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What are you paying for health insurance Lakeside?


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Most think it's better to bank the money monthly and pay out of pocket for medical needs when they arise.  Be aware that Medicare is not legally available here for those who live here full time.  If you are visiting, have parts B&C, and have an actual emergency then you could be covered.  Better to pay with a credit card and then get reimbursed from Medicare because the hospital will charge many times more if they bill directly to Medicare or other private insurance carrier.  If the bill gets rejected for any reason you could be liable for the larger bill.  This is true no matter what local providers might tell you in local ads seen in newspapers.  Many commit fraud and many have been caught.

Alan

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I am reluctant to share much information but the question caught my attention and I know dozens of ex-pats with Mexican medical policies.

We are a married couple...male in his 80's; female in her late 70's. All insurance in Mexico is charged with age as a strong factor. After 70 yrs old it becomes much harder to get but not impossible and your choices drop way down.....pre-existing conditions can leave you very, very few options. Agents are found from rank amateurs to very good and knowledgeable.  Our policies started out when I was seventy and my wife in her sixties. It was several thousand USD dollars a year with a 6000 mx pesos deductible ....then, like or not, our deductible and annual cost rose. We now pay 11,000 usd with a 50,000 mxp deductible. My wife is very ill and her medical costs exceed 25,000 usd a year.....we are fully reimbursed for most of that minus a 10% copay as we have long since covered the deductible which is necessary only one time per medical incident. We can go to most hospitals, see any doctors and buy drugs at any source we wish as long as we present a "factura." So my costs, unless something new happens which I am sure will, are $11000 usd for the policy and 2500 usd for the deductible (which varies and can rise or fall).. 

I would love to not have to pay for a medical insurance plan and considered staying with the Mexican "free" plans but free is a lie and without insurance my wife's recent hospital stay of 728,000 mxp plus everything else would have destroyed us.

So here are my terms......I will not recommend any agents nor any insurance companies unless I am reached privately but I will try to answer any questions you might have that are within our experiences.

Edited by Fred Habacht
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If you are over 80 and have any pre-existing conditions, all you can do is cross your fingers and also pay "out of pocket".  It helped to drop the Medicare premiums monthly.  I can't face the hassle of flying and trying to use Medicare in the States.

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Not to shock you but I am willing to share my information. When I came here at age 60 I took out an insurance plan.  I first had to have a home examination by a physician.  I wish I could remember what I paid back then, but compared to now it was cheap.  When I hit age 70 the rate  took a significant increase.  It increases yearly now at a dramatic rate. Last year my charge by MetLife was $189,497.62  (IVA was $26,137.60 of that.)  I have only used it twice for hospitalizations.  Yes, I could have saved money by paying out-of-pocket, but the worry of some catastrophic medical event was always in the back of my mind. I was a hospital pharmacist for over 20 years and I know what medial tragedies can befall a person. Now, at age 78  I am seriously considering dropping the insurance.  I will decide when I get the new statement.

 

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The cost of private Mexican health insurance depends a lot on the age you begin. We purchased our first policy in 2007 when in our mid 50's at a cost of under $25,000 pesos per year. Would the same policy issued to a couple of the same ages today cost the same as 2007? Probably not but that answer would need to come from an insurance agent.

Since 2007, the premiums have increased tenfold, some due to age and some due to the increased costs of providing medical care. 

We've only used the insurance a few times, mostly in the last couple of years which is probably why premiums start really increasing as we age.

The insurance company won the bet of premiums versus payouts since inception so being self-insured would have been cost effective in hindsight. However insurance is there so should you face a catastrophic event you won't get financially wiped out. I too know people who got cancer which required the insurance company to payout multi-millions of pesos, far more than the premiums they collected. Health insurance is a crapshoot. Always has been, always will be, unless you're clairvoyant and can predict the future. 

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This subject and contributions makes interesting reading. Maybe it should be mandatory reading for all Newbies. Incidental the latest IMSS inscriptions are "going thro the roof" .

At first sight the MediVac service seems to offer a "good" package for those interested in returning "back home"...Until you give your age, then most are non eligible! Its a challenge getting old.

One thing for sure if you do decide to go into a nursing facility here or NOB be sure you have a "trusted" relative or advocate to look after your affairs

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Insurance depends on age. Policy chosen and deductible. The higher the deductible the less $$ the policy. Having stage 4 cancer with 6 months chemo and 10 years follow up insurance paid. Also another person stage 2 cancer 6  

1 1/2 years chemo and 5 years prevention med insurance paid. You just never know. It is peace of mind to have insurance but goes up and up each year. With so much covid premiums are rising for everyone to cover covid cost of others. 

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The one poster mentions IMSS annual premiums as "going through the roof".  Not exactly sure what these are now, but am reasonably certain they are considerably less than the average annual health isurance premium. Won't IMSS (when fully vested the start of the third year) protect you from financially devastating healthcare costs?

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I've posted many times that we made sure[due diligence] that we have a medical slush fund to enable paying out of pocket to great success. If I get cancer,I won't be spending huge just to get a coupla more months which won't be any picnic quality of life anyway.

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I don't mean to hijack this tread. I find it a fascinating and horrifying topic for a European / Canadian, who's been through several long term hospitalizations and surgeries in Europe and Canada, and never in my life saw a bill or paid out of pocket (universal healthcare), with the exception of paying for medication in Canada. I've been coming to Mexico for 20 yrs, with only travel insurance. Later this year I'll be applying for permanente visa, with the goal of becoming a citizen down the road. And I hope to get on the national medical insurance here. Is there a reason for a permanente / citizen to buy private insurance? 

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16 hours ago, happyjillin said:

I've posted many times that we made sure[due diligence] that we have a medical slush fund to enable paying out of pocket to great success. If I get cancer,I won't be spending huge just to get a coupla more months which won't be any picnic quality of life anyway.

I want to slightly hijack this topic, too,  because happyjillin (above)made a really valid point. Have a medical slush fund if at all possible! You may be able to have $$$$$ or you may only be able to have $$ but have something put aside and don't touch it. 

The reason I jumped in here is because I want to mention that it's not all dark if you have to pay for your medical. When the hubster was admitted for emergency treatment to a hospital in Guad,  I had to pay a $50,000mxn deposit upfront. By the time he was out, 6 days later, I had to pay the remaining balance. All told, it worked out to about $6500usd for a top-quality hospital, ambulance ride, two docs (one was just a cardio to test and consult due to other health conditions), and great care. We're lucky because we have insurance that covers us here and reimburses 75% (with a $3k catastrophic cap) but we still have to pay out-of-pocket first. Obviously, your particular treatment can raise things through the roof but maybe that will give you a bit of an idea of costs. I should add that if you don't have a reasonable fund set aside, don't forget that they take credit cards.

( I realize that if you're on limited funds then spending several thousand dollars may not be an option. This was just to give a reference point to US costs (not the only ones here, I know) as opposed to local costs.)

 

 

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5 hours ago, MakeItSo said:

I don't mean to hijack this tread. I find it a fascinating and horrifying topic for a European / Canadian, who's been through several long term hospitalizations and surgeries in Europe and Canada, and never in my life saw a bill or paid out of pocket (universal healthcare), with the exception of paying for medication in Canada. I've been coming to Mexico for 20 yrs, with only travel insurance. Later this year I'll be applying for permanente visa, with the goal of becoming a citizen down the road. And I hope to get on the national medical insurance here. Is there a reason for a permanente / citizen to buy private insurance? 

Yes. IMSS one of 4 socialized medicine systems which a legal resident or naturalized citizen would have complete coverage has many exclusions to join for chronic health illnesses. Waiting periods for others. Costs yearly up to $17,000 pesos per adult over 70. Another system INSABI which is free more or less and has no exclusions or waiting periods does not cover 3rd. tier illnesses. ISSSTE is the best system and covers almost everything, but is only available to federal government employees and their families. Military medical plan is good but only for military and their families. Pemex medical plan is only for their employees and their families. If you are excluded from joining the IMSS  because of chronic illness/es your options are to self insure for major illnesses. You possibly could return to your country for medical care.

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1 hour ago, mudgirl said:

Waits at IMSS, not having a choice of doctors, perhaps having everything explained in Spanish. 

Sounds exactly like Canada and Europe, except hospital staff I dealt with in Europe spoke only French, German and Czech :)

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A neighbor house keeper has IMSS. She has a diabetic illness and her husband cardiac illness requiring medication. IMSS they are enrolled to does not have their medicine available. That is the problem with IMSS. Limited treatment. The ladies husband for cardiac condition is 1000 pesos a box. 

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You did not state your age or family size, so I will just provide a little of my experience on this subject.  We had IMSS in 2009 and then had the unfortunate experience of a friend having major health issues and admitted to the IMSS hospital in Guadalajara.  During his stay there of 2 weeks, I visited many times to bring his wife tolitries, change of clothes, etc. as she had to stay there to attend to him as these services are not provided.  After my experience and observations there I bought my family our first health insurance in Mexico.  That was with MetLife.  At that time a family  of four (2 adults about 40 year old and two young children) our yearly cost was about 14000 pesos or $1000 USD at that time.  I ended up needing surgery for an injury and could not have been happier with the hospital/doctor/coverage.  Since then we have had policies with ING, WEA, and VUNI.  In the last 1.5-2 years there has been a huge increase in costs for health insurance in Mexico.  Personally, my  policy went up 30% in one year, and after shopping around I found this was pretty much across the board with all health insurance providers in Mexico. For a very similar policy now (low deductible, high maximums) our cost is about 88,000 pesos or $4400 dollars per year.  Obviously some of the increase was for children getting older, but it is a very significant increase.  This is the first year we are considering going with the "cash" policy or having a catastrophic policy with a very large deductable, but generally paying cash for everything.  For a high deductible policy I am being quoted about 20,000 pesos per year.  I find much of the advice above to be right on- cost is based on age, sex, heath history, etc.  Also, consider your financial position.  IMSS might be the care that fits one person best, while going with cash fits another best.  

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As a guest in this country (I am a permanent resident) I prefer to use my own resources for medical care and not use the Mexican health insurance programs that were set up and are funded for Mexican citizens.

I believe one of the requirements for Permanente status is that you can prove you have adequate resources/income to support yourself.

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8 minutes ago, Out1 said:

As a guest in this country (I am a permanent resident) I prefer to use my own resources for medical care and not use the Mexican health insurance programs that were set up and are funded for Mexican citizens.

I believe one of the requirements for Permanente status is that you can prove you have adequate resources/income to support yourself.

By accepting Permanent Residence you are an immigrant to this country. The Universal Health care here is a work in progress, and all stakeholders have to pull their weight. There is also the principle of reciprocity. In Canada, my ex home, there are a great many Mexicans moving there, certainly far more than Canadians moving to Mexico. The Mexican immigrants receive free medical, free public schooling, and a generous safety net if things turn out badly. I have some impressions of how the U.S.A. handles new immigrants but not enough experience to make a meaningful comment.

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1 hour ago, Out1 said:

As a guest in this country (I am a permanent resident) I prefer to use my own resources for medical care and not use the Mexican health insurance programs that were set up and are funded for Mexican citizens.

I believe one of the requirements for Permanente status is that you can prove you have adequate resources/income to support yourself.

You’re not a guest, you’re an immigrant.  Your country of birth…do you consider immigrants there guests???  Cuz if you do, it’s offensive.  

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I realize this is highly subjective, but since it's been mentioned: 

What would be a comfortable slush fund amount for medical emergencies in Mexico? For a permanente / naturalized citizen.

(Forgive my ignorance, but never in my life did I pay for private insurance, or any medical treatment / surgeries, or doctors visits, always had full universal coverage.)

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I would say that to feel at all comfortable paying for catastrophic care, $250,000USD is a minimum. Day to day and minor surgical/treatments/interventions are reasonable and easy to pay out of pocket, but cancer, brain surgeries, open heart surgeries, kidney failure, trauma from a car accident, etc., can pile up the bills quickly. Then, if you spend $100K the first incident, you need to have enough to cover another one , whether for you or your spouse. At my age, it is highly unlikely that I would be able to easily earn more $$$ to put in the fund.

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