# Healthcare with a stable, but pre-existing condition?



## Shhhr (Feb 2, 2014)

Hi! We are just starting to look at Peurto Vallarta for relocation. I have a preexisting lung condition and I am wondering about health care. It has been stable for seven years, but I am worried I won't be able to get affordable health insurance. Coming from Canada where health care is paid for, this is a BIG worry. Can anyone give me some guidance?


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## lagoloo (Apr 12, 2011)

We have two publicly supported health care plans in Mexico: Seguro Popular and IMSS.
Perhaps someone who is familiar with Seguro Popular can answer your question about pre-existing conditions.

IMSS has a waiting period for coverage of such conditions. You would need to get the details from a representative.

I am signed on with IMSS for emergencies, but otherwise, it's out of pocket.

Someone else may have good information on available private coverage here.


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## Shhhr (Feb 2, 2014)

Thank you so much! That actually sounds more positive than I had thought!


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## TundraGreen (Jul 15, 2010)

lagoloo said:


> We have two publicly supported health care plans in Mexico: Seguro Popular and IMSS.
> Perhaps someone who is familiar with Seguro Popular can answer your question about pre-existing conditions.
> 
> IMSS has a waiting period for coverage of such conditions. You would need to get the details from a representative.
> ...


Just to clarify… Do you mean you only use IMSS for emergencies and pay for other issues out of pocket? Or do you mean your contract with IMSS only covers emergencies?

As far as I know, IMSS doesn't have varying levels of coverage. It is a one-annual-fee that covers everything, emergencies, wellness visits, and everything in between. However, given the waiting times to see a specialist, I can see where someone might only use them in emergencies and go elsewhere for other care. I have done that.


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## Shhhr (Feb 2, 2014)

What I am worried about is, what if in the future the condition deteriorates and I require another bullectomy (lung surgery to remove pockets on the lining) Is it considered pre-existing, and therefore I pay out of pocket? Or is covered as this would be FAR off in the future.


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## Longford (May 25, 2012)

None of us can answer the "pre-existing" question for you because the determination will be made in the future and will be specific to your situation at that time - and, sometimes, at the whim of a government employee where you live. My advice is that, if at all financially feasible, you arrange for private health care insurance. The quality of government-affiliated health care facilities varies so widely in Mexico. Personally, I would not solely rely upon government-affiliated health providers/facilities.


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## Isla Verde (Oct 19, 2011)

Longford said:


> None of us can answer the "pre-existing" question for you because the determination will be made in the future and will be specific to your situation at that time - and, sometimes, at the whim of a government employee where you live. My advice is that, if at all financially feasible, you arrange for private health care insurance. The quality of government-affiliated health care facilities varies so widely in Mexico. Personally, I would not solely rely upon government-affiliated health providers/facilities.


Private health insurance may be almost impossible to get in Mexico if you are over 65 when you first apply for it.


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## Shhhr (Feb 2, 2014)

My husband is 58 and I am 38. Fortunately, he has a clean bill of health. We teach group fitness together. Thank you for the advice! I am now looking at private health care as an option. Here's hoping it's affordable!! 

Does anybody have a private insurance company they particularly like?


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## Hound Dog (Jan 18, 2009)

We use AXA for unlimited major medical coverage with a $30,000 Peso deductible and we carry it strictly for insurance against financial catastrophy in the event we (or one of us) is subject to lengthy hospital stays or complex surgery. We started with AXA at ages 63 and 58 and both have "noncancellable" policies although, of course, our premuims can and will go up annually as we age. I am now 72 and my wife is 67. Our annual premiums are, as expected, becoming more dear every year and some day may not be worth continuing as we reach decrepitude but as of this year, we are fine with the costs we are incurring. You must make this decisión for yourselves but at your ages , your premiums should be quite reasonable and you should have no trouble establishing accounts probably without actual physical examinations. Whether or not you have some pre-existing conditions not covered is a conundrum you must face.

By the way, the AXA major medical coverage is for the nation´s finest physicials and hospitals with private suites, not some shared room or dormitory for the ill like our old HMO coverage in the U.S. The very thought of depending on IMSS or (shudder) Seguro Popular (mainly for the destitute) makes my skin crawl. However, if you decide to go to one of those programs, when you get sick and must be committed to a hospital or clinic , bring your own toilet paper, soap, toothbrush, a friend or family member to nurse you and/or apply the toilet paper as required and be prepared for long waits and dormitory living among others afflicted with various afflictions they may pass on to you.

I don´t know your financial capacity and don´t care but remember that physician and hospital care costs are a mere fraction in Mexico of those same costs in the U.S. so being without coverage here is better than anything the U.S, has to offer.

As for Seguro Popular, the program not dissimilar to San Francisco General Hospital in San Francisco circa the 1990s, don´t worry about the long waits in line in the emergency room. At San Francisco General, the standing joke was that you were more likely to be shot in that neighborhood than see a doctor before you expired but, what the hell, the doctor would just as likely kill you anyway so go quickly.


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## Shhhr (Feb 2, 2014)

Thank you! This is very informative!


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## TundraGreen (Jul 15, 2010)

Shhhr said:


> Thank you! This is very informative!


I am not so negative about IMSS as the esteemed Hound Dog. 

For a relatively modest cost, about $3500 pesos/year, you get access to all of IMSS hospitals in the event of an emergency. They are located in all but the smallest villages throughout Mexico. With no additional expense, you get teeth cleaning, flu shots and other vaccinations. For non-critical conditions you can see a specialist in any field, you just have to be willing to wait, usually for months. 

You can use IMSS for routine or emergency care, then add other options when you don't want to wait for IMSS, either pay-as-you-go, or perhaps additional insurance.


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## lagoloo (Apr 12, 2011)

My husband and I subscribe to IMSS in its normal form, to cover all matters. We would prefer to use private doctors and even hospitals for most situations but are aware of the need for an emergency back up system for very serious, long term illnesses. Example: serious auto accident requiring weeks of hospital care and therapy.

Regarding Hound Dogs description of the IMSS hospitals, it's probably accurate enough, and Seguro Popular is probably the same bare bones deal. However, the same applies if you must be in a certain town and can't afford to stay at the Hilton, you stay where you can afford, and expect the amenities that do or don't do with it. If you're sick, it's better to get bare bones care than none at all.

So far, we have had no problems that require more than a doctor visit. We pay out of pocket for this, and any prescription medications.

Hope that clarifies it.


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## Hound Dog (Jan 18, 2009)

OK, guys, IMSS is a good program and so is Seguro Popular for that matter. Thank God Mexico has medical programs for those qualifying for social benefits and the poor and I applaud that. As I read the OP´s inquiry, I felt the OP was asking about private medical insurance and that was the gist of my response. IMSS and Seguro Popular are fine programs covering their constituencies and anyone else eligible to join and more power to them. 

I do wonder,at times, how expats,with no true financial or personal investments in Mexico and living here under temporary residency visas, are permitted to participate in any social medical programs. Something seems amiss.


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## lagoloo (Apr 12, 2011)

Maybe the answer is :
Many things in life are "optional". Getting sick isn't one of them (although it you don't take care of yourself to promote good health, it may be). I'm a great believer in making health care be something no one should do without.

As for those who have no stake in Mexico but want the health care system to be there for them, at least they are signing up and paying the modest fees involved: a lot better option than having nothing at all and expecting their friends and neighbors to pick up the tab when they suffer misfortune. 
Many countries in the world will care for tourists who have medical emergencies while in their country. Makes you feel all warm and fuzzy about those places.


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## Longford (May 25, 2012)

Hound Dog said:


> I don´t know your financial capacity and don´t care but remember that physician and hospital care costs are a mere fraction in Mexico of those same costs in the U.S. so being without coverage here is better than anything the U.S, has to offer.


I consider the above an apples-to-oranges comparison and exaggeration (negatively so) of what one would experience in the USA in a non-insurance situation and needing emergency care).


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## lagoloo (Apr 12, 2011)

Correct me if I'm wrong, but I believe that in the U.S., the uninsured poor go to the general hospitals' emergency rooms, and do get care whether they can pay or not. If they are in the right city, they will go to a one of the top teaching hospitals and get excellent care. No luxurious accommodations, though. 

Hound Dog's story is grim, but a good friend who is a surgical nurse in the U.S. said that sometimes there are long waits in the hallways before any treatment is given due to overcrowding and understaffed situations. Like any battlefield, it's "triage" time.


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## AlanMexicali (Jun 1, 2011)

lagoloo said:


> Correct me if I'm wrong, but I believe that in the U.S., the uninsured poor go to the general hospitals' emergency rooms, and do get care whether they can pay or not. If they are in the right city, they will go to a one of the top teaching hospitals and get excellent care. No luxurious accommodations, though.
> 
> Hound Dog's story is grim, but a good friend who is a surgical nurse in the U.S. said that sometimes there are long waits in the hallways before any treatment is given due to overcrowding and understaffed situations. Like any battlefield, it's "triage" time.


True there as a few specifically designated larger hospitals in San Diego that deal with people with no medical coverage or money to pay in emergency situations.

They do however investigate them and if they have an extra vehicle, IRA or money in a bank take action to recoup what they can from these people. You can have one vehicle and one house or condo, all else they can lien.

For standard non emergency medical issues they are turned away.


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## JoanneR2 (Apr 18, 2012)

Shhhr said:


> Hi! We are just starting to look at Peurto Vallarta for relocation. I have a preexisting lung condition and I am wondering about health care. It has been stable for seven years, but I am worried I won't be able to get affordable health insurance. Coming from Canada where health care is paid for, this is a BIG worry. Can anyone give me some guidance?


From what you have told us I think you would be able to get private medical insurance. However, most insurers will only cover pre-existing conditions after a period of time has passed without symptoms or treatment. With AXA, I believe you can purchase this option and the waiting period is 5 years. Without the option pre-exiting conditions would be specifically excluded on your policy. My suggestion would be to find a good agent in your area (if you are interested I can recommend on inPuerta Vallarta who specializes in Ex-pat policies and can send an email with the details). They can tell give you options and prices and explain better the various options available. Good luck with the move. Jo


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## lenstewart (Nov 16, 2013)

JoanneRS: I am a few months from moving to the Baja, and am intersted in learning more about ex-pat health insurance policies. Does your agent in PV perhaps have general information or referrals s/he could share with me? Or sell policies out of area? [New on this forum. Do we have opportunity to DM or contact each other by regular email?]


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## Isla Verde (Oct 19, 2011)

lenstewart said:


> JoanneRS: I am a few months from moving to the Baja, and am intersted in learning more about ex-pat health insurance policies. Does your agent in PV perhaps have general information or referrals s/he could share with me? Or sell policies out of area? [New on this forum. Do we have opportunity to DM or contact each other by regular email?]


Once you've made 5 posts, you can send and receive PMs. Just left-click on the member's name you want to write to and a menu will drop down. Left- click on "Send a private message to XXXXX" and you're in business.

And welcome to the Forum!


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## lenstewart (Nov 16, 2013)

Thanks. Think this makes five right here!


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## Isla Verde (Oct 19, 2011)

lenstewart said:


> Thanks. Think this makes five right here!


Yes, it does!


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