BajaNomad - The Healthcare Conundrum

The Healthcare Conundrum

pauldavidmena - 5-28-2013 at 12:20 PM

I did some research on this forum before posting this question, so please forgive me if the topic has been covered before. When I retire (hopefully 6 or 7 years from now) I will have access to savings and 401K distributions, but will no longer be covered by my company's healthcare benefits. It seems that many retired ex-pats on this forum split their years between Mexico and either the U.S. or Canada, making use of Mexico's health care for minor injuries and the like, but deferring elective surgery and other procedures for trips to the U.S. Is this an accurate observation? If that's the case, I'll have to decide whether to pay out of pocket in the U.S. or to purchase some sort of private health insurance, which I expect will be a tall order when I'm over 60.

I'd be interested to find out the experiences and perspectives of others on this forum. And thanks!

DENNIS - 5-28-2013 at 12:39 PM

Are you a veteran? Many of us are and have VA care.

pauldavidmena - 5-28-2013 at 12:55 PM

@DENNIS - I'm not a veteran myself, although I do have a son in the Marines.

I work in the computer field - good salary and benefits as long as I'm working, but no pension or post-retirement health insurance afterward. My wife and I are in good health, but we do know that things happen and would never try to get by on luck alone.

DENNIS - 5-28-2013 at 01:08 PM

Quote:

Originally posted by pauldavidmena
@DENNIS - I'm not a veteran myself, although I do have a son in the Marines.

Will you fit in his uniform? :lol:

Jes kiddin'.

Well....a lot will depend on where you end up in Baja. The further away from the border you are, the more you have to consider the local option.
As soon as you get Medicare age, you can get hooked up with an HMO.

Someone here from down south should be adding to this as soon as they see it.

pauldavidmena - 5-28-2013 at 02:07 PM

We're looking to move to Todos Santos or thereabouts - certainly no further north than La Paz, but definitely north of Los Cabos.

mtgoat666 - 5-28-2013 at 02:35 PM

Quote:

Originally posted by pauldavidmena
I did some research on this forum before posting this question, so please forgive me if the topic has been covered before. When I retire (hopefully 6 or 7 years from now) I will have access to savings and 401K distributions, but will no longer be covered by my company's healthcare benefits. It seems that many retired ex-pats on this forum split their years between Mexico and either the U.S. or Canada, making use of Mexico's health care for minor injuries and the like, but deferring elective surgery and other procedures for trips to the U.S. Is this an accurate observation? If that's the case, I'll have to decide whether to pay out of pocket in the U.S. or to purchase some sort of private health insurance, which I expect will be a tall order when I'm over 60.

I'd be interested to find out the experiences and perspectives of others on this forum. And thanks!

Individual non-medicare coverage/rates is in flux this year. Calif just published draft insurance rates for the coming-soon health care exchange. If you go to Covered California website you can use their calculator to estimate your 2014 insurance rates,... an indication of what individual insurance will cost after obamacare kicks in. I was surprised to see pretty affordable rates, certainly more affordable than individual rates today.

Bajatripper - 5-28-2013 at 02:37 PM

I made use of Seguro Popular, which is a government program, while living in La Paz. Until two years ago, it was a single price for the entire family and based on your income. But recent changes indicated that it was going to a per-person annual charge instead. The down side of this program is that you have to wait in some pretty long lines to be seen for routine things, and some of the doctors aren't the most qualified. But, if all you need is a prescription for drugs or something minor, it can have its uses.

I also use to get the occasional solicitation phone call from local health care groups that aim at the foreign retiree market. I believe one operated out of Los Barriles. So you'd have those types of options, too. As Dennis said, someone from down there should be posting more info shortly.

pauldavidmena - 5-28-2013 at 03:03 PM

By way of full disclosure, some of the what I've read on this subject comes from "The Best How-To Book on Moving to Mexico" by Rolly Brook, Carol Schmidt and Norma Hair, but hearing a uniquely Baja perspective would be extremely valuable.

DavidE - 5-28-2013 at 03:27 PM

I can offer little but opinion and experience...

Too many times I have been told to go to Guadalajara, Mexico, or to the USA. An operation that with rehab that cost a quarter of a million in the USA 2 years ago would have "only" cost me $18,000 in Mexico. But in Mexico City. Where there is NO recourse for botched surgeries. Or analgesics stronger than Tylenol and codeine.

Getting to San Diego is FASTER than deep within the mainland, and from personal experience I can tell you when I went north in an ambulance I crossed at San Ysidro in so short a time (I timed it) it may have set a record. One minute seventeen seconds, ambulance to ambulance, flashed CBP my passport. Nobody screwed around. I remain highly impressed.

Unlike the veterinarian grade medical facilities in Nogales or El Pazo®, Chula Vista and San Diego are top tier. Been there done that, on the mainland it's a long way to an international airport, and then there is never a flight to where you want to go when you need to.

SEGURO POPULAR insurance is good enough for me to get patched up enough to haul don-kee north to the border.

In Mexico, you ain't getting out of the hospital unless you have coverage or a radioactive grade credit card. They PHYSICALLY prevent you from leaving until payment arrangements have satisfied them. This can get dicey with a ten thousand dollar plus hospital stay. This comes from real-life it-happened-to-me in La Paz in 2011 at Seguro Popular so save your breath.

SEGURO POPULAR and my HMO north is the way I chose. The medical center I use in Chula Vista has more equipment in it than half of Mexico.

durrelllrobert - 5-28-2013 at 03:44 PM

Once you are old enough to be on Medicare the Kaiser HMO facility in Chula Vista will accept that as full payment for annual membership. After that you only pay a co-payment that is $15 for a doctor visit and $30 for lab, x-ray, MRI, etc. A hospital stay is $200 per night.

PS: You do need to maintain a US address within there operating area but a Postal Mail Box will work.

[Edited on 5-28-2013 by durrelllrobert]

pauldavidmena - 5-28-2013 at 03:56 PM

Thank you for the informative replies. Please keep them coming!

While the details are likely to change several times between now and then, once I retire, our Master Plan is to close up shop in New England and split time between BCS and the Upper Peninsula of Michigan (where my wife grew up and a whole lot less expensive than New England). Truth be told, I haven't thought as much about post-retirement health insurance as I have my 401K and retirement destinations, so perhaps I should do that before I actually need it...

DENNIS - 5-28-2013 at 04:00 PM

Quote:

Originally posted by pauldavidmena
perhaps I should do that before I actually need it...

Good idea. Being unprepared in an emergency can be a wipeout.

pauldavidmena - 5-28-2013 at 04:16 PM

Quote:

Originally posted by DENNIS

Quote:

Originally posted by pauldavidmena
perhaps I should do that before I actually need it...

Good idea. Being unprepared in an emergency can be a wipeout.

Thanks. I'm only 53, but if I'm old enough to ask questions about where I'm going to retire, I suppose I'm old enough to think about Medicare as well. I won't be eligible until I'm 65, but I doubt that I can survive in the computer field until then. Perhaps I can find some "bridge" between when I retire and when I'm eligible...

EnsenadaDr - 5-28-2013 at 05:51 PM

Seguro Popular is a good program, and I would certainly sign up for it while living in Mexico. I knew of an American veteran who had many major surgeries under this program in Mexico and was quite satisfied. As someone mentioned, there might be a charge in certain areas but another satisfied American patient in Ensenada who is currently under treatment for breast cancer in Tijuana is very thankful for the program because she does not pay for her chemotherapy/radiation treatments and is worried that the regulations will be changed for Americans but so far they haven't. If you don't have the money for private hospitalization down here, it's a good bet. Things are improving in the health care field, with better technology and equipment, slowly but surely. I was surprised to see the very attractive Hospital General Tijuana building, but I have not been inside. I have a fellow classmate who is doing her Gynecology residency there and she seems quite happy.

[Edited on 5-29-2013 by EnsenadaDr]

EnsenadaDr - 5-28-2013 at 05:55 PM

As a transplanted New Englander myself, the weather change is heavenly!! Where are you living now?

Quote:

Originally posted by pauldavidmena
@DENNIS - I'm not a veteran myself, although I do have a son in the Marines.

pauldavidmena - 5-28-2013 at 06:11 PM

Quote:

Originally posted by EnsenadaDr
As a transplanted New Englander myself, the weather change is heavenly!! Where are you living now?

@EnsenadaDr - Thank you for your reply!

I live in Cochituate, MA, about 15 miles west of Boston and 2 miles east of Framingham. The weather is lovely for 6 months a year, and brutal for the other 6.

I've read reasonably good things about Seguro Popular, and it seems like a good safety net for bumps and bruises and occasional emergencies. The question for me is, what is the availability in the "Deep South" of Baja, for example Todos Santos? I know that there is a St. Luke's Clinic in town, but I know nothing about the level of care, the relationship with the various Mexican health insurance programs, etc. It will be one thing to be visiting the E.R. as a tourist over the next few years, but I imagine there will be differences as a resident.

pauldavidmena - 5-28-2013 at 06:18 PM

Quote:

Originally posted by pauldavidmena
I've read reasonably good things about Seguro Popular, and it seems like a good safety net for bumps and bruises and occasional emergencies. The question for me is, what is the availability in the "Deep South" of Baja, for example Todos Santos? I know that there is a St. Luke's Clinic in town, but I know nothing about the level of care, the relationship with the various Mexican health insurance programs, etc. It will be one thing to be visiting the E.R. as a tourist over the next few years, but I imagine there will be differences as a resident.

Lo and behold: a slick looking website - complete with testimonials - from St. Luke's Clinic in Todos Santos here.

EnsenadaDr - 5-28-2013 at 06:45 PM

Here's my advice. Go down to the area you might want to live in. Spend a week or two on your vacation and see if this is the area you like. You never know unless you live there how you will feel. There are Seguro Popular hospitals in all areas, however, St. Luke's looks like a private hospital, and Seguro Popular is not accepted in every hospital, it has its own hospitals. You don't want to get tangled up in a private hospital unless you want your credit card tied up to the max to get out of the place. Find where you want to retire first, then go from there.

pauldavidmena - 5-28-2013 at 06:56 PM

Quote:

Originally posted by EnsenadaDr
Here's my advice. Go down to the area you might want to live in. Spend a week or two on your vacation and see if this is the area you like. You never know unless you live there how you will feel. There are Seguro Popular hospitals in all areas, however, St. Luke's looks like a private hospital, and Seguro Popular is not accepted in every hospital, it has its own hospitals. You don't want to get tangled up in a private hospital unless you want your credit card tied up to the max to get out of the place. Find where you want to retire first, then go from there.

@EnsenadaDr - thank you for your sage advice. We will be spending a week in Todos Santos in July in order to check it out during the low season, to find out how easy or difficult it is to prepare our own meals, etc.

I should have realized that St. Luke's is a private hospital. Again, that's the difference between being a tourist with a credit card and a retiree on a fixed income. I'll need to make that adjustment soon enough, but I should do my research well before that. It looks like this website provides information about the locations and facilities of Seguro Popular throughout the country. Now to work on my Spanish...

DavidE - 5-28-2013 at 07:32 PM

Superb idea. I've had Mexican doctors "no entiende español suddenly when faced with a question they did not wish to address. Confident Spanish is a plus. I had one male nurse so stubborn I had to yell "¿Entiendes español?" to get him to respond with a red face. The rest of the enfermeros were laughing their rear off. He had been propping up a wall for a half hour en chisme and I needed to get out of bed. Asking politely six times the previous half hour didn't seem to work.

The Shortfall in the formulary of medication in Seguro Popular did not impress me either. Meaning the range and scope of medications. Having to have -someone- run across the street and purchase (of course out of pocket) medicamentos de patente, priced ten times higher than a discount pharmacy also did not tickle my funny bone. Medicine priced more expensive than at a Walgreens in the USA.

Stabilization, Seguro Popular. Then Adios!

monoloco - 5-28-2013 at 09:59 PM

ING offers health insurance plans for ex-pats that a lot of my friends swear by. Apparently it is good coverage that will cover you anywhere and is quite a bit cheaper than anything you can get in the US.

EnsenadaDr - 5-28-2013 at 10:05 PM

Yes David, the lack of pain medication for post op patients and terminal cancer patients is alarming as well as very distressing...in any of the hospitals, private or public.

Quote:

Originally posted by DavidE
Superb idea. I've had Mexican doctors "no entiende español suddenly when faced with a question they did not wish to address. Confident Spanish is a plus. I had one male nurse so stubborn I had to yell "¿Entiendes español?" to get him to respond with a red face. The rest of the enfermeros were laughing their rear off. He had been propping up a wall for a half hour en chisme and I needed to get out of bed. Asking politely six times the previous half hour didn't seem to work.

The Shortfall in the formulary of medication in Seguro Popular did not impress me either. Meaning the range and scope of medications. Having to have -someone- run across the street and purchase (of course out of pocket) medicamentos de patente, priced ten times higher than a discount pharmacy also did not tickle my funny bone. Medicine priced more expensive than at a Walgreens in the USA.

Stabilization, Seguro Popular. Then Adios!

chuckie - 5-29-2013 at 02:56 AM

The Adios part is pretty important..make sure you have a plan to get to the Border, even if its just an iron clad deal with a friend to drive you out...I have had to do that twice....Once with a blownout knee, and once with a gut gremlin.....AND make sure you know where you are going once you cross the border....

EnsenadaDr - 5-29-2013 at 04:52 AM

A few members mentioned a DAN insurance, which someone mentioned is $45 a year, originally for divers but can be used for anyone as evacuation insurance. Here is a quote from one of the members on the board:

. one look at her in the local clinic and told the husband he had to get her back to the US. They had DAN insurance (which is marketed toward traveling SCUBA divers), and had an excellent experience. And after several surgeries and a year of recovery she is doing very well.

There are several companies offering this sort of insurance, and I have no personal experience with any of them.

SFandH - 5-29-2013 at 05:25 AM

When thinking about medical care while living in Mexico, and if I were living in or near an urban area, my preference, I've decided I would use private doctors and hospitals if needed and pay cash or use a credit card. I have the means and credit. If I get a chronic condition that requires expensive ongoing care, I would move back to the US and use medicare.

EnsenadaDr - 5-29-2013 at 06:04 AM

If you have the means, then that choice is always a good option.

Katiejay99 - 5-29-2013 at 06:08 AM

I have used St. Lukes as well as Hospital Salvatierra in La Paz. I had pneumonia in January and spent 3 days and 2 nighst at St. Lukes. They were professional and the doctors were great. Nobody had to go buy my meds across the street - like you have to do at Hosp. Salvatierra. The cost was around $2,500 as opposed to appx. $100 at Hosp. Salvatierra for a week (based on income and at the time I had little). At Hosp. Salvatierra someone has to stay with you and sleep on the floor beside your bed. The room was shared with 5 other occupied beds. My "someone" had to go out and buy me a pillow and a blanket because they were not included. If I needed anything, my someone had to go and get a nurse for me. This was like 7 years ago, so things may have changed since then.
The doctor care was very good and followup went well.

A couple of years ago a friend was in Hosp. Salvatierra and had a private room. He was belligerent to the one and only person who could type his blood for him - I happened to be visiting at the time - I stood outside the room and could hear him complaining to her about why they didn't type his blood when they had him in the emergency room and he was bleeding everywhere. She walked out of the room and I asked her if she got it okay - she told me he had insulted her and she was not going to do it and that he would have to find a way to go to a private clinic outside of the hospital to get his blood typed. Well, that wasn't going to happen because he had a compound femur fracture and needed surgery. They won't do surgery unless someone donates blood for you. Then he had to negotiate a price for the surgery and have his sister wire down the money first. They came to an understanding about the blood donation (I think he had to pay more) As I left the hospital the security officers tried to make me stay because someone had to be there with him. I absolutely positively refused to do that and they let me go. My friend had his surgery and returned to the US and went through 2 more. He is fine today.

I guess the end to this story is that the hospitals cannot be compared in any way to the US, but the end result appears to be good.

I live in Todos Santos and I don't mind going to the local public hospital/clinic (it is not a hospital) but chose St. Lukes this year to compare the two. For the short time frame, St. Lukes was better (not cost wise) but for anything else I would probably go with Salvatierra without my "this isn't the way we do it in the US" hat on.

I don't have insurance - which is not a smart thing - but I am working on it.

pauldavidmena - 5-29-2013 at 06:11 AM

I suspect I'll be somewhere between a rugged frontiersman living off the land and a well-off retiree, so even though St. Luke's seems to be a high-quality option right in Todos Santos, I may not be able to afford a private hospital all the time. On the other hand, the nearest Seguro Popular is in La Paz or Cabo San Lucas - both about an hour away. I guess it will depend upon the severity of the situation should it ever arise. That and the timing, as we're likely to continue to live in The States for part of the year.

EnsenadaDr - 5-29-2013 at 06:53 AM

If anything gets that severe, I would opt for the DAN insurance and get to the border quickly. If your stay becomes extended, the best options are in the US. For instance, a person who has a stroke would not have the rehab resources in Mexico that they do in the US.

El Jefe - 5-29-2013 at 07:20 AM

We live down here most of the year and pay dearly for USA medical insurance. We travel up when necessary for the odd medical issue that is not time sensitive. Last year I fell off a ladder and busted my melon on the deck. Went to Amerimed in San Jose del Cabo, a private hospital, and had excellent care including a CAT scan and overnight stay. Total bill $10,000 US secured by my credit card and paid 100% by my US insurance since it was an accident.

So if you can cover a bill for an accident in the short run while the hospital sorts it out with your US insurance co. you are golden. Best to check with your insurance and see what they cover while you are staying in your "vacation house."

Since I retired we have been able to keep our insurance with the City where I worked. I just have to pay for it. It is great coverage so we do not want to let it go even though it is over $1,000 per month. Others I know down here have international policies from Europe or somewhere that cover them in Mexico and the US or most anywhere else for a lot cheaper.

pauldavidmena - 5-29-2013 at 07:34 AM

Thanks @ElJefe. My health insurance is currently provided by my employer, who pays 20% of the premium. I have the option of continuing to carry the same insurance via COBRA, but would end up picking up the whole tab, which is about $650 per month. I have the option of switching to a higher deductible, which would reduce that.

According to the DAN Insurance website, I don't need to be a diver in order to purchase a plan, which seems to provide extensive benefits at a low cost.

bajaguy - 5-29-2013 at 07:42 AM

Quote:

Originally posted by chuckie
The Adios part is pretty important..make sure you have a plan to get to the Border, even if its just an iron clad deal with a friend to drive you out...I have had to do that twice....Once with a blownout knee, and once with a gut gremlin.....AND make sure you know where you are going once you cross the border....

Sharp Medical Center, Chula Vista......east on Telegraph Canyon Road from the 805

http://www.sharp.com/chula-vista/index.cfm

SFandH - 5-29-2013 at 07:58 AM

Quote:

Originally posted by El Jefe
Others I know down here have international policies from Europe or somewhere that cover them in Mexico and the US or most anywhere else for a lot cheaper.

I'm going to look into that.

Of course, you can buy insurance in Mexico that covers the best of hospitals. I have a friend who is 53, in good health, that has a plan with AXA, full coverage, 30% discount on already cheap meds. $1,100 per year.

http://www.bnamericas.com/company-profile/en/AXA_Seguros,_S,...

[Edited on 5-29-2013 by SFandH]

DENNIS - 5-29-2013 at 08:37 AM

Quote:

Originally posted by El Jefe
overnight stay. Total bill $10,000 US

Who supports these hospitals when the occasional insured foreigner isn't available? Certainly not the locals, rich or poor.
This price, even with a Cat Scan, seems ludicrous.
What makes it worse is, when someone is checked into one of these places, he becomes their prisoner until bailed out.

monoloco - 5-29-2013 at 08:45 AM

Quote:

Originally posted by SFandH

Quote:

Originally posted by El Jefe
Others I know down here have international policies from Europe or somewhere that cover them in Mexico and the US or most anywhere else for a lot cheaper.

Check out the ING policy. My friends have it and it even pays for their medical care in the US. They are in their 60's and told me they pay around $300 a month.

mtgoat666 - 5-29-2013 at 08:53 AM

Quote:

Originally posted by DENNIS

Quote:

Originally posted by El Jefe
overnight stay. Total bill $10,000 US

it just takes one injured gringo to pay for xmas bonuses for all staff!

the imprisonment seems to be in conflict with hippocratic oath,... perhaps la doctora can explain how the prison approach to collecting from patients jives with legal and ethical standards of medicine, eh?

DavidE - 5-29-2013 at 10:16 AM

We need to have a USA constitutional amendment that specifically addresses the issue of malpractice awards, and sets limits and guidelines for awards. Felonious doctors don't need to be sued (they have insurance) they need to go to prison. Scumbag ambulance chasing lawyers need to change occupations like over to shoveling ----.

I am not a gosh darnned piggybank for "INJURED? SICK? WE'LL COME TO YOUR HOSPITAL BED!" freakin' leeches. Take them OUT of the equation, force the industry to adjust their prices down to compensate for greatly reduced insurance costs, and doctor administrative costs and let the system HEAL PEOPLE.

Remember 99.99% of POLITICIANS are failed lawyers. Like hiring a security company consisting of failed burglars.

DENNIS - 5-29-2013 at 10:20 AM

These people who are pimping the low cost Mexico Health Industry, need to become vocal in this issue. It's highway robbery of the desperate.

EnsenadaDr - 5-29-2013 at 01:58 PM

I try to make others aware the best I can.

Quote:

Originally posted by DENNIS
These people who are pimping the low cost Mexico Health Industry, need to become vocal in this issue. It's highway robbery of the desperate.

DENNIS - 5-29-2013 at 02:09 PM

Quote:

Originally posted by EnsenadaDr
I try to make others aware the best I can

Yes, you do, by suggesting the affordable alternatives.
Thanks.

I'm not looking for cheap, by any means, but ten thousand dollars for a one night bed and a Cat Scan?
Maybe insurance rates wouldn't be so high if these things didn't happen.

DENNIS - 5-29-2013 at 02:12 PM

This keeps appearing on my screen....part of the mind-reading advertising campaign going on:

http://www.cigna.com/individualsandfamilies/international

I haven't as yet read it, but it's for international health insurance.

El Jefe - 5-29-2013 at 02:18 PM

Dennis, I didn't think the bill was so bad. I had to be put under for surgical repair of a big, swollen gash on my head. So there was a surgery team, plastic surgeon, anesthesiologist, brain doc. whatever you call her, and a cardiologist to make sure I was OK to go under.

Yes, I think the call went out to all the specialists in town "We got a live one!", but I got the best docs and am glad I could afford it. Insurance from states paid it all and I'm sure they would have paid much, much more in the USA for the same treatments.

DavidE - 5-29-2013 at 02:37 PM

In my opinion, positively the last word on whether or not "it is worth it"

"but I got the best docs and am glad I could afford it."

I would like to find out the salaries of the TOP EXECUTIVES of IMSS, ISSSTE and SEGURO POPULAR

DENNIS - 5-29-2013 at 02:52 PM

Quote:

Originally posted by El Jefe
Dennis, I didn't think the bill was so bad. I had to be put under for surgical repair of a big, swollen gash on my head. So there was a surgery team, plastic surgeon, anesthesiologist, brain doc. whatever you call her, and a cardiologist to make sure I was OK to go under.

And here I was thinking you only had a team of one. I'm surprised they didn't call in an accountant. They sure didn't miss anyone else. :lol:

Glad you're OK, Jefe.

pauldavidmena - 5-30-2013 at 06:58 AM

These have all been some great replies. Not too surprisingly, people's experiences run the gamut from pleasant surprises to near disaster. I'm hoping to be prepared for when the time comes.

EnsenadaDr - 5-30-2013 at 08:10 AM

Not more than $50,000 American dollars a year, I can assure you that. Most doctors in IMSS make around $30,000 a year, that is why they work in 2 or 3 different jobs.

Quote:

Originally posted by DavidE
In my opinion, positively the last word on whether or not "it is worth it"

"but I got the best docs and am glad I could afford it."

I would like to find out the salaries of the TOP EXECUTIVES of IMSS, ISSSTE and SEGURO POPULAR

EnsenadaDr - 5-30-2013 at 08:12 AM

The pleasant surprises and near disasters happen in the US as well. Concentrate on getting down here, having a heck of an adventure, and find out where you want to live first. Everything else will fall into place, or not!

Quote:

Originally posted by pauldavidmena
These have all been some great replies. Not too surprisingly, people's experiences run the gamut from pleasant surprises to near disaster. I'm hoping to be prepared for when the time comes.

DavidE - 5-30-2013 at 01:50 PM

TOP executives? 50K? I mean the ones in Mexico. D.F. You know the ones that live in El Pedregal and Polanco.

Yes, their "working homes" not the ones in Cuernavaca nor Acapulco.

[Edited on 5-30-2013 by DavidE]