BajaNomad - Mexican Health Insurance 101

Mexican Health Insurance 101

mojo_norte - 9-19-2013 at 09:18 AM

Seeking info on Mexiacan health insurance:
Plans?
Costs?
Deductibles?
Where to buy? - LaPaz - Cabo

Would like to hear people's real experiences rather than speculation and cookie cutter - cargo cult political rants on Obama care etc.

Pescador - 9-19-2013 at 11:40 AM

There has been lots written about Seguros Popular and IMSS. There is a good thread going on right now and the search function can give you the old posts.
AXXA sells a policy that is acceptable but has some holes. You will have challenges if you try to do a direct comparison to US policies which are written in a different manner.
There is also a policy that is marketed through Worldwide that is for expats who do not live in the US. You can google that.

monoloco - 9-19-2013 at 11:51 AM

I know several people here who have policies from ING that are specifically for ex-pats and offer worldwide coverage. They have been happy with their policies.

Alm - 9-19-2013 at 06:57 PM

What exactly you are asking about and what is your status? Private insurance for non-citizen, private for a citizen, or social? You don't "buy" a social like Seguro Popular, and you don't "buy" a quasi-social like IMSS - you join it if they let you to.

Pescador - 9-20-2013 at 07:22 AM

Quote:

Originally posted by Alm
What exactly you are asking about and what is your status? Private insurance for non-citizen, private for a citizen, or social? You don't "buy" a social like Seguro Popular, and you don't "buy" a quasi-social like IMSS - you join it if they let you to.

No, that is not accurate. If you choose to sign up with IMSS or Seguros Popular , you may have a sign up fee. Both are done on a sliding scale and depend on your income as well as the decision by the administrator. Both programs have a sliding scale of fees.

There are several insurance companies that do a policy for expatriates that are living abroad and since they will be getting most of their medical done in a foreign country, the rates are pretty good. Some have a limitation about coverage should you return to the United States.

There are also Mexican Insurance companies like AXXA, and several others that are marketed by brokers. They fill the gap for people who are self employed.

Most people in Mexico are covered by their work if they have a job.

Mula - 9-20-2013 at 07:29 AM

GNP Seguros:

http://www.bnamericas.com/company-profile/en/Grupo_Nacional_...

Too expensive for me, but I know several people who have this Insurance Program.

EnsenadaDr - 9-20-2013 at 08:17 AM

Pescador, ALL people in Mexico have insurance, Seguro Popular, whether or not they are working. As I said in the other thread, I had patients come to Seguro Popular because they were no longer working and IMSS wouldn't continue to treat them. And I as mentioned in the other thread as well, Seguro Popular chose to pay for a very sick expat's medication for a whole year before he passed away without one cent contributed by him. That was in Ensenada.

Quote:

Originally posted by Pescador

Quote:

SFandH - 9-20-2013 at 08:26 AM

Anybody here that lives in the Rosarito BC area and has Seguros Popular? Where do you sign up? Is a resident visa needed?

EnsenadaDr - 9-20-2013 at 08:51 AM

We have gone over these questions many times but the Rosarito Hospital might be a good place to start. Check the threads on Seguro Popular and IMSS and many of your questions have been answered and technically you need a visa but the rules are bended in many situations.

Que ?

MrBillM - 9-20-2013 at 09:57 AM

"..........but the rules are bended in many situations."

Alm - 9-20-2013 at 01:41 PM

Once again - Seguro Popular you don't buy. You sign up if they determine that you are eligible to. Citizens are eligible. Expats with permanent resident status - probably so, it appears to be a gray area here. Visitors are not. Yes, rules can be bended in Mexico and they might sign you up, and later you'll receive a bill form hospital because they suddenly realized that you are a visitor.

With IMSS the criteria are stricter yet, you have to work for Mex employer. Again, there were expats that somehow managed to bypass the rule, and later their plans were cancelled.

With either plan there are annual fees, yes, but first you have to be eligible.

Private insurance is a different matter, this you can buy, though hard to suggest anything without knowing the area of coverage that the OP is looking for.

One thing you should realize with those social plans is that with SP you can only go to public hospitals, and they are not quite the same as private. With IMSS you are restricted to IMSS hospitals only.

Edit - PS:
have just checked AXA, very briefly, so might have missed something. Pescador is right, it's written differently from plans issued by US insurers. And it doesn't pay much. $US 1,200 per surgery and $180 per broken bone is enough to cover in public hospitals only. They have another plan where I don't see those low limits, but it only accepts people under 64.

[Edited on 9-20-2013 by Alm]

EnsenadaDr - 9-20-2013 at 02:52 PM

I worked in the system and as I mentioned we had expat patients that got Seguro Popular free, and were not billed later on. Expats with permanent and temporary as well as no papers get by in Ensenada, approved by the director there. I don't know what part of Mex you are in. IMSS in Ensenada is available for expats, but they need to take a physical and it costs $250 American and I heard from someone you are restricted from using the ER for 1 year. Private hospitals might not always have the best doctors or equipment. I would like to see that Hermosillo IMSS that David was talking about, sounds impressive.

Quote:

Originally posted by Alm
Once again - Seguro Popular you don't buy. You sign up if they determine that you are eligible to. Citizens are eligible. Expats with permanent resident status - probably so, it appears to be a gray area here. Visitors are not. Yes, rules can be bended in Mexico and they might sign you up, and later you'll receive a bill form hospital because they suddenly realized that you are a visitor.

With IMSS the criteria are stricter yet, you have to work for Mex employer. Again, there were expats that somehow managed to bypass the rule, and later their plans were cancelled.

With either plan there are annual fees, yes, but first you have to be eligible.

Private insurance is a different matter, this you can buy, though hard to suggest anything without knowing the area of coverage that the OP is looking for.

One thing you should realize with those social plans is that with SP you can only go to public hospitals, and they are not quite the same as private. With IMSS you are restricted to IMSS hospitals only.

Edit - PS:
have just checked AXA, very briefly, so might have missed something. Pescador is right, it's written differently from plans issued by US insurers. And it doesn't pay much. $US 1,200 per surgery and $180 per broken bone is enough to cover in public hospitals only. They have another plan where I don't see those low limits, but it only accepts people under 64.

[Edited on 9-20-2013 by Alm]

greengoes - 9-20-2013 at 03:50 PM

Quote:

Originally posted by MrBillM
"..........but the rules are bended in many situations."

yea.......bent would have been better. But the message is dead on. If you want Seguro Popular and have temporal or permanente you can sign up for it. Depending on where you are the services are excellent to sparse.

Ron Hoff had the coverage but they forgot to mention it and you know what happened then. From what I have seen if he was admitted to Ensenada General with his wife he would have received excellent care at no cost. Gracias a dios the injuries he sustained were not as bad as they could have been.

La Doctora is on time with her statement but as you know, a blind squirrel finds an acorn now and then.

Alm - 9-20-2013 at 03:59 PM

The best place in Hermosillo is CIMA private hospital, not IMSS. Private and expensive. Yes, private hospitals are not all created equal, a lot of them are more like an outpatient clinic or a place for elective non-urgent surgeries.

Here is a good discussion on IMSS:
http://www.chapala.com/webboard/index.php?showtopic=45494

No emergency for the 1st year and no medications for non-working gringos.

Yes, SP services can be sparse but IMSS can be spars-er yet, depending where you are. Any public hospital takes patients with SP, and with IMSS you have to go to IMSS place.

[Edited on 9-20-2013 by Alm]

DavidE - 9-20-2013 at 04:40 PM

It is very clear law in Mexico that any and all medical doctors or facilities MUST STABILIZE a victim in imminent danger at no cost. When the patient is stabilized then they must have some form of insurance or the ability to pay the facility. At the discretion of the facility. Seguro Popular has a credit and finance office in their hospitals and clinics where a social worker can evaluate each case if needed and adjust a hospital bill to fit the proven income of the patient being discharged.

Ensenada Dr. when I toured the Hermosillo facility with Drs Molina, and Quintero I was impressed. But I should add a caveat that this was 20 years ago - my does time fly when one is having fun. It is still considered to be a first tier *Grado Primero" IMSS facility.

The referral via estudias ritual can be frustrating. For a heart bypass clearance for example, an MD must refer to the patient to a cardiologist. Then from there to a cardiologist who is in staff at the primero. That individual then brings forth the case in front of the committee of the hospital and they in turn authorize or deny the procedure. Specialists make rounds to perifericos and see patients who require "estudias de especialistas". The protocol can appear alien to a non Mexican and definitely frustrating.

Alm - 9-20-2013 at 05:11 PM

Quote:

Originally posted by greengoes
Ron Hoff had the coverage but they forgot to mention it and you know what happened then. From what I have seen if he was admitted to Ensenada General with his wife he would have received excellent care at no cost.

No, I don't remember the details other than they were taken to a private hospital. What coverage did they have, IMSS or Seguro? Expecting an excellent care in a public hospital would be ... let's say, "a gamble". Does anybody remember an account of a gentleman who had a heart attack and was taken to Ensenada public hospital? Was a fun to read. Not that there is anything funny in a heart attack, but he made me smile when reading about his ride in the ambulance, nurses sleeping on ward, and other things. Eventually he had to go to San Diego.

But we are deviating. The OP is - I think - in La Paz/Cabo area, from what he wrote.

It's good to know that Seguro Popular have a financial office that can match the treatment cost to the patient income when the patient is not covered, but don't expect to get a free ride either. I recall a recent account - August 2013 - of an elderly patient on a fixed income who spent 9 days in a public hospital, no coverage. The bill was $US 6,500. Don't know the level of service, probably didn't matter much to him at 90-something years.

Mulegena - 9-20-2013 at 07:27 PM

I have to take exception to Alm who states that a 90-year old hospital patient wouldn't care too much what quality of care they received.

If I read Alm's intention correctly, this insinuation is insulting. It diminishes your otherwise insightful critique of healthcare, either here in Mexico or anywhere else in the world.

People do care what quality of care they receive. Families do care what quality of care a loved one receives. Society does care and do the dedicated medical providers.

Age is not a determining factor in quality or care given or expected.

Mulegena - 9-20-2013 at 07:48 PM

Now what I came on to share before I read Alm's last paragraph.

This is about how Mexico's public insurance plans can be flexed at the discretion of the people in charge, which corroborates statements made by DrEnsenada:

My mother-in-law is in-hospital at this moment. She had an inactive Seguro Popular which was easily verified and updated when she became an in-patient in Sta. Rosalia Seguro Popular Hospital two weeks ago. No worries.

Last week she was transferred to the Seguro Popular hospital Salvatierra in La Paz for specialist(s) care. She was again evaluated as to her qualifications, a simple matter of a short verbal chat with a social worker.

When a diagnosis was determined it was found that the treatment coverage (read, "paid for by") Seguro Popular was not available for her illness. Not at all. 0% coverage. Zip.

She has a son in La Paz who has Seguro Social coverage, IMSS. He signed her up on his policy as a dependent living with him. She was transferred out of the Seguro Popular hospital and directly into the Seguro Social/IMSS hospital. Her medical treatment is covered by the insurance, 100%.

I think it's great that the two public insurance providers will coordinate and work together, and that one of her sons is employed by a Mexican company.

Alm - 9-22-2013 at 12:39 PM

Quote:

Originally posted by Mulegena
Families do care what quality of care a loved one receives.

Sure. The family had to pay the bill and were happy to pay a fraction of what US hospital would've charged. The didn't tell any details about the level of care - either they were not there to see, or there was not much to tell

EnsenadaDr - 9-22-2013 at 10:05 PM

From what I know, there are no pre-existing condition clauses and no exceptions to treatment. I'd like a little more information to understand why they denied her at the second Seguro facility.

Quote:

Originally posted by Mulegena
Now what I came on to share before I read Alm's last paragraph.

This is about how Mexico's public insurance plans can be flexed at the discretion of the people in charge, which corroborates statements made by DrEnsenada:

My mother-in-law is in-hospital at this moment. She had an inactive Seguro Popular which was easily verified and updated when she became an in-patient in Sta. Rosalia Seguro Popular Hospital two weeks ago. No worries.

Last week she was transferred to the Seguro Popular hospital Salvatierra in La Paz for specialist(s) care. She was again evaluated as to her qualifications, a simple matter of a short verbal chat with a social worker.

When a diagnosis was determined it was found that the treatment coverage (read, "paid for by") Seguro Popular was not available for her illness. Not at all. 0% coverage. Zip.

She has a son in La Paz who has Seguro Social coverage, IMSS. He signed her up on his policy as a dependent living with him. She was transferred out of the Seguro Popular hospital and directly into the Seguro Social/IMSS hospital. Her medical treatment is covered by the insurance, 100%.

I think it's great that the two public insurance providers will coordinate and work together, and that one of her sons is employed by a Mexican company.

Alm - 9-22-2013 at 10:51 PM

There are no pre-existing conditions in SP, yes, but there are exceptions, kind of. There is a list of covered procedures, pretty long list.

OTH, IMSS does not cover - not supposed to cover - pre-existing conditions. How IMSS could accept somebody with a recently diagnosed condition, is beyond understanding. Oh, land of wonders...

Btw, did anybody notice that the OP never specified whether he/she was interested in a Mex social healthcare at all. Or whether he/she was a resident or somebody with a visitor status. The question was "Plans, costs, deductibles", and where to buy in La Paz/Cabo area.

Mulegena - 9-23-2013 at 07:34 AM

Again, to point out the inequalities of Seguro Popular/SP vs. Seguro Social/IMSS coverages:

Another relative has a condition that has become potentially life-threatening, an aortic hernia that's been present from birth; the lady is now in her 30s.

She has Seguro Popular (and cannot change to IMSS, btw, for whatever reason). She was sent to La Paz for a current exam which included x-rays and an endoscopy. SP did not cover the endoscopy, nor of course will it pay for any medications or the necessary surgery to save her life. She was sent home and told to come back when she had the money. Kinda cold. The family is raising payment at the moment by selling tamales door to door.

This brings up another point: Fundraisers.
Each little village helps to look after their own. When someone is sick they have fundraisers, usually a planned collective lunch sale with tickets available by advance sale or "at the door". All proceeds are put into a bank account for that beneficiary's health care. Fundraisers are an essential part of community life down here and are an excellent way tourists can help. When someone approaches you, buy a ticket. Ask who in town is in charge of the Association (for example, in Mulege see Saul Davis). Go to that person and ask how you can help. Make a donation. Save a life.

Pescador - 9-23-2013 at 10:45 AM

Quote:

Originally posted by Mulegena
Again, to point out the inequalities of Seguro Popular/SP vs. Seguro Social/IMSS coverages:

Another relative has a condition that has become potentially life-threatening, an aortic hernia that's been present from birth; the lady is now in her 30s.

She has Seguro Popular (and cannot change to IMSS, btw, for whatever reason). She was sent to La Paz for a current exam which included x-rays and an endoscopy. SP did not cover the endoscopy, nor of course will it pay for any medications or the necessary surgery to save her life. She was sent home and told to come back when she had the money. Kinda cold. The family is raising payment at the moment by selling tamales door to door.

This brings up another point: Fundraisers.
Each little village helps to look after their own. When someone is sick they have fundraisers, usually a planned collective lunch sale with tickets available by advance sale or "at the door". All proceeds are put into a bank account for that beneficiary's health care. Fundraisers are an essential part of community life down here and are an excellent way tourists can help. When someone approaches you, buy a ticket. Ask who in town is in charge of the Association (for example, in Mulege see Saul Davis). Go to that person and ask how you can help. Make a donation. Save a life.

Mulegena, that is excellent advice. The problem with the fundraisers is that a lot of tourists never know who the sick person is because they have very little interaction with the people who live in the village. We had a guy who was working over San Lucas Trailer Park, Dos Amigos, Punta Chivato, and as far as the campgrounds at Concepcion. He had a Fonatur shirt and a typed up and signed sheet of paper. On closer examination the guy who was supposed to be needing surgery had died 4 years prior and this guy was using this fundraising as an excuse to obtain money. Checking with Saul would have brought that to a stop for sure. I knew the person who had died so I was not vulnerable. He also changed the amounts donated to reflect a higher amount. So if you gave 20 pesos, by the time your neighbors read the sheet, it looked like you gave 200 or 2,000 so you upped your amount to reflect what he showed the others as having given.

EnsenadaDr - 9-23-2013 at 11:02 AM

Wow I am sending this to the boss at Maneadero in Ensenada for his comment, this is crazy. He speaks good English. I will ask him what he thinks. But between us, the Internal medicine guy probably decided he didn't want to take any further action on this because of the risks involved. But he should say that not deny funding.

Quote:

EnsenadaDr - 9-23-2013 at 12:55 PM

I just got a response from the head boss over at Maneadero and wants to know more information. Name, and address. He said he could help her with Seguro Popular in La Paz. If you don't want to make it public please U2U me.

Quote:

[Edited on 9-23-2013 by EnsenadaDr]

Alm - 9-23-2013 at 01:15 PM

Have forgotten about Rolly Brook site, in case if the OP is still reading: http://rollybrook.com/health.htm

Kind of 101 on the subject. With links to private insurers as well, that Pescador and Mula mentioned.

pauldavidmena - 9-23-2013 at 04:05 PM

Quote:

Originally posted by Alm
Have forgotten about Rolly Brook site, in case if the OP is still reading: http://rollybrook.com/health.htm

Kind of 101 on the subject. With links to private insurers as well, that Pescador and Mula mentioned.

the Rolly Brook site, as well as the book he co-authored is definitely a good primer on not just Mexican Health Insurance, but on the ex-pat life in general. Of course the continued experiences of people on this forum is even more informative.