| Pages:
1
2 |
mojo_norte
Senior Nomad
Posts: 725
Registered: 2-14-2006
Member Is Offline
|
|
Mexican Health Insurance 101
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
Ultra Nomad
Posts: 3587
Registered: 10-17-2002
Location: Baja California Sur
Member Is Offline
|
|
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
Elite Nomad
Posts: 6667
Registered: 7-13-2009
Location: Pescadero BCS
Member Is Offline
|
|
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.
"The future ain't what it used to be"
|
|
|
Alm
Ultra Nomad
Posts: 2753
Registered: 5-10-2011
Member Is Offline
|
|
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
Ultra Nomad
Posts: 3587
Registered: 10-17-2002
Location: Baja California Sur
Member Is Offline
|
|
| 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
Super Nomad
Posts: 1663
Registered: 8-16-2011
Location: San Nicolas y Lopez Mateos
Member Is Offline
|
|
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
Banned
Posts: 5027
Registered: 9-12-2011
Location: Baja California
Member Is Offline
Mood: Move on. It is just a chapter in the past, but don't close the book- just turn the page
|
|
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: | 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. |
|
|
|
SFandH
Elite Nomad
Posts: 7433
Registered: 8-5-2011
Member Is Offline
|
|
Anybody here that lives in the Rosarito BC area and has Seguros Popular? Where do you sign up? Is a resident visa needed?
|
|
|
EnsenadaDr
Banned
Posts: 5027
Registered: 9-12-2011
Location: Baja California
Member Is Offline
Mood: Move on. It is just a chapter in the past, but don't close the book- just turn the page
|
|
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.
|
|
|
MrBillM
Platinum Nomad
Posts: 21656
Registered: 8-20-2003
Location: Out and About
Member Is Offline
Mood: It's a Zip-a-Dee-Doo-Dah Day
|
|
Que ?
"..........but the rules are bended in many situations."
|
|
|
Alm
Ultra Nomad
Posts: 2753
Registered: 5-10-2011
Member Is Offline
|
|
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
Banned
Posts: 5027
Registered: 9-12-2011
Location: Baja California
Member Is Offline
Mood: Move on. It is just a chapter in the past, but don't close the book- just turn the page
|
|
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
Select Nomad
Posts: 10322
Registered: 6-27-2011
Member Is Offline
Mood: Today I slay the Red Dot.
|
|
| 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.
ANUNCIATE AQUI
DISPONIBLE
INFORMES LLAMA SNOWBALL - 646-115-7754
|
|
|
Alm
Ultra Nomad
Posts: 2753
Registered: 5-10-2011
Member Is Offline
|
|
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
Ultra Nomad
Posts: 3814
Registered: 12-1-2003
Location: Baja California México
Member Is Offline
Mood: 'At home we demand facts and get them. In Mexico one subsists on rumor and never demands anything.' Charles Flandrau,
|
|
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.
A Lot To See And A Lot To Do
|
|
|
Alm
Ultra Nomad
Posts: 2753
Registered: 5-10-2011
Member Is Offline
|
|
| 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
Super Nomad
Posts: 2412
Registered: 11-7-2006
Member Is Offline
|
|
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.
"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
|
|
|
Mulegena
Super Nomad
Posts: 2412
Registered: 11-7-2006
Member Is Offline
|
|
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.
"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
|
|
|
Alm
Ultra Nomad
Posts: 2753
Registered: 5-10-2011
Member Is Offline
|
|
| 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
Banned
Posts: 5027
Registered: 9-12-2011
Location: Baja California
Member Is Offline
Mood: Move on. It is just a chapter in the past, but don't close the book- just turn the page
|
|
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. |
|
|
|
| Pages:
1
2 |
![[*]](images/xmbforum/default_icon.gif){kind=icon}
