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Medical concerns about moving to Ajijic


DavidRC

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15 hours ago, DavidRC said:

Thanks, Lakeside, Chillin, and everyone else:

We are adequately covered in the U.S., and aren't looking for any sort of free lunch, if that's the impression I somehow gave--(really?)--we would would gladly pay for care. We love Mexico and Lake Chapala--imperfections and all-- which is the primary reason for considering it; nothing to do with saving money on health care. I was just wondering what people do about pre-existing conditions and how they handle them.  Lots to think about.

Many of the newspapers and magazines give the impression that medical care "is free" well not really

I hope that you will find a package to suit your issues 

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The main issue is not about getting free or inexpensive medical insurance:  it's about pre existing conditions.  There is a variety of private insurance plans available, but the deal killer can be those conditions.  If you're in good health, it's best to invest in one of the good private insurance plans while living in Mexico.  Bellon Insurance in Ajijic has several to choose from that people like. Others are also available.

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31 minutes ago, gringal said:

The main issue is not about getting free or inexpensive medical insurance:  it's about pre existing conditions.  There is a variety of private insurance plans available, but the deal killer can be those conditions.  If you're in good health, it's best to invest in one of the good private insurance plans while living in Mexico.  Bellon Insurance in Ajijic has several to choose from that people like. Others are also available.

Thanks Gringal, for understanding what my original question was!  I have been in touch with Andre Bellon and it was he who (very helpfully) explained that my husband can't get ANY insurance because of the pre-existing condition, even though he's now in fantastic health--hence that first query.

In any case, I'll ask one last question--hopefully not a stupid one--which is this: if we set aside $150,000 USD (about $2, 800,000 pesos) specifically for some kind of emergency/hospitalization-whatever--some day, is that likely to cover, say, E.R. + brief hospital stay (two weeks) in a place like San Javier, plus follow-up care? (Of course, as suggested above, the follow-up care, once stabilized, could be in the U.S.).  I'd mentioned before that we would use clinics and local doctors for everything. The funny thing is I apparently made it sound like we're on our last legs when in fact we are both agile and totally mobile. We don't anticipate any more strokes now that he's completely recovered and on the right medication, so absolutely nothing might happen, but you never know. That could happen to any of us at any time as we all know. :) I can get health insurance, BTW--no pre-existing conditions.

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A few months ago a friend who was told he may need open heart surgery in the near future was given a total cost of 45,000 USD by a leading GDL cardiologist for this surgery, which included his fees, anesthesiologist fees, hospital charges including 7 day stay and all meds, meals, etc. needed prior to discharge. This does not include any follow up meds, rehab or physical therapy costs that may be needed after discharge. The surgery would be performed at a small, private hospital in GDL which specializes in treatment/surgeries for heart disease. 

This is major surgery for double heart valve replacement.

I hope this helps you with the answer to your last question.

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41 minutes ago, simpsca said:

Medicare does pay for medical emergencies here and in Guadalajara. Four years ago I smashed my big toe into 8 bone chips. My foot was black and toe nail sticking up in the air. I had surgery in Guadalajara. I submitted the bills to my Medicare Advantage insurer (and no I don't have a Medigap policy). I was reimbursed for all except the medications because Medicare does not cover medications when you were out of the US. 

I thought Medicare  Advantage plans require participants to live in the US, in an area served by the specific plan.  

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13 minutes ago, simpsca said:

Oh and I forgot to mention that if one of you does have a problem needing hospitalization, it needs to be an emergency to be covered by Medicare and you need to enter the hospital through the emergency room.

While I do not suggest that what you say (about a Medicare Advantage policy reimbursing your foot surgery), I am HIGHLY skeptical that this is either the norm (I know it is NOT that) nor what that program is designed to cover.

I have had Medicare Advantage policies now for 11 years. I stay tuned to their policies and intents and offerings annually.  ALL of the Advantage programs that I have 'owned' and researched (I am in Colorado but the Advantage program is administered Federally by Medicare) are not only not available outside the US  but are also closely aligned to your domicile area. Most are also HMO type policies which provide service only from medical providers who are "in network" locally.  For example I cannot get an certain Advantage policy that is available just 35 miles from me because it is not qualified to be offered in my 'district'.

Most/all Advantage policies DO cover payment of 'emergency' situations if one is 'out of their district' and cannot reasonably get back home to go to their domicile doc/hospital. BUT in order for this to be available the client must be traveling away from 'home', and 'home' cannot be in another district or state and surely not another Country.

Again, I am not suggesting that Simpsca is misleading us by saying she was reimbursed for her emergency by her Medicare Advantage policy, I am just wondering how she actually GOT ONE in the first place living full time in Mexico.

Simpsca, could/would you respond to how you actually have an Advantage policy while living full time in Mexico.... either here or by PM.

Regards.

 

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Absolutely fantastic information--thank you all!  I think we can do it...we're not going into this with naivety nor illusions!! (wow, Al Berca--exactly the sort of example I was looking for--thanks!--not that I'm looking forward to open-heart surgery--just very good to get a ballpark on something like that)

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9 hours ago, DavidRC said:

 

....In any case, I'll ask one last question--hopefully not a stupid one--which is this: if we set aside $150,000 USD (about $2, 800,000 pesos) specifically for some kind of emergency/hospitalization-whatever--some day, is that likely to cover, say, E.R. + brief hospital stay (two weeks) in a place like San Javier, plus follow-up care? (Of course, as suggested above, the follow-up care, once stabilized, could be in the U.S.).  I'd mentioned before that we would use clinics and local doctors for everything.....

My 2 cent's worth on your question is..... Yes, under the circumstances that you have described previously and this 'new' information, I would suggest that his plan is very workable. IMO, you would want to maintain your Medicare Part B payment in case things 'don't work out'.

Disclaimer:  I do not live at Lakeside but have a 20-year presence there and visit usually more than once a year. Since I consider myself a possible candidate to live there, I keep up with things that would impact my decision to come there and medical issues (I don't have any, but...) are at the top of my list as I am over 75.

 

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OK... I guess that I did not know that you treated the US as your permanent home. Thought that was Mexico.

None-the-less, contrary to what has been said, Medicare nor Medicare Advantage are available in Mexico for anyone who is living here... and that is what this thread is all about: Medical options for someone who is living IN Mexico.

 

 

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One other possible component in the decision is the possibility of needing an assisted living/nursing home facility. Another possible need is home health care support. We know several people that have used local assisted living/nursing homes and have been very satisfied. And I needed round the clock in home nursing care following triple bypass surgery for a week or two. High level of satisfaction.

These services and more are readily available at Lakeside and there are several options. They are a fraction of the cost NOB but obviously not free and not covered by insurance. It might be worthwhile to explore some of those options as part of the decision process, Just to have an idea about those issues including costs.

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On 11/30/2017 at 7:37 PM, RickS said:

None-the-less, contrary to what has been said, Medicare nor Medicare Advantage are available in Mexico for anyone who is living here.

RickS, can you elaborate on this?

I read on Ajijic's Lakeside Medical Group's website that they accept Medicare Advantage Plans.  It is listed in their accepted insurances.  https://www.lakemedicalgroup.com/lake-medical-services/lake-medical-site-content/lake-medical-insurance-accepted

Are you saying that they will only accept Medicare Advantage Plans for people on a tourist visa and after you get your Residente Perminente they will not longer accept it?

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https://www.medicareinteractive.org/get-answers/medicare-and-other-types-of-insurance/medicare-and-living-abroad/medicare-advantage-plan-or-stand-alone-part-d-prescription-coverage-if-you-live-outside-the-united-states

Quote

 

When you move abroad, you should stop paying premiums for your Medicare Advantage Plan or stand-alone Part D prescription drug plan. You are no longer eligible for these plans if you do not live in the plan service area, and your coverage must end if you live outside of the United States. If you enroll in Medicare for the first time when abroad, you will only enroll into Original Medicare Parts A and B, as Medicare Advantage Plans and Part D plans require you to live within the plan service area in the United States. If you move back to the United States, you have a Special Enrollment Period (SEP) to join a Part D prescription drug plan or a Medicare Advantage Plan. Your SEP begins the month before your move and lasts up to two months after your move.


 

 

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43 minutes ago, AngusMactavish said:

It is QUITE EASY to have a residence in Mexico and keep your domicile in the US. Read between the lines for Medicare eligibility.

Would like to educate us/me as to how one can accomplish that legally within the rules and intent of the US Medicare program? I’m not talking ‘gaming the system’ but legal and above board.... such that one could, with confidence of having Medicare SOB, move down and purchase a house and live happily ever after. 

 

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8 hours ago, airchamby said:

RickS, can you elaborate on this?

I read on Ajijic's Lakeside Medical Group's website that they accept Medicare Advantage Plans.  It is listed in their accepted insurances.  https://www.lakemedicalgroup.com/lake-medical-services/lake-medical-site-content/lake-medical-insurance-accepted

Are you saying that they will only accept Medicare Advantage Plans for people on a tourist visa and after you get your Residente Perminente they will not longer accept it?

I don’t know their intent BUT, as shown above, Medicare Advantage is ONLY available in the service area in which it is offered. Period. The one exception is that, when traveling out of the Service Area (and this does not insinuate living!) if one has a true emergency (not something that one could wait until they get back home to have attended to), a Medicare Advantage policy will reimburse reasonable expenses. I truly do not know if this provision covers travel/emergencies Abroad. 

Before I believed their website, I’d call and ask ‘under what conditions’ can they bill your Advantage or any other Medicare policy! 

 

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10 minutes ago, RickS said:

...such that one could, with confidence of having Medicare SOB...

 

Google, "Residence vs Domicile". You can not have Medicare SOB, but you can return and legally receive benefits while home at your domicile. I did it for a long time and quit when I saw no reason to return again, save in a box.

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5 minutes ago, AngusMactavish said:

Google, "Residence vs Domicile". You can not have Medicare SOB, but you can return and legally receive benefits while home at your domicile. I did it for a long time and quit when I saw no reason to return again, save in a box.

Yes of course one can use Medicare NOB...either their Part A which is free and Part B if they pay that premium.  And Medigap if they buy into it.  That's not the topic being discussed here.  Using Medicare SOB is the topic, something a few posters have said they have done here and/or alluded to hospitals/clinics accepting it here.   

Other than emergencies under certain circumstances (i.e., a Medigap policy that covers emergencies outside the US during the first 60 days of travel) I don't know of any Medicare coverage that is allowed here.  PS: Even in that circumstance, Medicare itself is NOT paying for that emergency.  Only the Medigap private policy is.  

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On 11/30/2017 at 1:08 PM, Bisbee Gal said:

I thought Medicare  Advantage plans require participants to live in the US, in an area served by the specific plan.  

Emergency service are covered here when one is a Medicare Advantage subscriber.

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