Health Insurance in Mexico

Many of us buy health insurance in Mexico from major Mexican providers. Here is one example of what happens with the premiums as we get older. This quote is for a husband and wife and they asked for a quote on a lower deductible - current deductible 25,000 pesos.

Health insurance renewall coming the 25th of February 2012.
With the same deductible of $25,000 pesos as last year the annual cost is $49.882.94 pesos.
You have the best plan for México. Unfortunatly the medical services are going up besides your age encreasements every year.

You asked for different deductible quotes:
With a $5,000 pesos deductible as you recuested it goes up to $94.126.00 pesos a year.
And with $10,000 pesos deductible the annual cost is $74.729.59 pesos a year.

The lower the deductible the higher the price is. If you lower the deductible you are increasing the risk with the company and they ask for a new medical application---you have the risk of being rejected. Please remember this is a type of medical plan has deductible per event or illnes, not per year.

By the way - I am old enough for Medicare this year and am looking at that as opposed to buying insurance in Mexico. The only medical event I can think of that would exceed the premium and my deductible is open heart surgery. There are several air evacuation companies around. There is a new one lakeside and I see on ADT - alarm system in Guadalajara - they have many services and one is air evacuation (if I read their website correctly). And medicare has a maximum cost which caps your total costs for the year. I have two friends who do this now - buy Medicare and go back to the US.

Many local doctors will negotiate a discount price for you for surgery in particular. For example I helped a friend who only has IMSS and can't navigate their system with a private surgery for a prostate problem. Cost of surgery all in at a very nice and clean clinic in Guadalajara with two doctors and assistant was less than 10,000 pesos all in. Of course I had to bring cash to get him that price.

simpsca wrote:By the way - I am old enough for Medicare this year and am looking at that as opposed to buying insurance in Mexico. The only medical event I can think of that would exceed the premium and my deductible is open heart surgery. There are several air evacuation companies around. There is a new one lakeside and I see on ADT - alarm system in Guadalajara - they have many services and one is air evacuation (if I read their website correctly). And medicare has a maximum cost which caps your total costs for the year. I have two friends who do this now - buy Medicare and go back to the US.

Many local doctors will negotiate a discount price for you for surgery in particular. For example I helped a friend who only has IMSS and can't navigate their system with a private surgery for a prostate problem. Cost of surgery all in at a very nice and clean clinic in Guadalajara with two doctors and assistant was less than 10,000 pesos all in. Of course I had to bring cash to get him that price.

Great thought, EXCEPT if you end up with a major illness at your age, Medicare only pays 80%. Are you ready to cover the other 20% if you end up with a Heart operation, Cancer, Diabetes etc? A possible $ 100 K +, you pay, $ 20 K out of pocket. Your 20% deductible that you'll have to pay will cover a few years of private Medical Insurance here. Better do all the numbers before jumping from the frying pan into the fire. And what will it cost to stay in the US for follow up treatments plus airfare?

simpsca quote "And medicare has a maximum cost which caps your total costs for the year." Are you sure about this? I think you mean they have a cap and you pay the rest. Medicare will change drastically for the worse, if OBummer care isn't repealed which it should be.

John, Are you saying that adding B,C,D coverage won't cover balance?

There are many plans you can choose through Medicare such as HMOs. I'm not eligible yet but have been reading the website for options. Right now I'm paying for all doctors visits and prescription medicines that are not covered by my policy here in Mexico which has a deductible for each illness or accident plus a deductible and 10% co-pay. I haven't finished my analysis yet but I may be much better with medicare. A friend says her medicare plan mails her prescriptions to her here in Mexico. That is my biggest out of pocket expense, prescriptions that are under the deductible.

Jim W wrote:John, Are you saying that adding B,C,D coverage won't cover balance?

Yes, they would cover, but have deductibles.

I'm looking at moving to the US for Medicare and Medicare Part B at $ 115 per month or $ 1,380. a year. There's a $ 330. deductible on that. If you need another plan as everyone does, you need either a MA or MAPD (with prescriptions). There are all kinds of deductibles even those for regular Doctors and Specialists visits. They don't pay everything. MAPD plans pay for prescriptions AFTER you have met their deductibles which is in the approx $ 3,000. a year range.

I was just looking at the available medicare plans for Houston Tx. and you can choose an HMO where you only pay $10 for a regular doctor visit and $35 for a specialist. Copay on drugs runs by tier from $5 to $35. And the plan has a max per year out of pocket cost feature. They also have regular medicare and many other types of plans. On the medicare website you can put in the meds you take, your zip code, and it will list the best plans for you. It also has a feature to compare the plans and they are rated by stars as to quality. You can look at the doctors available in the plans and look at medical centers, hospitals, and even drug stores available in the plans.

Medicare now has regular medicare, PPO, HMO and other types of plans you can choose from.

In order to compare plans you need to know a zip code where you will reside so they can tell you which plans are available in your area. So you start here with the zip: https://www.medicare.gov/find-a-plan/questions/home.aspx

I have friends who maintain a Houston address and use medicare - the husband has cancer to they go frequently for treatment.

simpsca wrote:I was just looking at the available medicare plans for Houston Tx. and you can choose an HMO where you only pay $10 for a regular doctor visit and $35 for a specialist. Copay on drugs runs by tier from $5 to $35. And the plan has a max per year out of pocket cost feature. They also have regular medicare and many other types of plans. On the medicare website you can put in the meds you take, your zip code, and it will list the best plans for you. It also has a feature to compare the plans and they are rated by stars as to quality. You can look at the doctors available in the plans and look at medical centers, hospitals, and even drug stores available in the plans.

Medicare now has regular medicare, PPO, HMO and other types of plans you can choose from.

In order to compare plans you need to know a zip code where you will reside so they can tell you which plans are available in your area. So you start here with the zip: https://www.medicare.gov/find-a-plan/questions/home.aspx

I have friends who maintain a Houston address and use medicare - the husband has cancer to they go frequently for treatment.

What you have said is true. I checked out the MAPD plans in Temecula, CA and Charlotte, NC as we may move to either place. Check out other deductibles in the plans. Your $ 5 - $ 35 must be on generics or you take less expensive meds than me. One of my tiers and they're mostly all the same in every plan (Tier 1 - 4) is like $ 69. My 3 meds total over $ 13,000. a year and because they're expensive and I'm in the higher tier, that's where I got the $ 3,000. a year for my share. I now pay $ 2,650. last year for my epilepsy meds here. Segurous Monterrey pays for my Fosamax at $ 885. pesos/month for the rest of my life.

Again consider your stay in a hotel/motel and cost of plane flight at approx $ 600. to anywhere in the US.

These are my Mexico Health Insurance and RX costs. $ 5,920. These will be my US Health care costs $ 4,710. Our combined Mexico health care costs are $ 9,465. Our US health care costs will be $ 6,090. A difference of $ 3,775., enough to pay house taxes.

Given a choice between Charlotte, N.C. and Temecula, CA..........personally, I'd go for Charlotte. I did time in Temecula for about a year in its boom time days, and the problem is the weather: really cold in the winter (but it's short) and so hot in the summer that I had to get my morning walk in by around 7 a.m. and hide in the air conditioning the rest of the day. Big A/C bill.
Don't know about Charlotte, but a friend lives there and loves it.

I have a brother in Houston - so no housing costs - just transportation. Yes most of my meds are generic. My out of pocket here for 2010 was over $13,000 US which includes the Seguros Monterrey premium, deductible for hospital stay and under deductible meds, dr. visits and tests. The problem here is every illness/accident has a separate deductible. I need more info on the cost of the medicare plans available, but one HMO is the one my brother uses and they love it.

simpsca - When you choose an MAPD plan, choose one with $ 0 monthly premium as I did. The others can range from $ 0 - $ 100 + per MONTH. Basically they're all the same, except for the Tier cost of drugs and what their Formulary includes.

John - not sure what you mean. According to Medicare, to choose part B which is coverage for doctors, most people pay $99 per month. If you chose an HMO you can get the drug coverage thrown in. If you buy traditional medicare the part D drug coverage is an extra premium. Do you mean don't buy the extra delux coverage - for example for an extra fee Kelsey will provide coverage outside your area? Is that what you mean.

If I understand it correctly, Medicare free coverage is hospital coverage only - no doctors no meds. It is fairly complicated and I'll bet you don't know what you are getting until you try it.

simpsca wrote:John - not sure what you mean. According to Medicare, to choose part B which is coverage for doctors, most people pay $99 per month. If you chose an HMO you can get the drug coverage thrown in. If you buy traditional medicare the part D drug coverage is an extra premium. Do you mean don't buy the extra delux coverage - for example for an extra fee Kelsey will provide coverage outside your area? Is that what you mean.

If I understand it correctly, Medicare free coverage is hospital coverage only - no doctors no meds. It is fairly complicated and I'll bet you don't know what you are getting until you try it.

You are correct about Part B cost being $ 99.90, but since I'm already 3 years late, it will cost me $ 132.97 per month with penalty. Any way they can get me!!!

See those deductibles for Part A:
Hospital Inpatient Stay You pay:
■$1,156 deductible per benefit period
■$0 for the first 60 days of each benefit period
■$289 per day for days 61-90 of each benefit period
■$578 per "lifetime reserve day" after day 90 of each benefit period
(up to a maximum of 60 days over your lifetime)

Skilled Nursing Facility Stay You pay:
■$0 for the first 20 days each benefit period
■$144.50 per day for days 21-100 each benefit period
■All costs for each day after day 100 in a benefit period

Part B Services:
Services--------------------You pay
Part B Deductible----You pay: $140 per year.
Blood In most cases, the provider gets blood from a blood bank at no charge, and you won't have to pay for it or replace it.
However, you will pay a copayment for the blood processing and handling services for every unit of blood you get, and the Part B deductible applies.
If the provider has to buy blood for you, you must either pay the provider costs for the first 3 units of blood you get in a calendar year or have the blood donated by you or someone else.
You pay a copayment for additional units of blood you get as an outpatient (after the first 3), and the Part B deductible applies.
Clinical Laboratory Services: You pay: $0 for Medicare-approved services.
Home Health Services You pay: $0 for Medicare-approved services. You pay 20% of the Medicare-approved amount for durable medical equipment.
Medical and Other Services-- You pay: 20% of the Medicare-approved amount for most doctor services (including most doctor services while you're a hospital inpatient), outpatient therapy*, and durable medical equipment.
Mental Health Services: -----You pay: 40% of the Medicare-approved amount for most outpatient mental health care.
Other Covered Services: You pay: copayment or coinsurance amounts.
Outpatient Hospital Services: You pay: a coinsurance (for doctor services) or a copayment amount for most outpatient hospital services.
The copayment for a single service can't be more than the amount of the inpatient hospital deductible.

* In 2012, there may be limits on physical therapy, occupational therapy, and speech language pathology services. If so, there may be exceptions to these limits.

Note: All Medicare Advantage Plans must cover these services. Costs vary by plan and may be either higher or lower than those noted above. Review the Evidence of Coverage from your plan.

I read there is a penalty for not joining right away. In fact I just received information by mail and if I don't want part B I have to sign a card and send it back. That's why I'm looking now. I have two months to decide. That is a stiff penalty for three years of not buying the coverage. Thanks for the info.

simpsca wrote:I read there is a penalty for not joining right away. In fact I just received information by mail and if I don't want part B I have to sign a card and send it back. That's why I'm looking now. I have two months to decide. That is a stiff penalty for three years of not buying the coverage. Thanks for the info.

Best to check the penalty clause. I've heard it's 10% more for each year you decline it after you have become eligible . On the other hand, you can't use it in Mexico,and unless you have a U.S. address to use as well as a place to stay there........it is sometimes more logical to decline it and put the money in a personal medical savings account for getting care out of pocket in Mexico. Depends entirely on your situation.

gringal - Yes, it's 10% a year. I think they have a GD nerve to charge a penalty to Seniors. Obviously they didn't think that expats may return to the US and want the coverage like myself. Also, if you don't live in the US, it's fraudulent to use a US address without living there. I have a legal US address too, not a PO Box, but won't use it for that purpose.

John:

I am not tracking on your logic on the 10% penalty and seniors. If you decline Part B, the system isn't collecting the current $99/month for the additional coverage or about $12K/year. If you have a sudden need for that coverage after declining, then you have the option of picking it up with a s penalty. If it was private insurance, they would probably decline you for a pre-existing condition and you would have no coverage. All insurance is a gamble which only pays off when you need it.

On TOB, they are having a discussion about Gringo seniors being discriminated against since they are receiving a lower discount than Mexican seniors. Are not all Senior Discounts discriminatory in the first place? While not a popular theory, I see no reason that I have earned special treatment or prices just because I have managed to somehow to almost attain 65 years old. While some places NOB extend senior discounts to those 55 or even 60, I have never asked for or to my knowledge ever received a senior discount. Maybe it is because I rarely think about age until I am somehow reminded?

John, I admire your ability to put these numbers together. However I must ask....when you compare medicare and all their BS, had you signed up 3 years ago, what would your cost be, vs corupt pricing for Mexican insurance....Premium, plus ........deductible?

Jim W wrote:John, I admire your ability to put these numbers together. However I must ask....when you compare medicare and all their BS, had you signed up 3 years ago, what would your cost be, vs corupt pricing for Mexican insurance....Premium, plus ........deductible?

How would I know that since it's 3 years ago and I wasn't checking those figures then? Corrupt pricing in Mexico??? Maybe corrupt pricing anywhere??? Depends on the Insurance Company and Agent and what you're covered for.

You can't call out ALL Mexican Insurance companies as corrupt because you had a bad experience with one. And who knows if you had all your paperwork done properly? I'm always careful to have the i's dotted and t's crossed when I submit a claim.

I believe you had ALLIANZ, I wonder how many others had good experiences. My experience with Segurous Monterrey has been very positive as simpsca can attest to for herself. My agent picks up Facturas and delivers checks to me monthly. I hear GNP is excellent as well as Met Life.

John....I am confused by your anger......We all made concious choices...what are you saying

Yes, I've had a good experience with Seguros Monterrey New York Life and I believe part of that is my agent Edgar. He told me to be sure to get facturas for everything. And like John said if the doctor is in Guadalajara he will get them for you. When I had pneumonia a year ago I called Edgar on his cell phone and said - I don't have approval and I have to go to the hospital right now, what should I do. He told me to go to San Javier where my insurance company has an office and they would bring the forms up to the room for the doctor to fill out. Doctor filled them out and I only payed deductible and co-pay when I left the hospital. I had been to the same hospital several times but it's now where I will go it there is an emergency and know my insurance company is there and can do immediate approval for an emergency.

Knowing the ropes and what to do before you need the insurance or go to the hospital is the key to making it work for you.

Jim W wrote:John....I am confused by your anger......We all made concious choices...what are you saying

Whose angry? You're ticked off at your Insurance company. I'm not.

simpsca - And I had a similar experience as you did, although not an Emergency when I was in Del Carmen Hospital and Edgar took care of the paperwork. I paid $ 0 deductible because mine was an accident.

johninajijic wrote:

Jim W wrote:John....I am confused by your anger......We all made concious choices...what are you saying

Whose angry? You're ticked off at your Insurance company. I'm not.

simpsca - And I had a similar experience as you did, although not an Emergency when I was in Del Carmen Hospital and Edgar took care of the paperwork. I paid $ 0 deductible because mine was an accident.

John I was going with New York LIfe until the LCS incident.....In all fairness my issue with Allianze.....cuts deep. I "ASSumed" my Allianz policy for international coverage....meant I would be covered by Allianz in USA.....fact is NADA MO FO......Allianz subcontracts to other companies.....for international coverage.......WHO'D a thunk.....an international company would bone their clients? LMAO

Insurers all over the works "bone" their clients! Probably not a lady like thing to say, but I worked for large companies and one thing I learned about insurance is that there are a lot of insurers out there that don't pay their claims even when it's clear cut. Maybe John and I got lucky with S. NY Life.

Simpsca.......You have a way with words.....when you say boned....sounds much more eloquent. LOL