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oxxo
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Mood: If I was feeling any better, I'd be twins!
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Medicare in Baja
I have elected to use Kaiser Senior Advantage for my Medicare coverage. KP is my primary provider. I pay nothing for this coverage other than the
$100 taken out of my SS check every month. Although I have a California address, I spend almost all my time in Baja. I asked KP what would happen if
I needed medical care in Mexico. Would I still be covered? They told me that they would not cover routine medical care but they would cover any
"emergency" medical service in Mexico. I agree that routine care should not be covered, but the definition of "emergency" bothered me.
Well the unthinkable happened! Recently I had to go to Amerimed in San Jose with a severe medical problem. I spent one day in the hospital including
an overnight. They were able to fix me in a professional manner. The total bill was US$820 for everything - hospital, all doctors and specialists,
ultrasounds, etc. I thought that was VERY reasonable. I paid the hospital in cash and received all receipts, diagnosis, test results, and supporting
documents (all in English). I sent everything in to KP in California........and hoped for the best. Today, I received a reimbursement check from KP
for US$770 ($820 minus $50 deductible). No questions asked and no run around! I AM ONE SATISFIED CUSTOMER!
KP told me if a future problem is serious enough and needs medical attention in California (heart attack for instance), they will make arrangements
for and pay for air evacuation! Based on this last experience, I believe them!
[Edited on 3-21-2012 by oxxo]
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Bajatripper
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Nice to hear some good news about our overpriced medical coverage, oxxo.
There most certainly is but one side to every story: the TRUTH. Variations of it are nothing but lies.
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tiotomasbcs
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Glad you are feeling better--fixed up! Great news for those of us living in Baja esp BCS. I will qualify soon for Medicare and will fill a major
concern living here. Thanks for sharing. Tio
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SFandH
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Significant news! Glad you're fixed up. Does the paperwork KP provided with the policy address care in foreign countries?
Expats vs. vacationers?
I'm going to have to dig into this.
Thanks for posting.
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bajaguy
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Three things
1. "I have a California address"
2. "Emergency"
3. Depends on the Medicare carrier (KP)
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Hook
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This is not an uncommon occurrance over here, when using the fine CIMA hospital in Hermosillo. Most US plans happily pay the amount that is often
50-60% less than the cost in the US.
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Pescador
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Ok, but be careful, most of the medicare supp. plans have a requirement that you are not out of the country for more than a limited amount of time.
You always need to report that you are traveling here for vacation when you get sick or need something and not that you live here.
Common sense would dictate that you would get good care for a reasonable cost here, but it is still an out of pocket expense for Kaiser whereas if
you go to their facility, all the doctors and medical people are on a salary.
Another novel thought would be to read your policy for Medical coverage when you have a little spare time.
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Santiago
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| Quote: | Originally posted by Pescador
Another novel thought would be to read your policy for Medical coverage when you have a little spare time. |
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vandenberg
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| Quote: | Originally posted by Pescador
Another novel thought would be to read your policy for Medical coverage when you have a little spare time. |
...and
don't miss the fine print..... 
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oxxo
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| Quote: | Originally posted by SFandH
Does the paperwork KP provided with the policy address care in foreign countries?
Expats vs. vacationers? |
Yes, the policy does address this. It says essentially that if you have a medical emergency anywhere in the world, get yourself to the nearest
medical treatment for services and they will pick up the cost.
They don't care if you are an expat or vacationer. I discussed this with them. I told them I was an expat. They said they didn't care as long as it
was an emergency. They won't cover routine medical care in a foreign country.
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vacaenbaja
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Kaiser must have been pleased/shocked at the unbeatable "nice price"they were charged for the professional services that you received. They managed
to
keep their cool enough not to forget your deductable!
Great news that you were able to get reimbursed at the
highest level.
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oxxo
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| Quote: | Originally posted by Pescador
Ok, but be careful, most of the medicare supp. plans have a requirement that you are not out of the country for more than a limited amount of time.
You always need to report that you are traveling here for vacation when you get sick or need something and not that you live here.
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Yes, that is true for many Medicare supplemental plans, but Kaiser Senior Advantage is the exception.
My full time neighbor, Carol, just moved back to the States for this very reason. Her Medicare plan (not Kaiser) required that she return to the
States every 6 months and report in. She was having frequent serious medical problems in Mexico and her plan would't pay for her care because she was
a full timer. She finally gave up and moved back because of health issues and having virtually no coverage even though she was paying a Medicare
supplement premium of around $400 per month.
I return to the US a couple of times a year for "doing stuff" and that is when I have my routine medical taken care of. I can make my appointments
on-line in advance while in Mexcio and I am good to go for an appointment as soon as I arrive.
Research all the plans carefully.
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MitchMan
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Good research and good info, Oxxo. KP is definitely in my sights if my current medicare advantage policy doesn't work out. I use Health Net. My
father-in-law is getting excellent care at KP and they built a big new facility close to me in So Cal.
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estebanis
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Thanks for this Thread! Guess this is one reason for settling in Northern Baja when I retire with my wifes chronic issues. Sure will miss that
tropical sun...
Esteban
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Iflyfish
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Thank you so much for sharing this with us. I started a thread a while back on Medical Care in Mexico and this is a very important piece of the
puzzle. I too have Kaiser Senior Advantage and it is top notch.
Iflyfish
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Pescador
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For those who live most of the time in Baja and have another program in the United States, one of the things you might wish to consider is signing up
with Seguros Popular which usually runs about $100 a year and covers basic medical treatment. It does a very good job with things like lab tests,
diagnostics, and the like and acts as a good supplement to your US Coverage. It is not a panacea for coverage since there is a lot of private medical
care in Mexico but for general coverage, I think it does a pretty good job of what it was intended to do.
As far as coverage in the United States is concerned there are several ways to go. Some elect to use HMO's or Health Maintence Orginizations like
Kaiser for their services. That is a good option but it does limit you to seeing mainly their own doctors and staff. Again, that is a good option
for most treatments but when you get into really specialized things where you might need treatment at Sloans-Kettering or Mayo clinic, you will
normally be disappointed and unable to get into the more specialized clinics. It sometimes happens, but the HMO has to pay out of their operating
expenses for you to go out of system and it normally does not occur.
The second type of coverage is with a PPO or a Preferred Provider Orginization which means the Insurance company has a contract and agreed upon rates
for each procedure or treatment and the Doctor, hospital, and staff have agreed to those costs ahead of time. Again here, it is a limitation of
providers who have agreed up front. This may or not mean limitations of services. For example, Blue Cross and Blue Shield is one of the largest
PPO's in the country and most doctors and hospitals have discovered that it is necessary to agree to their rates and costs in order to get enough
people in the door.
The final type is coverage anywhere anytime but with the rapidly rising costs of healthcare, this is almost a dinosaur and non-available anymore.
There are a few remnant plans out there that do this but you will almost always find a "Reasonable and Customary Clause" that means the insurance
company will only pay what is predetermined to be "Reasonable and Customary" and that usually means below what the Doctor and Hospital is willing to
accept so you end up paying the difference.
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Mulegena
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about Mexico's health care
Remember, you'll be responsible paying up-front before care, and you will be waiting your turn for non-life threatening care, including emergencies. I
think we could venture to say Mexico's healthcare system is a form of socialized medicine.
You'll need a private attendant at your bedside 24/7. The hospital staff is minimal. On discharge, you're responsible for obtaining wheelchairs,
crutches, etc.; they're not provided.
Seguro Popular is very limited in its coverage which means that even if you have membership, if your needs are not within their scope of coverage
you'll still be responsible for payment up-front (which might run into thousands of US dollars).
All this being said its great that Kaiser P. offers a reimbursement option for "emergent" needs out of country.
[Edited on 3-22-2012 by Mulegena]
"Raise your words, not your voice. It's rain that grows flowers, not thunder." ~Rumi
"It's the mark of an educated mind to be able to entertain a thought without accepting it." ~ Aristotle
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Alm
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| Quote: | Originally posted by Pescador
The final type is coverage anywhere anytime but with the rapidly rising costs of healthcare, this is almost a dinosaur and non-available anymore.
There are a few remnant plans out there that do this but you will almost always find a "Reasonable and Customary Clause" that means the insurance
company will only pay what is predetermined to be "Reasonable and Customary" and that usually means below what the Doctor and Hospital is willing to
accept so you end up paying the difference. |
Doesn't look like Ihi Bupa is going the way of dinosaurs. I also wouldn't worry about Mexican treatment cost exceeding "Reasonable and Customary" cost
- it's usually half or less of what it costs in the US. Premiums of Bupa and similar insurers are terribly high, though.
Edit - PS:
with "reasonable costs" clause they would probably pay $800 on $1,000 bill from Mexico because this is in their opinion "reasonable" in this area,
even if it costs 3 times more in the US. $200 difference covered by the client wouldn't be disastrous, but there is another problem with Mexican
healthcare. With only 4 real hospitals in entire Baja, chance of getting a proper care is a hit and miss. Air evacuation to SD would've been my first
choice, if only the condition would allow me those 12-15 hours.
[Edited on 3-27-2012 by Alm]
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durrelllrobert
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I have also had extraordinary luck with KP reimbusing me for emergency care in Baja. Once I submitted a bill in $mn and the reimbursed it (less
percription drugs and equivalent hospital co-pay) in $US. Of course I brought this to their attention 
Bob Durrell
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durrelllrobert
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| Quote: | Originally posted by Alm
With only 4 real hospitals in entire Baja, chance of getting a proper care is a hit and miss.
[Edited on 3-27-2012 by Alm] |
 There are more than 4 in Ensenada alone.
Bob Durrell
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