Health Insurance Choices

[Serenity6]

Someone asked, why leave the US if you need Medicare, and move to MX. A very reasonable question.

I had to make the difficult decision at age 38 whether to stay in the US or leave. I was too sick to work and receive the max amounts of social security disability each month. While Medicare was great, my quality of life diminished significantly. The cost of living made i very difficult for me to live relatively comfortably in California. My social security check barely covered the bare necessities. I had to live with housemates, each of which ended up being a nightmare scenario. Renting inexpensive apartments usually meant living in a terrible part of town, in a dump, where you needed ten locks and a weapon under your pillow for personal safety.

Some people suggested moving to a different and cheaper state in the US - makes sense. Except, any cold weather state was out, as cold weather made the chronic pain much worse. I also can't handle high heat or humidity. That narrowed my options down a lot.

So Mexico, with its nice climate (here, at least) was much better for my health and meant less pain. Also meant I could afford to rent a small, but comfortable place, away from noise, which is also better for my health. I have insurance that covers me as a foreigner, which means I pay up front for stuff I can afford, and for surgeries, I get pre approval. Prescription meds here are, for the most part much cheaper than in the US. Doc visits are on average $40. In the US, I'd be charged from $125 to $300 for 10 minutes of my doc's time. And in the US, many of my docs didn't take medicare.

The biggest thing was I needed to heal, physically and emotionally, from a long-term catastrophic illness, so I can hopefully one day return to work and contribute to society. With social security as my only income, that just wasn't an option in the US. But here, life is less stressful, I have access to docs and the meds I need, the climate benefits my health, and I am much more relaxed.

Of course, every person's circumstances are different, and for others, it could make more sense for them to stay in the US. But, Medicare alone isn't the end-all, save-all. If you have Medicare, but can't afford to pay rent, what's the point of staying in the US? If you are on your own and medicare is your only source of income, good luck finding a reasonably comfortable place to live, and have enough money left over for food, a car, and other basic life needs, in the CA.

[Yo1]

Best Doctors annual deducible is now $3000US and the annual premium is a little over $1000US. Best Doctors is catastrophic insurance for cancer, heart, stroke, and illness etc treatments and will not cover office visits, x-rays or MRIs (except when related to hospitalization) or hip or knee replacements unless you have an accident, like falling off a ladder. If you need coverage that includes joint replacements, you will have to pay considerably more with another company.

FYI--keep in mind that Medicare covers 80% of the allowable amount of most medical bills. You are responsible for the other 20% if the allowable amount. So if the Dr. charges $150 for something and the allowable is $60, Medicare will pay $48 and you are liable for $12. If the Dr. doesn't "take assignment", you are also liable for the difference between $150 and the $60 allowable which would be another $90. Most Drs. "take assignment" because if they don't they are penalized by Medicare. That's why many Drs. don't take new Medicare patients because they can't afford to see patients for a payment that is less that it costs to see them. Some doctors and some hospitals don't "take assignment" so one needs to be sure to ask. Otherwise you will be liable for a huge bill you aren't prepared for.

[sm1mex]

Plan SeguroSeguro is a good policy at the good hospitals. You can get it over age 70 if you are pretty healthy. I have Met Life of Mexico. Excellent policy if you are 69 or under. Check with Andre Bellon at Bellon insurance when you get down here. Excellent customer service.

[Al Berca]

There are many types of individual policies with Best Doctors, as well as at least two group policies available. The group policy with Focus on Mexico is currently 1300 USD for policy and 3900 USD deductible, a 30% increase from last year. It is worldwide coverage and deductible is paid only once a year, regardless of which or how many covered services one needs. It has a direct pay contract with five of the finest hospitals in Guadalajara and many in the States and other countries.

[gypsyken]

A friend who went to Puerto Vallarta recently became abruptly and so seriously ill that emergency hospitalization and surgery were required. The person has no Mexican health insurance, only Medicare that is useless in Mexico, and although the costs of hospitalization and surgery in P.V. were less than they would have been in the U.S., they were nevertheless very substantial--and the hospital, while providing good care, was not at all reticent about demanding payment in advance, even delaying the surgery, which the surgeons were waiting to perform, until more money was provided. (Despite the significant problems with health care in the U.S., a hospital there would not have been permitted to do that.) It thus became painfully clear to me that, as other posters have said, if a U.S. citizen cannot, for any reason, obtain health care insurance in Mexico and does not have the financial resources to pay out of pocket for medical care here, he should stay in or return to the U.S. I seem to be in good health, but as I am now in my 88th year, I think that it is time for me to return to the U.S. where my Medicare can be used, I hope before a medical emergency might put me in the position that my friend was in.

[lakeside7]

Thank you for sharing your friends experience..I wonder if there is a Civil Hospital in PV that takes "indigent" people, similar to Guadalajara?

As you so correctly state regardless of the lower cost than what the US would have charged..if you do not have it , you are in deep problems

.

Sadly the numbers of people in those circumstances seems to be growing at Lakeside.

[gringal]

Is there any reason why people don't apply for Seguro Popular? Very low cost and available to nearly anyone living in Mexico, including expats.

[ajijiccharlie]

Thank you for sharing your friends experience..I wonder if there is a Civil Hospital in PV that takes "indigent" people, similar to Guadalajara?

As you so correctly state regardless of the lower cost than what the US would have charged..if you do not have it , you are in deep problems

.

Sadly the numbers of people in those circumstances seems to be growing at Lakeside.

Are you talking about indigent expats?

[cedros]

Is there any reason why people don't apply for Seguro Popular? Very low cost and available to nearly anyone living in Mexico, including expats.

Two Mexican lawyers who are both facilators have told me not to sign up with Seguro Popular but to stick with IMSS as they say SP doesn't have a proven record yet. One said that when 3 clients that she had switched from IMSS to SP wanted to switch back to IMSS, IMSS would not take them back.

[gringal]

Two Mexican lawyers who are both facilators have told me not to sign up with Seguro Popular but to stick with IMSS as they say SP doesn't have a proven record yet. One said that when 3 clients that she had switched from IMSS to SP wanted to switch back to IMSS, IMSS would not take them back.

We have IMSS and intend to stay with it. I'm only referring to the people who have absolutely NO health insurance, can't qualify for IMSS end up in a real mess if they get sick. The sorriest cases are those who seem to think a fund raiser to have their friends and neighbors foot their bills is a solution.

[gypsyken]

Re two questions posed: There is, of course, a large "Civil Hospital" in P.V., but that was not offered as an option for my friend who was told that immediate emergency surgery was required, and that flying to the U.S. for it would be impossible to do. I don't, of course, know what would have happened if the money that the hospital demanded had not been forthcoming. (Despite the fact that when my friend went to the hospital on Saturday, emergency surgery was said to be required, it was first delayed until the next day, because of what was said by the surgeon to be a need for further tests and a whole blood transfusion that required transfer to another hospital of the same company, and then delayed for a full hour the following day, Monday, while the hospital awaited the delivery of more money and the surgeons waited to perform the surgery.) And I think returning to the U.S. to receive needed service under Medicare would be much preferable to hoping to receive service in a Hospital Civil for which one could not pay a private hospital in Mexico.

As to being an "indigent" expat, one with, say, $50,000 USD in the bank cannot be said to be "indigent," but neither is such a person able to afford a possible out-of-pocket expense for medical care in Mexico.

[gringal]

This is the reason I asked the question: Why don't expats sign up for Seguro Popular, at the very least, BEFORE they need emergency care? What's the reason? We are ALL likely to need care at some point. None of us are going to get out of this alive, and a head in the sand approach is foolish. Planning ahead just makes sense.

We've dropped cash for eight years at IMSS without costing them a peso. That's okay. Insurance is something you hope you won't need.