What Wikipedia Can't Tell You About Healthcare in Mexico
First a little background. One of the most vexing questions for me as an expat in Mexico has been what to do about health insurance.
The horrifying rise in costs of healthcare in the U.S. was a key factor in my coming to Mexico. Since I still spend time in the U.S every year, I wanted to research the rather contrarian solution of full coverage in Mexico with provisions for emergency care while I am in the U.S, almost the opposite of what a snowbird would do.
How much would full “catastrophic” coverage for both countries cost? -That would be insurance that would cover major illnesses and also cover me whether I trampled by an elk in Evergreen, Colorado or walk in front of racing bus in Mexico.
If you read up on what expats say about doctors, hospitals and treatments in Mexico, you will see the reviews are overwhelmingly positive. Patients summarize their positive reviews with comments on how much less it all costs, from 50% less to a fraction of the cost in the U.S. They are grateful for both the quality of care they’ve been given and the quality of life they can still afford to keep.
Of course the cost varies by doctor, hospital, and what illness you have, just like the U.S, but most costs are lower, sometimes to the extreme. In Mexico an office visit with a doctor or specialist will cost 350 to 500 pesos (about $30 to $43). Doctors still make house calls in Mexico and those visits cost about the same. Lab tests will cost about a third of what they cost in the U.S. An overnight stay in a private hospital room generally costs less than $140.
Many expats who live here full-time and have resident visas or visas temporals opt for IMSS (the Mexican Social Security System) coverage for 3,200 - 6,200 pesos ($177- $345 U.S.) a year, feeling that can cover them in an emergency.
From what I have read and heard, the facilities are vanilla but the doctors are the same doctors who work in the private sector. Doctors divide their time between the private and public sector to earn their pensions.
People tell me that the care in the IMSS system is very good. The downside is the ease, or lack of ease I should say, of getting prescriptions filled and making appointments. The experience is often compared to our HMO care. It is described as functional, assembly-line treatment but very adequate.
The main reason I would never consider IMSS is that you have to set up your own meals and nursing care. In the Mexican culture, with their extensive family networks, this makes a lot of sense. Who would take better care of you than family?
As neurotic as they are, I’d still trust my friends and family over the American nurse who gave me a dinner of broccoli and fried fish the day after intestinal surgery in a Richmond Virginia hospital 10 years ago (My boyfriend at the time “broke me out” of the hospital two days early, in the belief that jello, ice cream and a private room without a coughing roommate was worth the risk).
As an American, if you are part of a couple, the IMSS system would be workable if your spouse is a good caregiver. For a small premium, this insurance can also cover you in an emergency until you can get home. Part-timers who are here only a few months can also opt for travel insurance, enough coverage to get them stabilized here, then home in an emergency
For a single person like me, IMSS coverage is not an option. If I’ve just had a heart attack, I may not be in much of a position to advocate for myself. I need some bells and whistles on my policy.
Most of the expats in Mazatlan are clients of health insurance broker Juan F. Chong (the “F” stands for Flynn or Franz, I reckon). I set up a visit to find out more about Mexican coverage and find out what my options are based on how much time I spend in Mexico.
Most of Juan Chong’s clients live here year-round, so they are exempt from the Affordable Care Act (Obamacare) but it seemed like a good place to start and did answer some general questions regarding how Mexican coverage is different.
Me: What are greatest concerns of expats who come to you?
J.C. - Catastrophic illness; cancer, heart disease or diabetes, for example.
Me: What are some of the most important factors in choosing a plan?
J.C. One of the most important factors to consider is the level of hospital included in your coverage, that the best hospitals are included. Here in Mazatlan, that would be Sharpe Hospital, Hospital Bilboa, Worldclass and Hospital Marina. You can also go to any other top level hospital in Mexico. Mexico City, Guadalajara and Monterrey are considered the cities with finest hospitals and specialists in the country. [aside: that's good enough for me!}.
With these upper-tier policies, the insurers pay the hospital directly, rather than reimbursing you. One of the things that costs are easier to track here is that hospitals use a single claim system.
Me: What are the standard deductibles people take?
J.C - Policies deductibles my clients take range from 25,000 to 35,000 pesos ($1,388 - 1,944 U.S. base on an exchange rate of 18 pesos to the U.S. dollar). [aside: I have friends with yearly deductibles of $5,000 in the U.S.}.
One important difference in Mexico concerning those deductibles is that a deductible applies to the lifetime of a single medical “event” or incidence. They are not paid every calendar year. If you are being treated for an illness multiple years, you don’t have to pay that deductible every year. You pay deductibles per diagnosis.
Let’s say for example you got diagnosed with lymphoma. Your deductible, once paid for, would apply for the remainder of the period of your treatment. If you were diagnosed with a second illness however, you would have another deductible to cover.
Me: What about co-pays?
The insurance company pays a percentage of the bill, usually 90/10. It’s important when choosing a policy is to make sure that the policy has a cap on how much you have to pay on co-pays. Typically, that cap should be 35,000 pesos ($1,945).
Me: What are the considerations regarding age?
JC: People who are considering retiring to Mexico need to understand that unless they are in terrific health, it will be very hard to get approved for a policy after the age of 64. The time to enroll is when your are healthy.
Me: I understand that new health insurance policies do not cover pre-existing conditions, just like U.S. policies didn’t until Obamacare.
J.C: That’s correct. The waiting period before you are covered for certain illnesses like cancer and diabetes can range anywhere from one to three years. This is another reason to get insured sooner rather than later. If you get diagnosed with a serious illness, you probably won’t be approved for coverage.
Me: So you can’t get insurance at all if you have a preexisting condition?
J.C. You can be covered but with exceptions, exclusions for that condition. You will have to pay the costs associated with that condition.
Me: When I was looking on line for expat policies, there were many to choose from online. Why should I use a health insurance broker?
J.C: Insurance brokers are familiar with the paperwork required to be admitted for surgery and what forms are required by doctors and underwriters. To guard against fraud there are a number of forms that require verification of identity for example. You might need someone who can help negotiate with insurance companies. If, because of an emergency, you are taken to a secondary hospital, the broker can orchestrate the process of reimbursement. Even if your Spanish was exceptional, that can be quite a challenge.
People should make sure that they are working with a licensed broker, someone who has passed the exams and is authorized to sell insurance. For some years people were getting away with selling insurance without those licenses and the special training they require, although that’s been cracked down on in recent years.
Me: What’s important to consider when choosing a carrier? Which are the best?
J.C: If you are considering among the top 4-5, I’d advise to choose one with a local office in the city in which you live.
Me: What about national health insurance? Can expats get that?
J.C: Yes, but you do have to have at least a Visa Temporal.
Me: What about drug coverage?
J.C: Medications are all covered by diagnosis.
Me: I understand that you need to give the hospital your credit card when you’re admitted.
J.C: Yes. Expats need to realize that they will need to have some cash available for some expenses that will be incurred at the beginning, x-rays, doctors visits for example. Some will be reimbursed. Some will be out of pocket. Medical insurance does not pay for everything upfront.
[End of interview]
You need to remember that when we think about upfront costs that Mr. Chong is referring to, they would probably add up to a fraction of the cost of the same items in U.S. The cost is so much lower on many procedures that many expats self-insure if they are on Medicare, that is they pay for their treatment and still come out ahead when compared to the United States. I know. Unbelievable.
Even with medical insurance with a private carrier here, they often will self-insure for minor, less expensive issues. At least less expensive in Mexico. When a band-aid can cost $629 in the U.S., you question if we even have less expensive issues.
Unless you have a Cadillac policy, having medical standard insurance has the potential of providing a false sense of security. We all have read or know people whose coverage has run out. Fifty percent of bankruptcies are caused by healthcare costs and many of those people have health insurance when they get sick or injured.
When so many things can happen to us, we can’t possibly run through every scenario and know every possible cost. All we can do is consider what needs to be covered now, and make some predictions based on personal and family histories. After that, you just keep your fingers crossed.
Keeping in mind Mr. Chong’s advise regarding pre-existing conditions, I feel compelled to get my Mexican coverage clock ticking now, rather than later. For all I do to protect my health, fate is fickle. You never really know. Should something serious crop up, I don’t want to locked out of a far less expensive but still high quality alternative. As it stands, I can always go back to the U.S. and get coverage, the same does not go for Mexico.
The rules for expat policies were changed as late as July of this year. According to the new ACA rules, three types of expatriates qualify for expatriate healthcare plans if the plan satisfy certain requirements, two of which apply to employment and group health plans:
Category A: Non-U.S. nationals who are assigned to the U.S. for a specific and temporary purpose due to their skills or job duties, and who require health coverage in multiple countries because they are expected to travel outside the U.S. at least once a year, and are periodically offered other multinational benefits.
Category B: U.S. nationals working outside the U.S. for at least 180 days in a consecutive 12-month period.
Presently, if I continue to live less than 330 days in Mexico, it appears that I have to get coverage just like I would if I lived in the U.S all the time, or pay the $795 penalty. Again, considering the possible out-of-pocket costs, I may still be ahead with the Mexican coverage, which will run me about $1,700 dollars U.S a year ($140/month).
If I add $66. per month for the penalty, my total monthly bill would be $206 a month, still less than Obamacare coverage, which will not cover me in Mexico. More important is that I start the clock on the waiting period on the Mexican comprehensive coverage.
If someone still wasn't confident about the quality of Mexican healthcare (that is, knew very little about Mexico) or were say, covered by the veterans' insurance, what they would probably do is opt for the inexpensive IMSS insurance in Mexico for emergencies when they are in Mexico and keep their ACA insurance too.
A friend of mine who is living basically on social security and has advanced cancer. During the whole course of his treatment, in spite of being covered by Medicare, he spent most of his day navigating the labyrinth of websites and agencies that provide assistance with daily needs and out of pocket expenses.
I question it would be much different if he had been covered by Obamacare. In the same situation, would I just spend away my whole retirement savings out-of-pocket costs until it’s gone, then to add insult to injury, have to spend my time in recovery and beyond trying to figure out how to financially survive?
This scenario happens every day in our country. You can’t just put your head in the sand because you still have your health.
Related: Mexico: What is the difference between ISSSTE and IMSS by Quora -
Barron's reports on the real cost of healthcare in retirement. While hard to pin down exactly, none of the numbers are good news.
Next up: One of the great things about practicing Spanish with Skype practice partners is that you become enlightened to the fact that maybe they too have an excellent quality of life. So why do we only compare ours to the worst in the world, not the best?
I'm a partner with Ventanas Mexico and the author of "If Only I Had a Place," on renting in Mexico, and my first love the "Interactive Guide to Learning Spanish Free Online,' geared to older adults thinking about moving or retiring to a Spanish-speaking country.
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