# How Does Your Health Care Compare to US



## ElPaso2012 (Dec 16, 2012)

This post is an offshoot of the discussion of how Obamacare will affect ex-pats in Mexico that is currently going on in another post. It seems the question I have would be a bit off-topic there, so I've started this new topic. 

For those of you who have health insurance in Mexico, public, private, whatever you have, I'd love to know your coverage compares in terms of coverage with what people purchasing private policies in the US will have soon. 

A pretty good breakdown of the new "metal" plans that will be offered in the US as part of the Affordable Health Care Act can be found here. Most people in the US will no doubt be buying the Bronze or Silver plan, both of which have annual out-of-pocket maximums of between $6,350/$12,700. The other details are in the article.

How does your coverage compare? Feel free to be as detailed or general as you wish. Information on what you pay for your policy would be welcome, but you may not want to include it. I'm just not familiar with what's available for ex-pats in Mexico in terms of coverage.


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## Hound Dog (Jan 18, 2009)

Two things:
* Everybody´s situation is different
* Most of us full-timers having lived in Mexcio for a number of years with no intention of returning to the U.S for medical care whether elligible for medicare or Obamacare or not, plan to use the Mexican medical system for all medical care except in those rare cases, such as organ transplants, where the U.S. medical system may have superior service and, even then, the older you get, the less likely that you will be a candidate for a serious transplant so adios, Planet if that happens or finger-crossing time here in Mexico.

Because we have no intention of ever returning to the U.S. even in pine boxes, we haven´t paid much attention to Obamacare although personally we think it is a move in the right direction for most people resident there and congratulate Obama for bulldozing the program through. No doubt improvements in the program will come with time and experience.

What I can do is tell the reader about our coverage with the major international insurer AXA here in Mexico which is unlimited major medical coverage ´with private rooms (suites, actually with excellent amenities including extra beds for loved ones) at the finest hospitals in cities throughout Mexico with care by the top physicians in those cities of our choosing. Our polciies are intended to insure against catastrophic financial costs associated with critical care over time and not ordinary doctor visits for routine, minor probems or the recurring costs of medication thus we each carry $30,000MXN about ($2,400USD at today´s exchange rate) deductible which keeps policy costs down as we age.

We took out these policies in 2001 when I was 60 and my wife was 55. These policies are non-cancellable no matter how old we become before we croak although the premiums go up annually as we get older. Our most recent annual premiums this past May were:

$33,975MXN for my wife who is now 66. (about $2,700USD today*)
38,149MXN for me, now 71. (about $3,000SD today*)
$72,124MXN Total ( about $5,700USD today*)

* Of course that exchange rate will change, perhaps significantly, over time and that USD information is just for comparison today. Since we are Mexico fulltimers, the USD costs are irrelevant to us but a comparison is still entertaining. Today´s exchange rate (MXN/USD) is over 12/1 wheras, when we purchased these policies the rate was 9/1 - a big difference.

Now, when we both retired from our jobs in 2000, we became elligible for COBRA coverage at HMOs in our California community (Kaiser Permanente in our case) for a dorm bed shared with several other sick goobers) and an assigned Kaiser physician at a cost of $1,100USD a month (subject to change according to availability). In comparison, today, 13 years later when we are significantly older, together we pay $6,010MXN per month (about $480USD today) for major medical coverage that is far superior to that offered as COBRA coverage 13 years ago in the U.S. God knows what our annual medical premium would be in the U.S. today before Obamacare kicks in.

Incidentally, those annual premiums are what they are despite the fact that I had major, life-threatening gall bladder surgery in 2008 which nearly killed me and I received coverage for most of my expenses despite the fact that that surgery took place in a non-accredited filthy hospital in Chiapas in a town where all of the hospitals are marginal at best.

Of course, many expats living here either full or part time opt for IMSS or Seguro Popular health insurance rather than private insurance but we are neither members of IMSS nor Seguro Popular and would avoid both like the plague but that may just be our ignorance of the programs. Perhaps someone who has participated in those programs can enlighten us as to their experiences. 

Top quality hospitals and physicians versus health mills and rotating doctors in the U.S. at *substantially *higher costs. Another reason to thank God we moved to Mexico even with Medicare and Obamacare kicking in up there. 

By the way, had we retired to my wife´s native France, an alternative we considered back in 2,000, we would have retired to a country with free medical care if one worked within France
throughout one´s career participating in the social security prgram there. However, since my French citizen wife worked in the U.S. all of her career, we would not have been eligible for free medical care in France - another reason, in addition to the unbelievable cost of living in that country and lousy climate much of the year, we are pleased to live in Mexico in retirement.


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## ElPaso2012 (Dec 16, 2012)

Thanks so much for answering. Your major medical coverage sounds pretty good, and thanks for even putting the name of the insurer in your post.

The reason I asked the question is because "Health Care" page on most sites about living in Mexico usually talk about high quality care being available at a reduced cost versus the US, but the specifics are lacking --- items such as your annual deductible, the extent of coverage, and the actual cost of the policies, the information you put in your post. No doubt, as you say, the situation varies by location and individual, but by hearing from a few people it should be possible to get a much better idea of what's available.

In your case, the major medical sounds very good indeed for the cost. I've put $250 a month in the budget for health care insurance, and it sounds like that will more than get the job done in Mexico. 

It just seems to me that health care insurance in the US borders on being a scam. You pay a monthly premium roughly equivalent to the cost of leasing a new Mercedes. Then when you need major medical you still wind up deeply in debt. That might be okay for a person still working and able to eventually pay it off, but it's financial ruin for anyone on a fixed income. Then there are the "exceptions" and the fine print. Right now, because a doctor used an out-of-state laboratory to analyze some biopsy results, Blue Cross will not pay the claim from the lab, which is $17,400 _just for analysis_. It makes me afraid to go to the doctor at all. 

Thanks again the info. Hopefully, someone who is using the public side of health care in Mexico will also post. I have been curious if it's possible to use the public health care plan for minor needs while also paying for a major medical policy like yours on the side.


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## TundraGreen (Jul 15, 2010)

ElPaso2012 said:


> Thanks so much for answering. Your major medical coverage sounds pretty good, and thanks for even putting the name of the insurer in your post.
> 
> The reason I asked the question is because "Health Care" page on most sites about living in Mexico usually talk about high quality care being available at a reduced cost versus the US, but the specifics are lacking --- items such as your annual deductible, the extent of coverage, and the actual cost of the policies, the information you put in your post. No doubt, as you say, the situation varies by location and individual, but by hearing from a few people it should be possible to get a much better idea of what's available.
> 
> ...


I have a few years experience with IMSS (Instituto Mexicano de Seguro Social). They provide both medical insurance and social security. Most members are working people whose jobs provide IMSS coverage. However, individuals can sign up for and pay for the medical coverage. I currently pay about $3600 pesos per year. It has gone up every year by about $300 pesos either due to inflation or my increasing age, I am not sure. Currently, I am 68 and pay for a single person, not family.

I am pretty healthy so I don't have much experience with the care provided but I can relate my experience. I was assigned a primary care physician and have to see her first for any kind of non-emergency care. I can either make an appt or walk in and wait. If you arrive early in the morning I can see her without an appt with a couple of hours wait. With an appt, I go in with almost no wait. If a specialist is required, I get an appt after talking to the primary care physician. The wait to see a specialist is about 6 months.

Once I had an infection in an elbow and went to the emergency room. There I waited about an hour and half and then saw a specialist who treated it (sling and antibiotics). The emergency room appears to have an effective triage system. If you are bleeding or not breathing, you get immediate care, if it is less urgent you wait in line.

I get my teeth cleaned every few months. No appt needed, I just show up, wait about 10 minutes and it is done.

The pharmacy has been out of the drugs that were prescribed the last couple of times. When I needed antibiotics for my elbow, they had them.

The only fees are the annual membership. There is no copay, no charge for drugs.
There are some excluded conditions for the first year or two and they don't cover things like cosmetic surgery. Also, I don't really know much about the effect of preconditions.

And finally none of the doctors I have dealt with spoke English. One receptionist recently did and it was a surprise.

In summary, I find it worth it for the emergency care if nothing else. There are IMSS facilities everywhere in Mexico. I have supplemented it by visiting a private doctor once when I had a shoulder that was bothering me. It was a non-emergency but I didn't want to wait six months to see someone. I could have gone to the emergency room for it but chose to pay for a private doctor.


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## ElPaso2012 (Dec 16, 2012)

TundraGreen said:


> I have a few years experience with IMSS (Instituto Mexicano de Seguro Social). They provide both medical insurance and social security. Most members are working people whose jobs provide IMSS coverage. However, individuals can sign up for and pay for the medical coverage. I currently pay about $3600 pesos per year. It has gone up every year by about $300 pesos either due to inflation or my increasing age, I am not sure. Currently, I am 68 and pay for a single person, not family.
> 
> I am pretty healthy so I don't have much experience with the care provided but I can relate my experience. I was assigned a primary care physician and have to see her first for any kind of non-emergency care. I can either make an appt or walk in and wait. If you arrive early in the morning I can see her without an appt with a couple of hours wait. With an appt, I go in with almost no wait. If a specialist is required, I get an appt after talking to the primary care physician. The wait to see a specialist is about 6 months.
> 
> ...


Well, thanks to you for the great info. Just being able to see a doctor for the flu without paying anything makes it great deal for $3600 pesos a year. No co-pay, no deductible sounds good, too. Also, you sound pleased with the service being provided to you at the clinic in terms of wait time, etc. 

I take it there would be nothing preventing you from taking out a major medical policy in addition to having IMSS if you wished?


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## Isla Verde (Oct 19, 2011)

Regarding buying private health insurance in Mexico, if you're over 65, it may be almost impossible to do, unless you have very deep pockets.


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## ElPaso2012 (Dec 16, 2012)

Isla Verde said:


> Regarding buying private health insurance in Mexico, if you're over 65, it may be almost impossible to do, unless you have very deep pockets.


Well, now that's very interesting. I'll be 63 in October, so there is time, I suppose. HoundDog reports above that his policy can't be cancelled so I don't plan to wait.


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## TundraGreen (Jul 15, 2010)

ElPaso2012 said:


> Well, thanks to you for the great info. Just being able to see a doctor for the flu without paying anything makes it great deal for $3600 pesos a year. No co-pay, no deductible sounds good, too. Also, you sound pleased with the service being provided to you at the clinic in terms of wait time, etc.
> 
> I take it there would be nothing preventing you from taking out a major medical policy in addition to having IMSS if you wished?


The wait time to get an appt with a specialist is a pain. Otherwise, I find it very convenient. I could, of course, pay for any kind of private insurance I wanted in addition, subject to Isla's comment about the cost at my age.


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## Isla Verde (Oct 19, 2011)

ElPaso2012 said:


> Well, now that's very interesting. I'll be 63 in October, so there is time, I suppose. HoundDog reports above that his policy can't be cancelled so I don't plan to wait.


I had a private policy with a Mexican company for several years till it was cancelled this year by the insurance company because my cholesterol numbers were too high. This happened when I was 67.


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## ElPaso2012 (Dec 16, 2012)

Isla Verde said:


> I had a private policy with a Mexican company for several years till it was cancelled this year by the insurance company because my cholesterol numbers were too high. This happened when I was 67.


Sounds like the US, a company that cancels you because the chances are increasing that you might actually need medical assistance... 

I don't trust insurance companies as a rule. My profession was software developer, and in 1994 an insurance company ordered me to create a list of all policy owners whose claims over the past four years had exceeded their premiums and then to do a mass mail out cancelling their policies with an indecipherable cover letter that was nothing but legalese. I learned later this was against the law. 

A few years later I shared a ride with an adjuster who bragged about her annual bonuses for denying claims. At the same company during an employee meeting the HR manager urged us all "to pray" that a hurricane approaching Florida would actually hit the coast so their emergency adjusters could move into the area. We were all shocked beyond belief. I don't trust insurance people, but it's a necessary evil I suppose. 

Sorry for your bad experience. All the premiums you paid over the years, for what?

Was your policy supposed to be non-cancellable?


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## Hound Dog (Jan 18, 2009)

Converning observations made after my posting above on private major medical insurance:
* One needs to take out a policy immediately upon establishing residency in Mexico if one is approaching his/her 60s because Isla is right, once you turn 65, you are no longer a valuable client and will either be rejected or pay outrageous premiums. Afetr your 70s, don´t bother even asking - our policies are what they are because we started coverage years ago.
* To be assured of permanent, non-cancellable coverage, you must deal with a scrupulous and highly competent agent and understand the fine print in your policy. When interviewing a potential agent, ask about this assertively and do not accept vague responses. For example, when I arrived here in 2001, I joined the venerable expat Lake Chapala Society (LCS) and took out a group unlimited major medical insurance policy for LCS members. The policy was underwritten by highly reputable New York Life/Seguros Monterrey and was being sold on LCS premises by their agent in an office supplied by the LCS. That agent assured me absolutely that the policy was non-cancellable. Then, a few months later.that policy was cancelled and a much inferior policy with limited coverage offered in its stead which I rejected as inadequate. When I confronted the LCS board member in charge of health insurance and told him of this unacceptable event, his response was that in his view, New York Life had acted irresponsibly and would never have dared do that in the U.S. He also told me that, frankly, the LCS board was also quite upset and had not known what it was doing when it allowed the issuanec of that group policy which the insurance company had summarily cancelled, _*It seems, according to this LCS board member in those days, that non-cancellable policies are just that but "group" non-cancellable poicies can, in fact be cancelled as long as the group policy is discontinued so avoid group coverage if a non-cancellation guaranty is important to you - take out your own policy in your name alone.*_

By the way, the decsion back in around the year 2000 by New York Life/Seguros Monterrey management at the time to issue a group major medical health insurance policy to a society composed almost entirely of elderly folks in their 60s through 80s and up has to have been one of the dumbest management decisions of all time and the company cancelled when they found themselves losing a ton of money as all these old goobers staring falling like flies or at least that´s what that LCS boad member told me.

The important thing is, despite this hearsay, you avoid group health insurance policies if possible.

In closing, I noted that someone posting above asked about trusted insurance agents so here goes. I am the son of a very successful South Alabama independent insurance agent whose practice thrived back in the 1940s through the 60s and he taught me through example that the integrity and good reputation of one´s insurance agent is of paramount importance when dealing with any insurance company. We have dealt with the same agent for health, car and home insurance now for over a decade and have had two complex claims, both in remote Chiapas for hospitalization and a car accident and, thanks to the hard work of this agent dealing wth AXA at the corporate level, we were highly satisfied with both claim settlements. We firmly believe one needs a local agent wherever one lives but if you are in or near Metropolitan Guadalajara, his name is Jesus Tejeda and he lives and practices in that city. I give him my unreserved highest recommendation. I´m sure you can reach him through AXA´s Guadalajara office.


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## Isla Verde (Oct 19, 2011)

ElPaso2012 said:


> Sounds like the US, a company that cancels you because the chances are increasing that you might actually need medical assistance...
> 
> I don't trust insurance companies as a rule. My profession was software developer, and in 1994 an insurance company ordered me to create a list of all policy owners whose claims over the past four years had exceeded their premiums and then to do a mass mail out cancelling their policies with an indecipherable cover letter that was nothing but legalese. I learned later this was against the law.
> 
> ...


All the premiums I paid were basically for naught. During the years I had the policy, I only used it for office visits, for check-ups and the like. I had to pay for the visits, but at a discounted rate. No, my policy did not have a non-cancellation clause.


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## Marishka (Feb 1, 2009)

Hound Dog said:


> We took out these policies in 2001 when I was 60 and my wife was 55. These policies are non-cancellable no matter how old we become before we croak although the premiums go up annually as we get older. Our most recent annual premiums this past May were:
> 
> $33,975MXN for my wife who is now 66. (about $2,700USD today*)
> 38,149MXN for me, now 71. (about $3,000SD today*)
> ...


Hound Dog, do you have any idea how much your premiums will cost when you get up into your upper 70s and into your 80s? If you ever ask your insurance agent about that, could you let us know his answer? 

I was exploring the option of getting international health insurance, so I checked out some policies. I just about had a heart attack when I saw the annual premium rates for older people for a policy from Lloyd's of London through the Worldwide Medical Trust. They will, btw, accept new policy-holders up to the age of 85, and they offer renewals for life. The following rates are for coverage up to $2,000,000 USD, with a $2,000 deductible:

AGE_______PREMIUM

50-54______$1,102
55-59______$1,307
60-64______$1,654
65_________$1,842
66_________$2,054
67_________$2,293
68_________$2,560
69_________$2,862
70_________$3,282
71_________$3,766
72_________$4,326
73_________$4,974
74_________$5,722
75_________$6,586
76_________$7,583
77_________$8,736
78_________$10,066
79_________$11,603
80_________$12,175
81_________$13,378
82_________$15,363
83_________$17,644
84_________$20,269
85_________$23,286


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## JoanneR2 (Apr 18, 2012)

Marishka said:


> Hound Dog, do you have any idea how much your premiums will cost when you get up into your upper 70s and into your 80s? If you ever ask your insurance agent about that, could you let us know his answer?
> 
> I was exploring the option of getting international health insurance, so I checked out some policies. I just about had a heart attack when I saw the annual premium rates for older people for a policy from Lloyd's of London through the Worldwide Medical Trust. They will, btw, accept new policy-holders up to the age of 85, and they offer renewals for life. The following rates are for coverage up to $2,000,000 USD, with a $2,000 deductible:
> 
> ...


Normally GMMI (gastos médicos mayores individual) policías in México are guaranteed renewal policies. That is, the policy will always be renewed providing you pay the premiums. The insurance companies cannot cancel because you have claimed. They also (as from April this year) cannot change certain of your policy conditions at renewal (e.g. Reduce your sum assured). most companies will accept people up to 65 as new customers and will then renew each year regardless of age or health status. However, prices do get very expensive for older people to reflect the costs of these customers as, unfortunately, the older we become the more likely we are to get ill. Insurance is there to cover risks and is priced according to the level of risk. With some companies there are exceptions made for people over 65 but most would expect the customer to be underwritten (to complete a medical questionnaire and potentially have tests to assess the state of health). Any pre-existing conditions would be excluded from the cover but anything new would be paid for. There often comes a point where it maybe cheaper to pay for treatment when the need arises rather than paying monthly premiums. However, it is worth investigating the costs of treatments for say common forms of cancer or heart disease before making a judgement call on this. The main providers of Individual Health Insurance in Mexico currently are AXA, GNP, Seguros Monterrey and MetLife. Hope that helps.


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## Hound Dog (Jan 18, 2009)

Well, it sounds as though my wife and I at 66 and 71 respectively are right on the mark with premium costs for unlimited major medical at AXA having paid an aggregate annual premium of the equivalent of $5,700USD (vs. $5,820 quoted above) and with a deductible of the equivalent of $2,400USD. That is entirely reasonable but when I am 80 a nd she is 75, (God willing), aggregate annual premium for us both will probably be on the neighborhood of between $18,000 & $19,000USD. What the hell, a shroud has no pockets so why get off the train when it´s moving so fast. Besides, by then, Nurse Cratchett will have gotten used to spooning me my simulated oatmeal in a straw and will make certain my premiums are current or I´ll hve to start stealing Fido´s All Beef Happy Chunks fresh from my blender.

I´m too superstitious to start self-insuring now so on we go.


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## Marishka (Feb 1, 2009)

JoanneR2 said:


> Most companies will accept people up to 65 as new customers and will then renew each year regardless of age or health status. However, *prices do get very expensive for older people* to reflect the costs of these customers as, unfortunately, the older we become the more likely we are to get ill.


That’s the sticky wicket. My grandparents and great-grandparents almost all lived well into their 80s and some lived into their 90s. My parents are 83 and are still hale and hearty. If I’m fortunate to live that long, I can see that somewhere along the line, I’d no longer be able to afford private health insurance in Mexico. 

Since my husband and I are going to keep a small place in the U.S., the best option for us might be to combine Medicare (including Part B and a supplement plan) with a medical evacuation policy. I wish I could find a supplemental plan that provided coverage for longer periods of time outside the U.S., though. My husband’s Blue Cross Medicare supplement only covers him for emergency care during the first 60 days of a trip outside the United States, and then only up to $50,000. Blue Cross has a plan for Californians that can be used both in the U.S. and at some hospitals in Baja Norte, but there are no plans like that in Texas.



JoanneR2 said:


> There often comes a point where it maybe cheaper to pay for treatment when the need arises rather than paying monthly premiums.


Then again, even in Mexico, people can end up owing tremendous sums of money to doctors and hospitals. It happens all the time.



Hound Dog said:


> Well, it sounds as though my wife and I at 66 and 71 respectively are right on the mark with premium costs for unlimited major medical at AXA having paid an aggregate annual premium of the equivalent of $5,700USD (vs. $5,820 quoted above) and with a deductible of the equivalent of $2,400USD. That is entirely reasonable but when I am 80 a nd she is 75, (God willing), aggregate annual premium for us both will probably be on the neighborhood of between $18,000 & $19,000USD. What the hell, a shroud has no pockets so why get off the train when it´s moving so fast. Besides, by then, Nurse Cratchett will have gotten used to spooning me my simulated oatmeal in a straw and will make certain my premiums are current or I´ll hve to start stealing Fido´s All Beef Happy Chunks fresh from my blender.
> 
> I´m too superstitious to start self-insuring now so on we go.


You are too funny, Hound Dog! They do say that laughter is the best medicine, don't they?


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## ElPaso2012 (Dec 16, 2012)

Marishka said:


> Then again, even in Mexico, people can end up owing tremendous sums of money to doctors and hospitals. It happens all the time.


That's a question that has arisen in my mind after reading all these great posts.

In the US, the bill collectors will hound you in hiding. What happens to people in Mexico who have large debts they cannot pay? I'll ask my friends in Juarez this weekend, but I'll bet some of you have insights into that situation as well.


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## mickisue1 (Mar 10, 2012)

ElPaso2012 said:


> Sounds like the US, a company that cancels you because the chances are increasing that you might actually need medical assistance...
> 
> I don't trust insurance companies as a rule. My profession was software developer, and in 1994 an insurance company ordered me to create a list of all policy owners whose claims over the past four years had exceeded their premiums and then to do a mass mail out cancelling their policies with an indecipherable cover letter that was nothing but legalese. I learned later this was against the law.
> 
> ...


See, that's USA-think. Insurance companies, for healthcare, anyway, are NOT a necessary evil. They are simply an evil, and because they have incredible amounts of money at their disposal, they can spend it to convince us, and the US lawmakers, otherwise.

My only beef with Obamacare is that it was written to, in part, avoid the insurance industry's nuclear attacks, like the ones they used in 1993 against Bill Clinton and Hillary.

I worked, like you, in the insurance industry for a long time. From 1989-2000, to be exact. But as an RN in claims. I got tired of working for the enemy, you know? The civilized world treats healthcare as part of the social contract, like schooling and police and fire protection. The US treats it as a huge profit center.


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## Marishka (Feb 1, 2009)

ElPaso2012 said:


> That's a question that has arisen in my mind after reading all these great posts.
> 
> In the US, the bill collectors will hound you in hiding. What happens to people in Mexico who have large debts they cannot pay? I'll ask my friends in Juarez this weekend, but I'll bet some of you have insights into that situation as well.


This article from _Mexico Expat Press_ answers that question: 6 Big Mistakes People Make in Mexican Lawsuits

I'll give you some examples of how much you might end up owing hospitals if you don't have good health insurance in Mexico.

A couple of months ago, a young man was hit by a train in San Miguel. He was in the hospital in Queretaro for 27 days, had to have several surgeries, and spent a lot of time in intensive care. He unfortunately didn’t survive. The hospital bill was over $1,200,000 pesos (about $100,000 USD). The family had to mortgage their home to the hospital, and were only able to pay off their bill and keep their home because of the donations they received from the expat and Mexican community and loans from family.

Earlier this year, an expat was hospitalized in a private hospital for 8 days in Guadalajara for Guillain-Barre syndrome before she was air evacuated to the U.S. Her hospital bill was $320,000 MXN.

Around the same time, another expat was taken to a Hospital in Queretaro for a stroke and died on the fourth day. His hospital bill came to around $500,000 MXN.

I also know of an expat who had heart bypass surgery in Guadalajara a few years ago. His hospital bill came to the equivalent of about $50,000 USD.

If you self-insure and have IMSS or Seguro Popular insurance as a backup plan, I think it would be wise to carry something with you that instructs others where to take you in case you are unconscious and can't speak for yourself.

A few years ago, an American expat (who also has Mexican citizenship) living in San Quintin, Baja reported that he and his Mexican wife paid out of pocket for most medical expenses, but had just enrolled in Seguro Popular, just in case something catastrophic happened. Well, a month later something catastrophic did happen. Ron and Christina were attacked by some thieves in their neighborhood. 

They were both taken to Hospital General, but for some unknown reason Ron was transferred to a private hospital in Ensenada. Since he was unconscious, he had no say in the matter. Thankfully, Ron and Christina both recovered, but by the time Ron was discharged a week later, his hospital bill totaled about $200,000 MXN. He never did learn why they transferred him to the private hospital.


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## ElPaso2012 (Dec 16, 2012)

Marishka said:


> This article from _Mexico Expat Press_ answers that question: 6 Big Mistakes People Make in Mexican Lawsuits
> 
> I'll give you some examples of how much you might end up owing hospitals if you don't have good health insurance in Mexico.
> 
> ...


Good info, but what happens to people who just cannot pay? Do they go to jail? Get deported? Go on a payment plan?

p.s. My apologies, I see you posted a link to an article at the top of the post. I'll go read the article now. Thx.


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## Marishka (Feb 1, 2009)

ElPaso2012 said:


> Good info, but what happens to people who just cannot pay? Do they go to jail? Get deported? Go on a payment plan?
> 
> p.s. My apologies, I see you posted a link to an article at the top of the post. I'll go read the article now. Thx.


Sorry about that, ElPaso. My reply didn't make clear which one of your questions that article answered. 

What I know for sure about Mexican hospitals is that the patient is generally expected to pay the bill in full before being released. They will accept credit cards and checks, but prefer cash.

If you want to know what can possibly go wrong when it's time to pay the bill at a Mexican hospital, I would suggest that you read the following two articles from the online magazine _Living at Lake Chapala_, (subscription required):

Things to Know about being in a Mexican Hospital

The WOWS and WOES of Private Hospitalization, 

In the first article, the author's husband wasn't allowed be discharged from Hospital Jardines de Guadalupe in Guadalajara before paying a bill of many thousands of dollars, even though he had health insurance. At the time the article was published the couple had still not been reimbursed by their insurance company. 

In the second article, the author asked for an itemized bill at Puerta de Hierro Hospital in Zapopan. They refused to even let her see the bill, the total kept increasing, and after the clerk made some phone calls, the bill mysteriously increased from $113,000 MXN to $175,000 MXN. The author pretty much had a meltdown in the hospital, as it was the first time in her life she had been expected to pay so much without getting an itemized receipt. She could understand getting a piece of paper with an amount scribbled on it at the tianguis, but at a hospital...not so much.


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## ElPaso2012 (Dec 16, 2012)

Marishka said:


> Sorry about that, ElPaso. My reply didn't make clear which one of your questions that article answered.
> 
> What I know for sure about Mexican hospitals is that the patient is generally expected to pay the bill in full before being released. They will accept credit cards and checks, but prefer cash.
> 
> ...


I'm afraid one of the links posted here leads to a blank page and the other one leads to the first few words of an article with a notice the remainder is only available to registered users. No problem registering, but there does not seem to be a link to do so anywhere. 

The other article you recommended in the previous post was very informative, however, about how the legal process handles debt claims. Basically, you get a trial and if you cannot pay they take your assets. 

I'm still wondering, though, how Mexico handles people who simply cannot pay and have no assets. Do they have debtors prisons? What do they do? I guess it may not be something that's come up with anyone on the forum.


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## Marishka (Feb 1, 2009)

ElPaso2012 said:


> I'm afraid one of the links posted here leads to a blank page and the other one leads to the first few words of an article with a notice the remainder is only available to registered users. No problem registering, but there does not seem to be a link to do so anywhere.


That's because I screwed up the link. Here's the corrected link: Things to Know about being in a Mexican Hospital 

I clicked on the website link leading to subscription info, but it led to an error page. I'll email the editor to let her know.



ElPaso2012 said:


> The other article you recommended in the previous post was very informative, however, about how the legal process handles debt claims. Basically, you get a trial and if you cannot pay they take your assets.
> 
> I'm still wondering, though, how Mexico handles people who simply cannot pay and have no assets. Do they have debtors prisons? What do they do? I guess it may not be something that's come up with anyone on the forum.


My husband had surgery in Mexico, but it was elective surgery. If I remember correctly, he paid the bill in advance.

I don't know what happens if you have an emergency situation, are taken to a private hospital and then don't have the money to pay the bill. I think most people put it on a credit card. In the case of Ron Hoff, who was taken to a private hospital, even though he had Seguro Popular, members of an online Baja forum collected about $10,000 USD and sent it to the hospital, and Ron's daughter came down from the U.S. and paid the rest. In the case of Antonieta Espinosa and
Roberto Kaczmarek, they mortgaged their home to the hospital in order to get their son's body released.

If you can afford it, I think the best solution is to have adequate insurance and a great insurance agent who will go to bat for you, like the one Hound Dog and citlali have.


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## ElPaso2012 (Dec 16, 2012)

Marishka said:


> That's because I screwed up the link. Here's the corrected link: Things to Know about being in a Mexican Hospital
> 
> I clicked on the website link leading to subscription info, but it led to an error page. I'll email the editor to let her know.
> 
> ...


I don't even know why I'm so curious about how Mexico handles debtors who can't pay, even after having been stripped of their assets. I'll ask some friends of mine this weekend in Juarez. One of them is involved in politics and the law. I'll let you know what he says.


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## Marishka (Feb 1, 2009)

ElPaso2012 said:


> I don't even know why I'm so curious about how Mexico handles debtors who can't pay, even after having been stripped of their assets. I'll ask some friends of mine this weekend in Juarez. One of them is involved in politics and the law. I'll let you know what he says.


You've got me curious, too, ElPaso. 

Another thing that I don't believe anyone has brought up is private catastrophic care health insurance. I know of two companies that sell policies in Mexico--Best Doctors Insurance, Ltd. and BUPA Mexico.

Here are some details on the Best Doctors Insurance, Ltd. plan:

You must be a Mexico resident and have a visa. 

They accept applicants up to age 74 and can't cancel because of age or usage. They also can't increase the deductible amount at renewal.

They provide direct reimbursement to specific hospitals in Mexico.

The plan includes worldwide coverage. 

You can be outside Mexico for up to 6 months a year.

You must wait one year for pre-existing conditions to be covered, and the plan doesn't cover diabetes or cancer within the first 24 months.

The plan provides up to $500,000 a year coverage and ONLY covers the following: accidents, cardiac surgery, cancer, severe trauma (multiple fractures), renal failure (dialysis), severe burns (including reconstruction), neurological illnesses (including cerebral vascular accidents), severe infectious disorders. 

Includes up to $25,000 USD for air ambulance to the nearest facility capable of handing the problem.

There is a $48 USD yearly membership fee.

They only sell one plan with a $5,000 deductible (deductible is per year, not per event/illness) that costs $900 USD a year for a healthy 65 year old. I have no idea how much premiums increase with age. Does anyone here know?


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## ElPaso2012 (Dec 16, 2012)

More good information. 

The reason I started this post is because I wanted to have more in my portfolio of reasons to move to Mexico than cheery statements such as "health care is high quality and affordable in Mexico" that are found on every international living site. 

Just from what I've already seen here --- thanks to those who have actually posted coverage and cost details --- is that the policies are very similar in structure to those available in the US with an annual deductible and premiums that go up as you get older. They are more affordable, but the table you posted showing how much they go up with age is quite alarming. So are the horror stories that you related and posted links to detailing people getting stuck with huge bills despite having coverage. Even without being able to read the articles I get the picture. 

For all the criticism of the healthcare system in the US it's not looking so bad in comparison right now, but this is a preliminary conclusion based anecdotal evidence from a few individuals. Still, something tells me a wealth of evidence exists in just these few cases that comprehensive health care policies in Mexico are quite pricey for people over 60 years of age and get worse as time goes on. For all that's wrong with the US system, Medicare is still functioning and those premiums will never be $15,000-$20,000 a year. 

Also, the issue of what happens to people who can't pay comes into consideration because while people are hounded by bill collectors in the US your home cannot be taken away from you to pay bills and you are definitely not going to jail. We all know that in either country intensive care, lengthy cancer treatments, or trauma can result in bills in the hundreds of thousands if not millions of dollars, bills so large that not many retired persons could ever pay even their 30%-40% share of the cost. What happens in Mexico is quite sketchy at this point. I did quite a bit of internet research before asking the question and came up with nothing. 

The IMSS program has some great features, but it's not enough. I have had four friends in Mexico die because the operations they needed were not covered by the program, two of them not just friends but people who became quite dear to me. 

So the information you have provided has been quite enlightening. You can be sure I'll find out more before actually selling my homestead and moving. Fortunately, what's available elsewhere will be available in Juarez which is just across the border from me. Private policies are not something average people even know about because they cannot afford them, but there are major hospitals and insurance agents in Juarez. I'll certainly report back my findings.


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## Marishka (Feb 1, 2009)

ElPaso2012 said:


> For all that's wrong with the US system, Medicare is still functioning and those premiums will never be $15,000-$20,000 a year.


Whether or not to keep Medicare Part B is another discussion that people should have before moving to Mexico.

A lot of people drop Part B, because they figure it’s a waste of money if they’re going to live in Mexico for the rest of their lives. But when weighing the decision of whether to keep it or not, it’s important to keep in mind that if you drop it and then want back in, a 10 percent penalty is imposed "for each full 12-month period" that you delay enrolling in Part B when eligible to do so.

Some expats drop Medicare Part B and that works out very well for them. Others keep it and end up being glad they did. I’m thinking of an expat at Lake Chapala who kept Medicare Part B along with a supplemental policy, paid for private care out of pocket in Mexico, and had IMSS as a backup plan.

His doctors in Mexico told him that he needed a liver transplant. They said they could do the transplant in Mexico, but that it’s very difficult to get a donor organ. So he went back to the U.S. and got a transplant 15 days later. While he was back in the States, he also found out that he had prostate cancer and had 43 radiation treatments for that. The total cost was over a million dollars, but he only paid $3,000 for some medications that were not covered. After that, he went back to Mexico, but goes back to the U.S. once a year for a checkup.

I’m also thinking about Carol Schmidt and Norma Hair, authors of _Falling in Love With San Miguel_. They truly were in love with San Miguel and never planned to leave. But ten years down the road, Carol started having severe breathing problems due to the altitude. They didn’t want to move to any of the low altitude areas of Mexico. Now in their 70s with multiple health problems, they also felt more secure having the type of emergency medical care they could get back in Phoenix. Carol's blood type was also a problem, as it could take many hours to get that type of blood to her in an emergency situation in Mexico. They had kept their Medicare Advantage policy during their ten years in Mexico (and had even gone back to the U.S. for surgery during that time), so they were able to move back to Phoenix without having to pay any Medicare penalties. 

On the other hand, Rolly Brook, the co-author of their book _The Best How-To Book on Moving to Mexico_, dropped Part B when he moved to Mexico, and self-insured. It has worked out very well for him, as the money he saved over the years by not paying for Part B has been enough to cover all his medical expenses so far in Mexico, including a four day stay in the hospital that came to about $2,800 USD.

My husband already has Medicare. Part B costs him $104 a month. He also has a Blue Cross supplemental policy. Since he has no medical issues and isn’t on any medications, he chose their high deductible plan, which has a $2,000 deductible. This plan also covers him for the first two months of travel outside the U.S., but only up to $50,000 of emergency care. The cost of the Blue Cross premiums depend on the area of the country you live in, A, B, or C. We live in area B and these are the monthly costs for that plan, depending on age:

65-66____$48
67-69____$56
70-74____$66
75-79____$75
60-84____$83
85+______$90

We’re keeping Part B, plus a supplemental plan, as we’re going to have a back-and-forth lifestyle, at least for the first few years. We’ll be able to go back and use Medicare for any non-emergencies, and will most likely get either a catastrophic care plan (if it turns out that the rates don’t go up too much with age), or a medical evacuation policy with a company such as Sky Med or Medjet that will get us back to the U.S. by air ambulance, if necessary.

I may not live to see this, but I am hopeful that one day we will be able to use Medicare in Mexico. The non-partisan Center for Medicare Portability (CMP), based in Washington, D.C., is working toward the goal of making Medicare portable for Americans who are living or traveling abroad. Details are at their website: The Center for Medicare Portability


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## ElPaso2012 (Dec 16, 2012)

Marishka said:


> Whether or not to keep Medicare Part B is another discussion that people should have before moving to Mexico.
> 
> A lot of people drop Part B, because they figure it’s a waste of money if they’re going to live in Mexico for the rest of their lives. But when weighing the decision of whether to keep it or not, it’s important to keep in mind that if you drop it and then want back in, a 10 percent penalty is imposed "for each full 12-month period" that you delay enrolling in Part B when eligible to do so.
> 
> ...


Thanks, it's a pleasure to talk to someone who does the kind of thorough research that you do.


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## Marishka (Feb 1, 2009)

ElPaso2012 said:


> Thanks, it's a pleasure to talk to someone who does the kind of thorough research that you do.


You're very welcome. I try to keep an ear to the ground as I prepare for our adventures in Mexico. I do believe in learning from my own mistakes, but I'd rather learn from other people's mistakes!

I think about the only insurance option we didn’t cover in this thread is travel insurance. That’s something I’ll certainly get before I go to Mexico on my exploratory trips. Sometimes, people neglect to do that and live to regret it.

I read a story about a Canadian who only had health insurance that covered her while in Canada. She took a trip to Belgium and ended up in ICU at the cost of $12,000 USD per day. In addition, the cost to fly her back to Vancouver via air ambulance was over $120,000 USD. She had to sell her house to cover her medical bills. 

Anyone can get sick or injured on a trip. You can have an auto accident as easily in Mexico as in the U.S. or any other country. In fact, depending on the country you live in, it might even be easier to get into an auto accident in Mexico, as the rate of traffic fatalities in Mexico is almost twice as high as in the United States. More than 50 percent of Mexican drivers don’t even have driver’s licenses. 

So for those who are considering not getting any type of insurance coverage, imagine that Clint Eastwood is standing in front of you. He looks you straight in the eye and says, “You've gotta ask yourself a question: ‘Do I feel lucky?’ Well, do ya, punk?” 

We're lucky to have so many options of what to do about health insurance in Mexico. For many of us there is no perfect solution, but I think most of us are better off with _something_ than nothing, if only for the peace of mind that comes with knowing you are adequately insured. 

There have been plenty of horror stories in this thread about people who had to pay huge sums of money for medical care in Mexico, but if anyone wants to read about how inexpensive routine surgeries usually are in Mexico, check out this thread, which also contains information on one way to find top doctors and surgeons in Mexico.


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## Caribbean Cat (May 2, 2013)

*Private International Health Insurance*

Hello, 

For people who are truly considered expats in the eyes of the American IRS, a private, international, major medical policy will provide the coverage you need in the event of a serious medical emergency abroad. BUPA and AXA policies were discussed. I would also like to suggest IMG, International Medical Group, as another option that is competitive in coverage and price. 

IMG is competitively priced with AXA and less expensive than BUPA. BUPA does offer a la cart insurance for less, but these policies are dangerous as they name what they will cover and if your condition is not named, your not covered. Since no one knows what they will be hit with in the future, it's risky to purchase a la carte insurance policies even though the prices are attractive. 

IMG is underwritten by Sirius International out of Stockholm. Their claim payment history is very good. The reason I know this is that I have been representing them for years now, and I only hear from my clients at renewal time. This is very encouraging and makes my job, and their happiness, much easier! I am bringing up claim payments because I read through some of the threads about having to pay before leaving the hospital in Mexico and then not getting reimbursed through the insurance company. Through IMG, you can find out if the hospital in Mexico has a direct billing relationship with them before you go. If they don't, you can get your treatment pre-approved and be reimbursed 7-10 days after the bills and claim forms have been sent in.

Also, for people who are considered expats under the eyes of the IRS, they do not need to worry about PPACA coming into affect January 2014. 

People who split time between the U.S. and Mexico may need to purchase an approved state exchange policy (which will not be effective in Mexico) and an international major medical policy. For this group of people, it's possible to purchase a domestic health care policy and an international health care policy without breaking the bank. 

I wrote a short article on U.S. state approved insurance Exchanges and about purchasing an international major medical policy that is posted on Mexico on my Mind titled Obamacare, the Self Employed and Expats.

I think the most important question for people is whether or not their insurance policy is actually going to pay in a time of crisis and cover what they believed was covered. IMG has an excellent claim payment history with their clients.


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## lagoloo (Apr 12, 2011)

For anyone lucky enough to reach 70, it is nearly impossible to get private health insurance in Mexico at an affordable rate. (Hound Dog and his wife were already in the AXA program before that age, so they're set. ) If anyone knows differently, please chime in. However, routine medical care is inexpensive enough that many healthy expats can afford to pay out of pocket for doctor visits and drugs. IMSS is a backup plan, in case of dire emergencies, but strictly no frills.


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## JoanneR2 (Apr 18, 2012)

lagoloo said:


> For anyone lucky enough to reach 70, it is nearly impossible to get private health insurance in Mexico at an affordable rate. (Hound Dog and his wife were already in the AXA program before that age, so they're set. ) If anyone knows differently, please chime in. However, routine medical care is inexpensive enough that many healthy expats can afford to pay out of pocket for doctor visits and drugs. IMSS is a backup plan, in case of dire emergencies, but strictly no frills.


AXA has a process for taking on people above the age of 65 but you need to get your agent to ask for it to be considered as a special case. In this case they will ask you to have a medical for which they pay if you are accepted and you pay if they reject you because you have pre-existing conditions which mean that you may be paying for cover that, with exclusions, you probably won't be able to use effectively. I don't know if other companies do this but it is worth asking your agent about it.


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## lagoloo (Apr 12, 2011)

Thanks for the info. Based on the rates quoted in another post, it may be available, but it's unaffordable for many.


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## ftm68_99 (Mar 12, 2012)

I'd like to echo ElPaso2012 compliments and thanks for your post, Hound Dog. 

Sincerely,

Tay

P.S. Though a sign seems to indicate that I'm an expat in France, I cannot claim to be such. I've visited France and I like it, but can't claim any other connection with it.


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## lagoloo (Apr 12, 2011)

MODERATOR ALERT: I just received a message supposedly from this forum based on this thread.
I think our emails have been hijacked. What gives?
I didn't create an option to get messages on my regular email.


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## Isla Verde (Oct 19, 2011)

lagoloo said:


> MODERATOR ALERT: I just received a message supposedly from this forum based on this thread.
> I think our emails have been hijacked. What gives?
> I didn't create an option to get messages on my regular email.


Did you receive a PM or a message on your regular email account? Please PM the details to me.


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## lagoloo (Apr 12, 2011)

Isla Verde said:


> Did you receive a PM or a message on your regular email account? Please PM the details to me.


This is what I received, and your PM function wouldn't accept this long a message:

"xpat Forum For People Moving Overseas And Living Abroad
To Me
Today at 8:31 PM
Dear lagoloo,

Isla Verde has just replied to a thread you have subscribed to entitled - How Does Your Health Care Compare to US - in the Mexico Expat Forum for Expats Living in Mexico forum of Expat Forum For People Moving Overseas And Expats Living Abroad | ExpatForum.com.

This thread is located at:
http://www.expatforum.com/expats/me...oes-your-health-care-compare-us-new-post.html

There may be other replies also, but you will not receive any more notifications until you visit the forum again.

Don't forget to look over some of these tools and resources we have available to members on the site:

- Click Currency Exchange | Expat Forum - For lots of useful foreign currency exchange tools, information and great transfer rates.

- Check International Moving Quotes From Removals Companies | Expat Forum - To get real quotes for your move abroad from many top removals and relocations companies.

All the best,
ExpatForum.com


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## lagoloo (Apr 12, 2011)

So, did that message get dropped my yahoo mailbox by the Expat Forum or did it come from some other source, as in "SPAM" from some health insurance hawker?


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## Isla Verde (Oct 19, 2011)

lagoloo said:


> This is what I received, and your PM function wouldn't accept this long a message:
> 
> "xpat Forum For People Moving Overseas And Living Abroad
> To Me
> ...


This is the standard message you get from the Expat Forum when someone has replied to a thread you've participated in. No hijacking of private emails involved, so you can rest easy.


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## makaloco (Mar 26, 2009)

Lagoloo, you can turn that feature off. Go to your control panel (where it says User CP in the menu bar) and under the Settings & Options, click on Edit Options. On the page you reach, scroll down to Messaging & Notification --> Default thread subscription mode. The drop down menu tells you how it's currently set. You can select from various options, including "No email notification". Mine is set to "Do not subscribe".


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## lagoloo (Apr 12, 2011)

makaloco said:


> Lagoloo, you can turn that feature off. Go to your control panel (where it says User CP in the menu bar) and under the Settings & Options, click on Edit Options. On the page you reach, scroll down to Messaging & Notification --> Default thread subscription mode. The drop down menu tells you how it's currently set. You can select from various options, including "No email notification". Mine is set to "Do not subscribe".


Thank you for the suggestions, but I have always had it set to "no email notifications" and that is why I wondered where this message came from, especially since it came to my personal mailbox. I've never received one before, on any subject. It has now been sent to me three times, even though I put it in SPAM. I have now set it to even more strict options.


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