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A very good reason to be happy we live here


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Some observations on medical care in Mexico and Lakeside in particular:

1.  In Mexico all test results, lab tests, x-rays, Ultrasound, MRI, CT Scan, etc. are yours and are in your possession.

2. All decisions concerning your medical care are your responsibility.  As a result, it pays to get several opinions before proceeding with any surgery.

3. There are many good specialists who visit Lakeside but very few who live here.

4. There are several popular GPs here but few good ones.

5. In case of emergency one best be prepared with a Dr. that will answer his/her phone 24/7 and a hospital that will take you.

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3 hours ago, idocdan said:

We will be moving permanently  to Lakeside next year from Illinois.  I will be Medicare eligible, but my wife will need private insurance for 2 years before becoming Medicare eligible.  It appears to me, like anywhere, there are good doctors in Lakeside and Guad, and good hospitals as well.  And like anywhere, asking around with people that seem sane (like here, for example!!) one should be able to hook up with quality health care in the Lakeside area.  BUT, what seems to be the rub is that as one ages past 75, private insurance locally gets very expensive, AND if you did not keep Medicare Part B, and want to get it, you will be penalized on your premiums 10% every year you have not contributed.  SO, it seems possibly best to pay out-of-pocket for routine care, and go back NOB for "procedures" as needed.  If so, is there communication between doctors here and there?  I would think staying with providers fluent in English would be helpful in this scenario.  THEN, what to do about an emergency.  Airlift insurance is cheap and probably useful for some things.  Can one depend on SP, or IMSS?  Would be so much simpler if Medicare would pay for care outside USA---probably save a ton of money too.

You have to keep part d prescription coverage too.  Will you wife try to get US or MX medical coverage?   When we move back to Texas from MX my spouse was charged the penalty for not having part D for several years.  We filed the paperwork and provided documents to show that he was living outside the US for those years and the penalty was removed.  It took several months and lots of back and forth but it worked.  They even refunded the few months of the penalty payments.

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1 hour ago, El Menudo said:

You have to keep part d prescription coverage too.  Will you wife try to get US or MX medical coverage?   When we move back to Texas from MX my spouse was charged the penalty for not having part D for several years.  We filed the paperwork and provided documents to show that he was living outside the US for those years and the penalty was removed.  It took several months and lots of back and forth but it worked.  They even refunded the few months of the penalty payments.

That's news!  I didn't that they made any exceptions re the penalty for those who can prove they were living outside the U.S.?  Would you be kind enough to give a link to that information?  Does that only apply to Part D, or is it applicable to Part B as well?

Re Docdan's statement: " Would be so much simpler if Medicare would pay for care outside USA---probably save a ton of money too. "  Yes, that would save US a lot of money, but when you consider the possibilites for fraud, it might bankrupt Medicare  (even sooner).

 

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Everytime I visit Miami and see the dozens of shop front "Medical Specialist" and hear the number of lab tests, this test that test, etc etc people are taking, I think the city must be the Medicare fraud capital of the USA

Re Docdan's statement: " Would be so much simpler if Medicare would pay for care outside USA---probably save a ton of money too. "  Yes, that would save US a lot of money, but when you consider the possibilities for fraud, it might bankrupt Medicare  (even sooner).

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5 minutes ago, gringal said:

That's news!  I didn't that they made any exceptions re the penalty for those who can prove they were living outside the U.S.?  Would you be kind enough to give a link to that information?  Does that only apply to Part D, or is it applicable to Part B as well?

Re Docdan's statement: " Would be so much simpler if Medicare would pay for care outside USA---probably save a ton of money too. "  Yes, that would save US a lot of money, but when you consider the possibilites for fraud, it might bankrupt Medicare  (even sooner).

 

At 65 he signed up for Medicare, nothing else.  Things stayed that way for the next four or so years while we lived in MX.  On return to Texas he signed up for a Medicare supplemental policy thorough Humana that included part b supplemental and part d prescription coverage.

From correspondence with SSI we learned that there would be a penalty, but, only for not having part D prescription coverage.  Part B (supplemental) was not penalized at all.

We filed a request for review and supplied them with a letter explaining our situation.  This is what we supplied them:

copies of lease agreements from homes we had leased

deed of house we purchased and papers where we sold it

his volunteer ID from LCS

copies on his temporal and permanente visas

copies of EVERY page from his expired and current passport

His Mexican will

Copies of MX utility bills, just one month, not all of them

I think we even sent a copy of one of our MX bank statements but not sure on this

Our email and phone numbers here in Texas 

Someone was put in charge of the case and she called us.  Was very nice.  At first, he was declined but a few days later he got a letter that his request had been reevaluated and approved.  HOORAY!

Hope this helps.

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On 6/4/2017 at 9:45 PM, JerryS said:

I have a blue cross PPO plan in San Antonio TX

It depends on what pool you are in.  If you are a former federal employee then yes you may get a PPO plan thru BCBS.  Those in the general population such as the self-employed then no PPO.  That info is two years old though, so maybe it has changed. 

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The OP said, "SO, it seems possibly best to pay out-of-pocket for routine care, and go back NOB for "procedures" as needed."

There are several possible 'gotchas' with the 'going back'. Sometimes/often one doesn't get much/any warning about serious problems as we age, so there may be no chance to go back right away (if ever). And where is 'back'?  If one has family 'back' and one doesn't mind imposing their emergency on them, then OK but this is surely not a given. And if there isn't family back, then how does an extended stay work.... for the 'patient' and the 'caregiver'. And after a while SOB, what doc/hospital does one go back to in that situation?  

These logistics and others would have to be worked out if possible before one could consider 'back' as an option for immediately serious problems and maybe even 'procedures'. 

As far as 'communications between doctors SOB/NOB', while I surely have no data to back this up, I would think that this would be more unlikely to happen than likely. 

 

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14 hours ago, El Menudo said:

At 65 he signed up for Medicare, nothing else.  Things stayed that way for the next four or so years while we lived in MX.  On return to Texas he signed up for a Medicare supplemental policy thorough Humana that included part b supplemental and part d prescription coverage.

From correspondence with SSI we learned that there would be a penalty, but, only for not having part D prescription coverage.  Part B (supplemental) was not penalized at all.

We filed a request for review and supplied them with a letter explaining our situation.  This is what we supplied them:

copies of lease agreements from homes we had leased

deed of house we purchased and papers where we sold it

his volunteer ID from LCS

copies on his temporal and permanente visas

copies of EVERY page from his expired and current passport

His Mexican will

Copies of MX utility bills, just one month, not all of them

I think we even sent a copy of one of our MX bank statements but not sure on this

Our email and phone numbers here in Texas 

Someone was put in charge of the case and she called us.  Was very nice.  At first, he was declined but a few days later he got a letter that his request had been reevaluated and approved.  HOORAY!

Hope this helps.

It's good to hear.  You were rewarded for your thoroughness!

 

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Part "B" not being penalized is really good news IF.....  it is actually true in all cases. I don't doubt the OP's experience but there has been forever information that, in dropping Part B, one would be penalized 10% for every year one did not pay into the system. This case 'may' be special as 'he' never signed up for Part B.... only Part A which comes with. Then 'he' signed up to Part B using Humana. That's probably the clue to 'no penalty'.

Me thinks I would contact Medicare before I decided to 'test the waters' by dropping Part B and then assuming I could get back in at a later date without penalty.  YMMV

 

 

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22 minutes ago, RickS said:

Part "B" not being penalized is really good news IF.....  it is actually true in all cases. I don't doubt the OP's experience but there has been forever information that, in dropping Part B, one would be penalized 10% for every year one did not pay into the system. This case 'may' be special as 'he' never signed up for Part B.... only Part A which comes with. Then 'he' signed up to Part B using Humana. That's probably the clue to 'no penalty'.

Me thinks I would contact Medicare before I decided to 'test the waters' by dropping Part B and then assuming I could get back in at a later date without penalty.  YMMV

 

 

Okay, this is me apologizing and correcting.  As the original OP stated it IS part B that has the penalty if you don't sign up right away and not part D.  Every other part of the scenario is correct except for that one HUGE blunder.  While in MX he only had part A and then signed up for part B and D when we returned.  Then penalty (that was removed)was for not having part B.  My sincere apologies.  I'm not getting any younger or smarter myself!

Once I read Rick's post, I did some research and reread the documents.  My bad.

There is no penalty for not having part D but to get it you must also have parts A and B.

 

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It's a real problem.  Checking the cost of even catastrophic with a big deductible it is $13 grand per year for two people in their 70's.

We've shelled out over $25K for emergency health care here in the last 3 years.  Medivac would have been worthless as the conditions needed immediate treatment.

Probably our next really big out of pocket medical hit will be our last and we'll have to head back north as so many others have done. :(

 

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15 minutes ago, Mainecoons said:

It's a real problem.  Checking the cost of even catastrophic with a big deductible it is $13 grand per year for two people in their 70's.

We've shelled out over $25K for emergency health care here in the last 3 years.  Medivac would have been worthless as the conditions needed immediate treatment.

Probably our next really big out of pocket medical hit will be our last and we'll have to head back north as so many others have done. :(

 

The $13K and 25K.....USD or pesos??

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2 hours ago, idocdan said:

All good information, but---- All permanent American Gringos over 65---What are you doing for health care. 

I am 71 and my wife is almost 65. We have been living in Mexico for about 12 years and have medical insurance here in Mexico which we put in place fairly soon after our move here. Our most recent renewal cost approximately $4,500 USD for the upcoming year. As others have said our premiums have gone up every year as we get older but with the current exchange rate our cost in USD has stayed about the same - maybe even down slightly this year. We understand that our premiums will continue to increase but we are prepared for that. We wouldn't live here without that insurance.

I have had a number of serious medical issues over the last 4-5 years - after being exceptionally healthy all my life. I have had a number of serious surgeries, 3 rounds of chemo, a round of radiation, triple bypass heart surgery, a pacemaker and most recently cataract surgery, I don't recommend any of that to anyone but I am alive and feel better than I have in years. WAY over $1MM pesos in total cost so far. Our insurance has fully met our needs and our out of pockets costs have been manageable. I have had exceptional medical care - all in Mexico.

Our policy has a $25,000 peso deductible per injury or disease - rather than per year. Much different than the way insurance works in the U.S. where an annual deductible is the norm. We have no lifetime limits on coverage.

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On 6/8/2017 at 5:56 PM, Mainecoons said:

It's a real problem.  Checking the cost of even catastrophic with a big deductible it is $13 grand per year for two people in their 70's.

We've shelled out over $25K for emergency health care here in the last 3 years.  Medivac would have been worthless as the conditions needed immediate treatment.

Probably our next really big out of pocket medical hit will be our last and we'll have to head back north as so many others have done. :(

 

That's upsetting to hear.  Seems like you decided not to use Seguro Popular or you couldn't get what you needed from SP?  Not sure it would make sense for us to move if major medical problems would drive us back NOB eventually. 

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Elizabeth: " That's upsetting to hear.  Seems like you decided not to use Seguro Popular or you couldn't get what you needed from SP?  Not sure it would make sense for us to move if major medical problems would drive us back NOB eventually.  "

I am hearing some stories about excellent medical care being delivered by Seguro Popular recently.  The program has expanded greatly in the last few years and new facilities are being built.  However, the fact remains that SP hospitals are nothing like NOB hospitals and many people can't stomach the thought of using them.  Beds are apparently shorter: nursing care must be brought in by the patient in the form of a relative or hired nurse. There is no such thing as a nice private room with TV such as is offered in U.S. hospitals.  As a result, some people would rather leave Mexico than deal with SP care as an option.  I dropped Part B when I moved here and rely on SP for catastrophic care, but until the funds run too low I intend to continue paying out of pocket for routine medical care and use one of the smaller private hospitals for minor matters.  My spouse and have been lucky so far and haven't had any hospitalizations at all.

Insurance costs for private insurance after 65 are very high: unavailable for many.  Before deciding to go the national health insurance route, it would be a good idea to visit one of the facilities and decide it that's going to be okay with you for a serious hospitalization............or not.

 

 

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We did sign up for SP as a back up. 

Our mistake was not buying catastrophic when we moved here 9 years ago.

We were able to get treatment for two cancers, one apiece, stents and knee for the wife NOB.  Otherwise we would be gone otherwise as the bills for those were really huge.

We're like a couple of old well maintained cars.  We run good most of the time but when things break it ain't cheap or easy.

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2 minutes ago, Mainecoons said:

We did sign up for SP as a back up. 

Our mistake was not buying catastrophic when we moved here 9 years ago.

We were able to get treatment for two cancers, one apiece, stents and knee for the wife NOB.  Otherwise we would be gone otherwise as the bills for those were really huge.

We're like a couple of old well maintained cars.  We run good most of the time but when things break it ain't cheap or easy.

Did you use SP for treatment?  If so, how was it?

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I will take my chances here. A well-known hospital in Washington Dc killed my father in law. New nurse that couldn't read the newly automated pill dispenser for patients gave him the meds for another patient. It was horrific, to say the least. One minute he was fine and 5 minutes later died in agony. Of course, the hospital covered that up real quick. Our major hospitalby our NOB house near Phila has cut nursing staff in half and doubled the work load for existing nurses. Have to keep those costs down so the top executives make their big fat checks. Transactional based medicine is falling apart in the United States. 

 

Medical errors now third leading cause of death in United States....

Martin Makary, a professor of surgery at the Johns Hopkins University School of Medicine who led the research, said in an interview that the category includes everything from bad doctors to more systemic issues such as communication breakdowns when patients are handed off from one department to another.

“It boils down to people dying from the care that they receive rather than the disease for which they are seeking care,” Makary said.

https://www.washingtonpost.com/news/to-your-health/wp/2016/05/03/researchers-medical-errors-now-third-leading-cause-of-death-in-united-states/

http://www.cnn.com/2016/05/03/health/medical-error-a-leading-cause-of-death/index.html

 

 

 

 

 

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