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Providers in Lake Chapala accepting Medicare?


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Hello all -- thanks for your ongoing help to a prospective retiree. I thought I saw someone post that at least one medical provider in the Lakeside area accepts Medicare. Anyone remember who that was? My search through the archives was unsuccessful. I'm guessing the coverage in question is a Medicare Part C coverage ... anyone know for sure how it would work Lakeside?

 

To clarify, we want to hedge our bets by maintaining Medicare coverage in case we don't love living in Lake Chapala. (I'm ready to go whole hog but husband is more cautious. :)) But I'm wondering how to have coverage for catastrophic events while living Lakeside. I had thought signing up for SP would work, but read here recently it doesn't cover heart attacks and broken hips -- awfully likely issues.

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It is not a question of the providers accepting Medicare but, rather, that Medicare does not cover one out of the states.  When we left we had a supplemental policy which covered one for the first 60 days out of the country.  Not sure if all supplementals have that same condition but it did help us as my husband had some expensive medical needs during that time frame.

We have a catastrophic coverage policy which we buy through a group policy offered by Focus on Mexico.  Your choices increase the younger you are so make sure to investigate and not get shut out because you reached a certain age. 

Do not be deceived that some practices take Medicare.  If they do they have a gimmick.

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Northernnewbie answered you question about Medicare in Mexico.... NADA.. You mentioned Part C which is actually Medicare Advantage, a version of traditional Medicare where one deals directly with an Insurance company and not Medicare. Since Part C is typically an HMO type of service, it is by definition locale dependent (one has to be 'In Network' for service) so it surely isn't going to happen in Mexico either. 

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ah that is true pappysmarket but just to stir the pot,such a pity since health care is 1/3 the cost here, medicare would actually save money to allow its use out of country, no? 

Bet a lot would hop right on that band wagon of fraud if possible.  Very sad...kind of like being held captive to get your benefits ..

 

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Medicare fraud is outrageous in the US with the officials saying they can't afford to hire any more investigators because of the cost.  So billions of dollars go to fraudulent providers while saving millions in employment costs.  Imagine what the fraud rate would be in Mexico?  That's part of the reason Medicare will never be accepted here.

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11 hours ago, Elizabeth said:

Hello all -- thanks for your ongoing help to a prospective retiree. I thought I saw someone post that at least one medical provider in the Lakeside area accepts Medicare. Anyone remember who that was? My search through the archives was unsuccessful. I'm guessing the coverage in question is a Medicare Part C coverage ... anyone know for sure how it would work Lakeside?

 

To clarify, we want to hedge our bets by maintaining Medicare coverage in case we don't love living in Lake Chapala. (I'm ready to go whole hog but husband is more cautious. :)) But I'm wondering how to have coverage for catastrophic events while living Lakeside. I had thought signing up for SP would work, but read here recently it doesn't cover heart attacks and broken hips -- awfully likely issues.

SP covers heart disease including heart transplants and open heart surgery. It doesn´t do hip replacements but does do hip surgeries including screws etc. The new rules as of June 1st. have you covered for all diseases and treatment that both SP and IMSS do combined including knee replacements at both IMSS and SP. IMSS does all manor of heart disease treatment and so does the SP. If IMSS in your area isn´t set up for it they will refer patients to the SP nearby that does and vice versa. They won´t be duplicating complex treatments in the same area if the IMSS has it and the SP doesn´t and visa versa if both don´t have it already. There is talk of one of them getting dialysis in the future for kidney failure.

"124. DIAGNOSIS AND TREATMENT OF HEART FAILURE

207. DIAGNOSIS AND TREATMENT OF ACUTE HEART FAILURE AND ACUTE PULMONARY EDEMA [liquid in the lungs].

284. Diagnosis and treatment of cardiac arrhythmias [pacemaker surgery]

268. SURGICAL TREATMENT OF CONGENITAL HIP DISLOCATION

276. REDUCTION OF HIP FRACTURE SURGERY

281. TOTAL KNEE Arthroplasty [replacement] "

http://www.seguro-popular.salud.gob.mx/images/Contenidos/gestion/CAUSES 2014.pdf

 

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Speaking of fraud:  the following scam has been attempted several times during my dozen years here.  A doctor or group of doctors who have connections with a U.S. medical practice will treat patients in Mexico and bill the treatment through their U.S.group to Medicare.  Once this is exposed, it is stopped.  This may have been what you heard of. Trust the posters who are telling you this fraud is not the way to go.

If you keep your multi part U.S.Medicare coverage, you can sign up with one of the "medivac" Insurance companies and you will be flown back to the States for care.  First, you must be "stabilized" here before you fly.  They advertise in the weekly Guadalajara Reporter.

If you are under 70, there is private insurance available in Mexico.  Bellon Insurace, across the road from Superlake, can advise you regarding some of these plans as can any other agent.  IMSS has a waiting period for coverage of pre-existing conditions and charges yearly fees, but is worth looking into.  Representatives from IMSS come to the Lake Chapala Society every Monday morning and can advise you.  Not necessary to be a member of LCS to use their services.

Medical costs such as office visits are so much lower in Mexico than in the U.S that many people sign up with either IMSS or Seguro Popular as a backup plan, but simply pay out of pocket for most medical care.

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If you or your husband are qualified for Tricare you can obtain coverage in Mexico. Lakeside Clinic takes Tricare and provides excellent service... They also take most major US plans... We pay for minor items out of pocket... We also keep our medicare coverage in the states... 

 

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24 minutes ago, rvanparys said:

If you or your husband are qualified for Tricare you can obtain coverage in Mexico. Lakeside Clinic takes Tricare and provides excellent service... They also take most major US plans... We pay for minor items out of pocket... We also keep our medicare coverage in the states... 

 

Where is Lakeside Clinic? 

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2 hours ago, gringal said:

 

  IMSS has a waiting period for coverage of pre-existing conditions and charges yearly fees, but is worth looking into.  Representatives from IMSS come to the Lake Chapala Society every Monday morning and can advise you.  Not necessary to be a member of LCS to use their services.

 

IMSS has a list of pre-existing chronic diseases that exclude you from joining. A few are: chronic  kidney disease/failure, advanced diabetes, chronic COPD, mental illness, drug and alcohol addiction, HIV positive and more. Other diseases have waiting periods of 6, 12, 18, 24 ..., etc. months including pregnancy. SP has no list or waiting periods.

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  • 2 years later...

I think you may be safe if a hospital takes it, but know of none so far.  I have paid cash for 10 surgeries, including a couple of minor ones, back surgery,  and TKA.  The majority of specialist, I doubt it.  Most work here once weekly for untaxed money (who cares?)  Prices reasonable.  No specialist is going to take Medicare.  I have only part A, thinking I could fly home if I needed surgery  inpatient.  But  I have had two emergencies and had to pay for them.  Personally, I heard this rumor as well, but have not seen it or.  Part B is useless.  We expats are free money to outpatient providers.  I live on very little, but can always afford the ajiic clinic and routine care as office visits are reasonable.  This is a cash based society.  More and more doctors and farmacias are taking credit cards.  I would forget about B and C here,, at least C and you will not get prescription help at all, buy all is affordable. Hope that helps.  When you are permanente,  you can purchase government IMSS,, but no preexisting conditions on that one.  There is free minor care at Seguro Populares, open to us that is really for poverty Mexicans, but will treat minor things.  There is expat insurance you can purchase here. That is your best bet if you can afford it.   I just cannot afford it

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If you keep your multi part U.S.Medicare coverage, you can sign up with one of the "medivac" Insurance companies and you will be flown back to the States for care.  First, you must be "stabilized" here before you fly.  They advertise in the weekly Guadalajara Reporter.

some of these medical companies promise more than they can deliver. The hard part is finding a hospital and a doctor willing to accept you. No one wants to accept the liability that a patient coming from another country brings with him. 

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On 8/5/2016 at 10:05 PM, bezerk said:

ah that is true pappysmarket but just to stir the pot,such a pity since health care is 1/3 the cost here, medicare would actually save money to allow its use out of country, no? 

Bet a lot would hop right on that band wagon of fraud if possible.  Very sad...kind of like being held captive to get your benefits ..

 

I was covered for a back surgery by Farm Bureau Blue Cross a dozen years ago. When Hospital San Javier said they would accept the US insurance they raised the price to US levels $41,000 USD. The hospital included the surgeon's cost. I didn't pay anything. But the truth is there would be no savings to Medicare. I was just thankful the insurance covered it.

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On 6/7/2019 at 6:37 PM, Nettie said:

I think you may be safe if a hospital takes it, but know of none so far.  I have paid cash for 10 surgeries, including a couple of minor ones, back surgery,  and TKA.  The majority of specialist, I doubt it.  Most work here once weekly for untaxed money (who cares?)  Prices reasonable.  No specialist is going to take Medicare.  I have only part A, thinking I could fly home if I needed surgery  inpatient.  But  I have had two emergencies and had to pay for them.  Personally, I heard this rumor as well, but have not seen it or.  Part B is useless.  We expats are free money to outpatient providers.  I live on very little, but can always afford the ajiic clinic and routine care as office visits are reasonable.  This is a cash based society.  More and more doctors and farmacias are taking credit cards.  I would forget about B and C here,, at least C and you will not get prescription help at all, buy all is affordable. Hope that helps.  When you are permanente,  you can purchase government IMSS,, but no preexisting conditions on that one.  There is free minor care at Seguro Populares, open to us that is really for poverty Mexicans, but will treat minor things.  There is expat insurance you can purchase here. That is your best bet if you can afford it.   I just cannot afford it

Seguro Popular has diagnosis and treatment for over 286 illneses comparable to as much as the IMSS and is a huge part of Mexican Socialized medicine with about 59,000,000 members and hundreds of newer clinics and state of the art hospitals and equipment. The last three governments invested many billions of dollars creating it in the model of other socialized medicine in sucessful social democracies which the current government denies happened and your 16 percent IVA tax supports it. Your informaion isn't close to the truth.

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If anyone wants to know what Medicare covers for people who have moved to Mexico, Senor Google will inform you.  The answer is, basically, nada. Part A is included with SS, but Parts B and other programs have a monthly cost, and you must go to the U.S. to use them.  If you drop Part B, and later move back to the U.S., there is a large penalty for re-upping it.

Yes, emergencies happening when traveling temporarily to Mexico are covered, but not for residents here.  If anyone tells you otherwise, they are either misinformed or trying to perpetrate a fraud.

Seguro Popular is available to residents, both temporal and permanente.  Pre-existing conditions are covered, but whether a particular procedure is covered is decided by group review:  in other words, a 80 year old is unlikely to get a heart transplant. The cost depends on the applicant's financial situation.   IMSS is also available to both temporal and permanent residents, but  pre-existing conditions are subject to a waiting period.  The cost for the latter is based on age.

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6 hours ago, gringal said:

If anyone wants to know what Medicare covers for people who have moved to Mexico, Senor Google will inform you.  The answer is, basically, nada. Part A is included with SS, but Parts B and other programs have a monthly cost, and you must go to the U.S. to use them.  If you drop Part B, and later move back to the U.S., there is a large penalty for re-upping it.

Yes, emergencies happening when traveling temporarily to Mexico are covered, but not for residents here.  If anyone tells you otherwise, they are either misinformed or trying to perpetrate a fraud.

Seguro Popular is available to residents, both temporal and permanente.  Pre-existing conditions are covered, but whether a particular procedure is covered is decided by group review:  in other words, a 80 year old is unlikely to get a heart transplant. The cost depends on the applicant's financial situation.   IMSS is also available to both temporal and permanent residents, but  pre-existing conditions are subject to a waiting period.  The cost for the latter is based on age.

The peer review does not take cost into consideration. In my experience most specialists in S.P. system are unlikely to even know the total costs. The review is to determine a likely successful outcome. You cannot pay to have the system speeded up or to bribe specialists. Unfortunately, your example of a heart transplant brings up another problem unique to Mexico - a severe lack of donor organs. The government and the main churches have to step up their programmes to encourage organ donors. I just read today that bodies not embalmed are buried or cremated the next day in Mexico.

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Here are 2 facts:

1) I met the head of Social Security for Mexico and asked about Medicare being able to be used in Mexico and he said no.

2) Met clients who had surgery done with a local doctor who promised Medicare would cover it.  Coincidentally right after they said that Medicare wouldn't and the doctor then called Medicare right on the spot.  Lucky for them the doctor didn't speak much English but they did speak to a Spanish speaking doctor at Medicare who explained that something changed.  

Lesson:  Anybody offering something to be covered by Medicare will be scamming you or the government.  

Best to stick to less risky activities like smoking crack, getting involved with timeshares, nationalizing older cars, opening the door for strangers, etc.

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