this country and get on IMSS, a system that is supposed to be there for the purpose of helping less fortunate Mexicans. I feel that it is pretty similar to Mexicans who move to the U.S. and then start collecting welfare. I suppose you could argue the two balance each other out or you could conclude that two wrongs don't make a right.

Private insurance here is pretty cheap, particularly for younger people. I wonder if it isn't a more moral choice to buy this and leave the slim resources of IMSS for the impoverished Mexicans who surely need it more than any of us do.

It really surprises me that Mexico hasn't put a citizenship requirement on this program.

I myself have no problem participating in the IMSS. I haven't used the service as yet, however I am paying my fees. So far the government is ahead on me.

When I built my house I spent over $250,000MXP on items that had a 15%IVA tax. I paid over $60,000MXP in government fees when I titled the house, not to mention the IMSS fees paid for the construction workers. Monthly I spend more than the average Mexican citizen, and pay the IVA in that as well.

I have benefited the Mexican economy, the Mexican government, and the Mexican people by my moving here. I was granted the right to be here, and pay a yearly fee for it. Based on averages I would surprised that the net effect to Mexico's economy isn't a plus for those of us who have IMSS.

I am certainly not equal to an illegal who pays nothing and gets welfare.

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I guess MC would want those of us without other options to go back to the USA instead of contributing to IMSS for years without having to use it yet. Then we could participate in purely socialized medicine; ie: welfare at his expense.

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Without making an argument about it, I find it very difficult to believe why anyone who lives here can say "They cannot afford private insurance"?

If you are on SS such as both of us are, I don't see why anyone cannot afford Private Health insurance. Does everyone here realize how cheap Private Health insurance is in Mexico compared to the States? It's one half or less than the cost in the US for far better coverage here.

If you were living in the US and on Medicare, it only pays 80%. What would you do to pay the other 20%? You would need to carry a MediGap Policy that could actually cost MORE than Private Health insurance in Mexico.

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