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Hound Dog

Apr 5, 2010, 3:04 PM

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Major Medical Insurance in Mexico Versus the United States

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OK. Let´s talk about major medical health insurance coverage in mexico vs. the U.S. The difference is astonishing.

I just received my 2010'/11 annual bill from AXA for major medical coverage and I have been with them since 2003.

Here are the statistics:

I am 68 years old and my wife is 63.
We have $27,500 Peso deductible.
We have unlimited major medical coverage in the top hospitals in private rooms in Mexico.
We have our choice of the best doctors in this country who are among the best in the world.
We have up to $50,000USD international emergency coverage anywhere in the world outside of Mexico.

What was our annual bill for this splendid coverage? $400USD a month at current exchange rates. When we left the U.S. in 2001, they wanted $800 a month under COBRA to hospitalize us in a dormitory with 400 other old goobers. Tell me where you would live - even with Medicare.

The U.S, is sick. Get out of that cesspool.

tonynico

Apr 5, 2010, 4:00 PM

Post #2 of 50 (5926 views)

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Re: [Hound Dog] Major Medical Insurance in Mexico Versus the United States

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Do you have any prior conditions? My wife and I have some I have a lot more then her and don't think I can get coverage will not know for sure until I apply. They tell me I cannot appy until a month or two before I leave the states

Tony

see saw sallie

Apr 5, 2010, 8:49 PM

Post #3 of 50 (5852 views)

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Re: [Hound Dog] Major Medical Insurance in Mexico Versus the United States

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$400USD a Month? With $27500 (MXPesos) deductible? Kind of high of a monthly payment....isn't it?

(This post was edited by see saw sallie on Apr 5, 2010, 8:50 PM)

Zorba

Apr 6, 2010, 1:24 AM

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Re: [see saw sallie] Major Medical Insurance in Mexico Versus the United States

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Give me a good public system over private health care any day. Im sure, being familiar with France, you would agree would you not, Dawg? I dont know.

Personally, I dont like my health care provider making life and death decisions based on how much it is going to cost them. Sure, public health care systems are not perfect, but their motives arent as tainted at least.

Nevertheless, I do plan to get private health care in Mexico on top of IMSS if I can afford it. Im glad you posted the details. It looks reasonable.

However, with these insurance companies the devil is always in the details. Do you know what they DO NOT cover? Do they cover bone marrow transplants, organ transplants, long term care costs, prescriptions for chronic disease? Diabetes? etc. etc. etc. Will they dump you on a claim of pre-existing condition? They will try to say breathing is a pre-existing condition if they can.

I have a colleague who thought she was covered with her private health care only to find out they would not cover her for a bone marrow transplant that she needs. Just one example. Perhaps all private health care buys you is a false sense of security.

Private health care is great....until you have to use it. Often times when you need it the most, they bail on you.

Btw, if I buy private health care but live in Chiapas will I have to use the private hospitals in Chiapas or can I go to any private hospital anywhere in the country?

(This post was edited by Zorba on Apr 6, 2010, 1:26 AM)

Hound Dog

Apr 6, 2010, 4:58 AM

Post #5 of 50 (5790 views)

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Re: [Zorba] Major Medical Insurance in Mexico Versus the United States

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Just a couple of points:

As to the seemingly high deductible; because of the normally quite low cost of routine medical care in Mexico, we take care of minor problems out-of-pocket carrying major medical to try to avoid the potential major problem that could bankrupt us or at least cause us serious financial harm. We also carry this type of insurance so that we can be accepted by top flight physicians and qualify for private rooms and the best care in th best hospitals in the country. $27,500 Pesos is about $2,200USD at today´s exchange rates. I just had cataract surgery at one of the top opthamological clinics in Metro Guadalajara and covered the cost out of pocket but I was able to get into that top clinic because I had major medical coverage in case something went awry (which it didn´t but who knows).

Does the approximate cost of $400USD a month sound high for a 68 year old guy and his 63 year old wife? If we had stayed in the U.S. I am told we would be paying (prior to Medicare) around $1,100 a month after retirement for a lousy HMO and assigned doctor. If we opted for full Medicare coverage including the supplemental cost of insurance to cover the 20% deductible, I´ll bet that would cost us at least $200 a month plus the cost of moving to and living in the U.S. while undergoing treatment to say nothing of having to get up there while still alive. If something happens to me that requires I seek Medicare treatment in the U.S. because a precedure is not available in Mexico, I can always miove to Texas (shudder) and pay back Medicare "B" payments plus a small penalty for coverage although that 20% deductible might come to a fortune up there.

We live in both Ajijic, Jalisco and San Cristóbal De Las Casas, Chiapas and, yes, we are covered if we seek medical care anywhere in Mexico. When I had emergency gall bladder surgery in San Cristóbal last year, I could have elected to fly to Mexico City or Guadalajara and had my surgery at the finest hospitals in those cities famous for their great hospitals. In fact, AXA agreed to medivac me by air to one of those places or Monterrey at their cost. As it happened I went ahead and had my surgery in San Cristóbal - a town not noted for even nice, much less great hospitals - because I was in no shape to fly back to Guadalajara. I had to pay this crappy hospital down here directly but was later re-imbursed for most of that cost by AXA.

More later. Here comes the garbage truck.. Gotta go.

(This post was edited by Hound Dog on Apr 6, 2010, 5:47 AM)

see saw sallie

Apr 6, 2010, 7:26 AM

Post #6 of 50 (5760 views)

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Re: [Hound Dog] Major Medical Insurance in Mexico Versus the United States

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What seems high to one (or not)...no matter. I'm glad you are posting this. All this info is very interesting to many folks here. I agree, you are saving compared to here at $400 a month. If you don't need to tap into the deductible unless absolutely necessary (emergencies) and pay private care out of pocket, then yes, this seems a good back up plan.

Gringal

Apr 6, 2010, 8:06 AM

Post #7 of 50 (5745 views)

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Re: [Hound Dog] Major Medical Insurance in Mexico Versus the United States

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We still need some basic answers, dawg: Does your policy cover pre-existing conditions? Are there age limits to getting the policy? Or in continuing on it? Will it cover all procedures (like bone marrow transplants)?

I don't think the cost is unreasonable at all. Back in the states, by the time you paid the Part B and had the supplemental policy, it ran at least that much.

Hound Dog

Apr 6, 2010, 8:56 AM

Post #8 of 50 (5728 views)

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Re: [Gringal] Major Medical Insurance in Mexico Versus the United States

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Gringal:

No, pre-existing conditions are not covered.

I am assured by my AXA agent and have been repeatedly, that our policies are not cancellable no matter how long I hang in there. Keep in mind that we became health insurance policy holders with AXA (then ING) in 2002 after New York Life/Seguros Monterrey abruptly cancelled all health insurance policies issued under the LCS group health insurance plan even though New York Life´s agent at the LCS assured us when we bought the policy in 2001 that the policies were not cancellable - ever. Later, when New York Life cancelled the LCS Group Plan without warning and tried to substitute some cheesy limited policies in their stead, the LCS board of directors were told by New York Life that , while individual policies were not cancellable group plans were cancellable. Appparently the then-LCS board did not do its homework. In other words, always remain skeptical. I will say, however, that we have all of our insurance through AXA including two homeowners policies, a car insurance policy and two health insurance policies and they have always performed in an excellent fashion as or better than agreed. I highly recommend this company based upon seven years of good experiences with them and their outstanding agent out of Guadalajara.

Our health insurance premiums and coverage are determined to some extent by the length of time we have been with the company. Each year the premiums have gone up and this year´s premiums for the policy period of April, 2010 to April 2011 will be $33,814 Pesos for me at 68 and a guy and $25,303 Pesos for my wife at 63 and a mujer. I do not know the age cut off to initiate a new policy although I think I remember that getting a new policy may be difficult from age 70 on but I can´t swear to that. Maybe someone else can enlighten us on this.

Thanks for the input Gringal that $400USD or more could probably be the monthly cost of Medicare with Part B and supplemental coverage for the deductible which could be outrageously expensive in the U.S. This does not surprise me and to that you have to add the cost of going to the U.S. and living there while being treated.

Now, I have to say something about this notion of flying off to Guadalajara or Mexico City or Houston or some such place instead of opting for care in some backwater medical center with limited resources such as San Cristóbal. We chose to live part of the year down here while living the rest of the year in Ajijic and it has been a fun experience but, let me tell you brothers and sisters, when your gall bladder or some other such thing inside you decides without consulting with you that it is time to check out, you may find the trip to Mexico City or Houston a bit of a trial to say nothing of damned dangerous and life threatening. Those of you still deciding on where to spend your last years and contemplating the adventures of living in the middle of nowhere versus, say, Metropolitan Guadalajara or some other highly reputable medical center, let me assure you from personal experience that you don´t want to be lying there in the recovery room in some fleabitten, undermanned, filthy hospital run by incompetents so, hey, admit you are a geezer and plan to be relatively near a place where they can pump you back up if you spring a leak. It just happens I had a good surgeon who knew the difference between a gall bladder and a pancreas. You may not be so lucky as discovered by the family of another patient in a much fancier hospital down here about the same time who had his pancreas removed inadvertently instead of his gall bladder. Yes, we all know this could happen anywhere but opt for the city or environs and the best hospital you can afford to improve your chances.

(This post was edited by Hound Dog on Apr 6, 2010, 9:07 AM)

Zorba

Apr 6, 2010, 9:14 AM

Post #9 of 50 (5711 views)

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Re: [Hound Dog] Major Medical Insurance in Mexico Versus the United States

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Ive heard good things about AXA myself from an doctor who deals with insurance claims all the time. He recommended that you go for a company that is huge. The bigger the better. This is because with so many members they have a bigger pool of money to draw from and are then less likely to hassle or deny you when you have a claim. I believe AXA is French so that may have something to do with it as well.

I have been wondering if perhaps the changes in the rules governing private insurance companies in the US would have some nice spillover effect for us expats. That is, if it is illegal for a US insurance company to deny pre-existing conditions would that also apply to them if they are selling me a policy as an expat? I doubt it.

ken_in_dfw

Apr 6, 2010, 10:54 AM

Post #10 of 50 (5674 views)

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Re: [Hound Dog] Major Medical Insurance in Mexico Versus the United States

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Thanks very much, Dog, for raising some excellent points and providing some good data points to consider. Health care is a really critical topic for anyone - but especially for expats.

I think others have made the point and I will back up with observations from friends who live SOB: if you have preexisting conditions, you need to think very carefully about whether your health and economic circumstances permit living outside of the social safety net of your home country.

As one who has preexisting conditions and knows that I will have to keep what insurance I have until I retire, this is probably cold hard fact #1 facing my considerations about moving south. That said, I know personally of a number of folks with similar chronic health issues who are managing to enjoy their lives in or near larger cities like DF, Guadalajara, Puerto Vallarta and Morelia. How do they do it?

1) By retaining whatever insurance they currently have and building that cost into their budget (no different than NOB)
2) By securing a local physician they trust for minor issues and emergencies that they pay for out of pocket
3) By making use of local educational and support services where possible (and financial supporting if they do)
4) By planning regular trips to their home country for regular physical exams and refills of their meds
5) By being realistic about their health and support system, thereby planning for what to do when or if they become more seriously ill - for many folks, it just makes more sense when you get sick to move back to where there is more physical/medical/social support

Is it expensive? Absolutely. Does it require planning and forethought? You betcha. Does it limit where you live? To some degree, but with a little forethought and ingenuity, you'd be surprised what you can still do.

The "healthiest" people to me have always been those who get on with the messy business of living instead of waiting for whatever happens next.

tonynico

Apr 6, 2010, 1:02 PM

Post #11 of 50 (5635 views)

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Re: [ken_in_dfw] Major Medical Insurance in Mexico Versus the United States

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My wife and I have had health issues. My wife had one health issue witch was major. This would preclude her from getting coverage from most companies. The others that would take her would not cover her for that or any related condition.

I have had so many conditions all minor but still would preclude those body parts. Cholesterol precludes heart and stroke.
The only things I could get coverage for is a broken limb.

So we are going to self insure. We will be putting money away incase of an an emergency. And if perchance we can get back to the states we will use medicare without supplemental ( because we will not have a residence in the U.S can't get supplemental) That said it might be cheaper then just to pay out of pocket in Mexico.

We will try to get insurance and we will be honest about the conditions rather then hiding it. but it will most likely will not be workable.

We did speak to one company that will insure you with preexisting conditons but the rate for two is over 8k and that is just the first year. You know they will be raising it. As a retired couple that is way to high.

Tony

Gringal

Apr 6, 2010, 1:29 PM

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Re: [tonynico] Major Medical Insurance in Mexico Versus the United States

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Don't know if you've considered this option, but the IMSS system will cover you with exceptions for pre-existing conditions in the first year. In the second, more things are covered. In the third, everything, including pre-existing conditions is covered. IMO, a good back up plan at a low cost....but it's a no frills kind of care.

Dawg gave us some good information, and anything further should probably be asked of the agent for the company.

He also made an excellent point about being aware, although not obsessed, about the health issues geezers are likely to face. Denial comes back to bite you. All the way from selecting a home with steep and many stairs which is otherwise charming, to choosing to live in an area remote enough that good medical care is far far away. We may never need to personally deal with the big health issues, but they should percolate through our decision making processes as we make other big decisions about the where and how of retirement. Nobody wants to become old and infirm. However, if you hang out on the planet long enough.......it's likely.

BTW, Dawg....before you get all warm and fuzzy about living in that vibrant city of Guadalajara, bear in mind that walking around in that bad air is about like smoking over a pack a day. That's what my doc told me about lovely San Miguel, and Guad is waaaay worse. But.......nobody lives forever, si?

(This post was edited by Gringal on Apr 6, 2010, 1:33 PM)

Hound Dog

Apr 6, 2010, 5:23 PM

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Re: [Gringal] Major Medical Insurance in Mexico Versus the United States

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BTW, Dawg....before you get all warm and fuzzy about living in that vibrant city of Guadalajara, bear in mind that walking around in that bad air is about like smoking over a pack a day. That's what my doc told me about lovely San Miguel, and Guad is waaaay worse. But.......nobody lives forever, si?

Actually, Gringal, the air quality in Guadalajara as in the Los Angeles Basin and the San Francisco Bay Area, varies greatly based upon where one resides although, unlike those other two metropolitan areas, that has nothing much to do with sea breezes. If we lived in Metro Guadalajara which is a distinct possibilty for the future, we would live in parts of the city which I have identified over the years which are not only much nicer than some other parts of the region but have better air quality. Some of the areas we like very much resemble the best parts of the Wilshire and other districts of Western Los Angeles County - a place we love but can´t afford.

As for air quality, the air in the seemingly pristine alpine Jovel Valley where high mountain San Cristóbal De Las Casas is located can be poisonous even though the atmosphere appears to be totally pollution free and crystal clear. Locals who have lived here all of their lives hate the warm weather brought on by the spring that stretches from March through the first part of May when warm air breezes carry bacterial laden dried fecal matter aloft and stored, unrefrigerated food in markets is more susceptible to contamination. In Chiapas the local folklore is that the ripening of the mangoes in the spring signals the advent of digestive and respiratory illness among the folks. When I returned from a recent trip to coastal Soconusco and its capital of Tapachula, known locally as the Tierra Caliente, nearly the entire faculty of my language school in San Cristóbal which is 95% Chiapas born and bred, were ill primarily from airborne digestive and respiratory afflictions. Everone is praying for the rainy season when the streets are flooded with agua negro but there is less contaminated dust.

The problem with life is it´s dangerous and results in death.

We´ve been meaning to join IMSS for 10 years. Maybe next year if they haven´t yet folded.

La Isla

Apr 6, 2010, 5:41 PM

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Re: [Hound Dog] Major Medical Insurance in Mexico Versus the United States

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I plan on joining IMSS soon. Then when the premiums for my current private health insurance go up a ridiculous 50% (because I'll be 65), and I drop the plan, I'll have at least partial coverage for major medical problems. The whole concept of pre-existing conditions is such a farce because by the time you've been around for 50 or 60 or 70 years or more, your whole life is a pre-existing condition (-: !

tonynico

Apr 6, 2010, 8:30 PM

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Re: [La Isla] Major Medical Insurance in Mexico Versus the United States

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You are dead on. How many people over 60 have no pre existing conditions? Not many.
I wonder how many people have insurance and never mention the pre existing conditions. They walk around thinking they will be covered when the unthinkable happens, then bam they find out they will not be covered because they did not disclose a condition. In the states this was taken care of. It went to court and the court ruled that eventhough it was not disclosed the insurance co had acess to the records and since they still insured the insuree, they cannot refuse coveradge.
I would not count on that being the case for international insurance. It is possible when tragedy hits you will find that you are not covered. That is why in this case honesty is the best policy ( no hidden surprises)

La Isla

Apr 6, 2010, 8:59 PM

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Re: [tonynico] Major Medical Insurance in Mexico Versus the United States

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Honesty is the best policy, especially if you're not a very good liar (-: !

Brian

Apr 7, 2010, 4:46 AM

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Re: [La Isla] Major Medical Insurance in Mexico Versus the United States

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At least one popular expat blogger has derided health care availability in the USA and compares it to Mexico where nearly everyone has access. That simply isn't true. This article indicates that 41% are not covered by either private insurance, social security or seguro popular or any other type of health coverage.

http://www.eluniversal.com.mx/primera/34729.html

Zorba

Apr 7, 2010, 5:03 AM

Post #18 of 50 (5438 views)

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Re: [Brian] Major Medical Insurance in Mexico Versus the United States

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I have Mexican friends who could afford to pay for IMSS, but they don't. Not a very forward thinking people. They're too tightfisted to take precautions. They would rather save a few bucks and then scramble around like a bunch of worry warts AFTER something goes wrong.

gpkgto

Apr 7, 2010, 5:43 AM

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Re: [La Isla] Major Medical Insurance in Mexico Versus the United States

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"I plan on joining IMSS soon."

Why wait? You lose the first year (or 2 in some places) until you get "sin restricciones" status at IMSS.

La Isla

Apr 7, 2010, 8:33 AM

Post #20 of 50 (5379 views)

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Re: [gpkgto] Major Medical Insurance in Mexico Versus the United States

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In Reply To

"I plan on joining IMSS soon."

Why wait? You lose the first year (or 2 in some places) until you get "sin restricciones" status at IMSS.

Procrastination is my middle name? That is true, but the real reason is that right now I have to deal with renewing my FM3, and I prefer to get tangled up in one type of Mexican government red tape at a time!

Gringal

Apr 7, 2010, 9:07 AM

Post #21 of 50 (5368 views)

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Re: [La Isla] Major Medical Insurance in Mexico Versus the United States

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I'm not encouraging people to join IMSS...it's already an overburdened system, but when there is essentially a three year period where many things are not covered, it makes sense to get the process started ASAP if you're going to do it at all.

It was a painless process here in Lakeside since some facilitators were there to help at LCS. No membership in LCS was required to use the service. It seems that in Mexico, you'll find a "facilitator" to hold your hand (for a fee) for practically anything involving Mexican red tape. They're well worth their fees, IMO.

This year, the rules changed and we had to get our bodies to the IMSS center in Guadalajara in order to get our renewal. So, we went and met our facilitator lady at the office. There was a large, very crowded room of people waiting to be seen. We groaned in anticipation, but Monica led us right up to the counter where a man witnessed our signatures and we were DONE. Now we have a folder stamped "sin restricciones". Whew.

Brian

Apr 7, 2010, 9:36 AM

Post #22 of 50 (5353 views)

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Re: [Gringal] Major Medical Insurance in Mexico Versus the United States

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Often, the lack of insurance is because of personal choice. Although Mexican employers are supposed to pay for social security benefits, many employees ask to decline the coverage and have what would have been paid for premiums added to their paychecks instead. I am aware of at least one foreigner with a working visa who took this route and then had to depend upon the largess of the expat community to help defray the costs incurred by a serious illness.

(This post was edited by Brian on Apr 7, 2010, 9:38 AM)

Gringal

Apr 7, 2010, 10:10 AM

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Re: [Brian] Major Medical Insurance in Mexico Versus the United States

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I think that goes along with the great Denial phase of youth: "I'll never get sick and furthermore, I'll never die." (That happens to OTHER people.) This usually wears off about the time middle age hits........but not always. But then, many people go directly from adolescence to old age without every stopping in at maturity.

Brian

Apr 7, 2010, 10:20 AM

Post #24 of 50 (5318 views)

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Re: [Gringal] Major Medical Insurance in Mexico Versus the United States

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The Mexican government has refuted the study referenced earlier and claims that there are only 11 million Mexicans who lack coverage as opposed to the 43 million reported. It blames the discrepancy on researchers using old data.

http://www.eluniversal.com.mx/notas/671164.html

La Isla

Apr 7, 2010, 10:25 AM

Post #25 of 50 (5315 views)

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Re: [Gringal] Major Medical Insurance in Mexico Versus the United States

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In Reply To

Who are these "facilitators"? Never heard of anyone like that in Mexico City to help you jump over bureaucratic hoops. I did hire a lawyer to help me get my FM3, but I don´t suppose that's what you're talking about. Anyway, I have spoken at length with an American friend here who recently signed up with IMSS. Since he had no one to help him with the sometimes opaque process, he made lots of mistakes along the way, which I will be able to profit from by not repeating them!

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