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oladulce
Super Nomad
Posts: 1625
Registered: 5-30-2005
Location: bcs
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A Retirement Tip
If you're looking forward to retirement in the near future and will be switching from group health insurance and applying for an individual policy,
I'd like to pass along some hard-earned advice.
As you're counting down the days during your last 6-12 months on the job:
1. DO NOT visit the chiropractor so you'll be in the best possible shape for all the surfing and paddling you'll be doing in your
leisure time.
2. DO NOT go in for the Surfer's ear surgery you've been putting off.
3. DO NOT see a doctor for little tune-ups before your move to Mexico and don't fill any prescriptions unless you absolutely need
them (or at least don't claim it on your insurance)
I just submitted the 4th application for an individual health insurance policy after being denied by 3 companies for reasons mentioned above (along
with the 1st company that refused to cover any future Cancer because I had cancer 25 years ago????).
Husband "Wooo" finally got accepted by Blue Cross on attempt #3 so at least we got him covered.
I tried Blue Shield 2 weeks ago and have been expecting an answer any time but learned that they lost my app. so I had to start all over and reapply.
I don't have a very good feeling about BS and I spent all day completing another online application for company #5.
We have no chronic, major, or minor medical conditions and are not on medication and we cluelessly thought insurance companies would be clambering to
sign us up.
Some companies want to know the past 10 yrs of your major medical history and some only go back 5 yrs for any big stuff. But all the applications I've
filled out have asked for the details of the past 2 years so I'd highly recommend that you and your family start backing off your insurance
usage during your last couple of years before leaving your group plan.
It's stressful and time consuming dealing with this stuff we've been working on getting coverage for 2 months. The house sold and we're down to just 3
more days here so we'll be living in our camper somewhere near our storage unit til we get it worked out. Then we can start hauling things South.
It never occurred to me that using our insurance would come back to bite us in the butt and I hope the message can help someone else.
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woody with a view
PITA Nomad
Posts: 15939
Registered: 11-8-2004
Location: Looking at the Coronado Islands
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Mood: Everchangin'
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if you 2 need a real place to lay your heads at night we have a futon in OB calling your names.....
great advice for the rest of the folks, we gotta wait another 20 years for NoBamaCare to kick in. by then we EXPECT to withdraw our ROTH IRA's with no
strings attached.......
edit: ALL CAPS
[Edited on 12-13-2009 by woody in ob]
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Hook
Elite Nomad
Posts: 9010
Registered: 3-13-2004
Location: Sonora
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Mood: Inquisitive
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Another tip, shop around for the meds down here. For my blood pressure med, the Benavides, Similares and the Leon pharmacies were all about 180 pesos
per month supply.
Walmart and Costco down here were 52 and 54 pesos, respectively.
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k-rico
Super Nomad
Posts: 2079
Registered: 7-10-2008
Location: Playas de Tijuana
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Another tip, something I learned the hard way. Insurance companies know about every prescription you have filled whether or not insurance paid for
them. Going back how far I don't know, but I think at least 20 years.
They know this because every prescription filled by a pharmacy in the US is recorded in a database. An insurance agent I was working with told me
this. I'm not sure what the "key field" (programmer talk) is that ties the prescription to the individual. Names are ambiguous, names and addresses
less so. Of course a social security number is unambiguous.
This tidy little system prevented me from being able to buy insurance I could afford.
[Edited on 12-14-2009 by k-rico]
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bajajudy
Elite Nomad
Posts: 6886
Registered: 10-4-2004
Location: San Jose del Cabo,BCS
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OD
That sucks
Hope you get it straight soon!
Take care!
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oladulce
Super Nomad
Posts: 1625
Registered: 5-30-2005
Location: bcs
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Woody, thank you for the generous offer. We've got the cargo trailer packed with our first load of stuff at a storage place nearby, and there are
several campgrounds within a few miles. Once we get something ironed out we'll hook up and go. Muchas gracias though.
k-rico, I believe the Rx data base is called Intelliscript. I read about it yesterday while researching "insurance denial and underwriting". An
insurance underwriting website said that it's a time saving tool for companies to use rather than poor through an applicant's entire medical history.
They start with your Rx history and compile your medical history from there. I'm sure you're right, it wouldn't matter if you kept an Rx off the books
or not because there would be a record of it. So far the 5 applications I've filled have only asked for the past 1 or 2 yrs of medication history.
My favorite denial so far has been because of the Surfer's ear surgery in June from which I am 100% recovered. Blue Cross denied me insurance
coverage because their "statistics show that sometimes people have complications later ". Once you've recovered from the surgery there are no
"complications" that can arise so what they really meant is "if you've had surfer's ear, you may get it again in 10 yrs because sometimes the bone
grows back so we're not going to give you insurance".
I'm beginning to see that it isn't always what your recent medical history has been, but how much you use your insurance that they look at. if I could
only divulge that over the past year i used my insurance more than usual in preparation for retirement and we're moving to Mexico so from now on I'll
only have a mammo and one doctor visit per year.
Next options are to try for a costly ex-expatriate policy and cobra which is also costly and only good for 18 months. But at least I have the cobra
option for now, and thank goodness my husband can get coverage.
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Santiago
Ultra Nomad
Posts: 3512
Registered: 8-27-2003
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I wonder how they deal with kind of stuff in Manitoba?
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djh
Senior Nomad
Posts: 936
Registered: 1-2-2005
Location: Earth mostly. Loreto, N. ID, Big Island
Member Is Offline
Mood: Mellow fellow, plays a yellow cello...
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ola, have your guys considered...
If you'll be a resident in Baja (FM3 or FM2) I believe that you can join the Mexican IMSS
I cannot remember where I copied this, but it was worth reading and considering. I'm on my 5th FM3 renewal and have not yet joined, since I'm still
working and insured in the US, but I plan to soon !
Here it is.
IMSS Medical Insurance is available to foreigners holding an FM3 or FM2 visa. The cost is quite low. To apply you will need copies of your passport,
FM#, proof of residency (utility bill, etc), birth certificate, marriage license, and two passport-type pictures. The birth certificate and marriage
license will probably be required to have an apostille and to be translated into Spanish by an approved translator.
A physical exam is sometimes required, depending on the answers to the questionnaire. Coverage of per-existing conditions is complicated. Some may be
covered after two years; others are never covered; and some will disallow your enrollment.
Rates for 2006:
Age: Pesos:
0-19 $1,062
20-39 1,241.19
40-59 1,855.21
60+ 2,971.78
As always, check with your local IMSS office to verify requirements and costs.
Benefits are phased in over a three year period.
In the first year only minor things such as colds, Moctezuma's revenge, etc. are covered. These are basically out-patient services for which you will
probably want to see a private doctor rather than wasting half a day or more waiting in the IMSS out-patient clinic. The first year will cover
automobile and other accidents and emergencies such as heart attacks.
The second year adds everything except broken bones and orthopedics.
The third year offers full coverage including medications so
long as you get them from IMSS, You will not be reimbursed for drugs bought from other pharmacies. This drug benefit is often pretty hollow as IMSS is
chronically short of medications.
The schedule of benefits and annual cost are subject to change, so get the latest word from your local office.
The following is a typical application questionnaire.
IMSS APPLICATION QUESTIONS
Name as it appears on your migratory document?
1. Father’s full name? /Apellido paterno?
2. Mother’s full maiden name? /Apellido materno?
3. How old are you? /Edad?
4. How tall are you? (cm) /Estatura?
5. How much do you weigh? (kg) /Peso?
6. What is your highest level of education? /Profesion o escolaridad maxima?
7. Are you active in any sports? /Practica algun deporte?
8. What is your occupation? /Ocupacion principal?
9. Do you drink? /Toma bebidas alcoholicas?
10. How many drinks per week? /Cuantas copas por semana?
11. How long have you been drinking? /Desde cuando empezo a tomar?
12. Do you smoke? /Fuma?
13. How many cigarettes per day? /Cuantos cigarros por dia?
14. How long have you been smoking? /Desde cuando empezo a fumar?
15. Do you take any over the counter medication? /Acostumbra automedicarse?
Do you have any of the following – Yes or No
16. Allergies or asthma? /Alergia o asma
17. Chronic blood diseases? /Enfermedades cronicas de la sangre
18. Cancer or tumors? /Cancer o tumores
19. Diabetes Mellitus with /Diabetes mellitus con
· Kidney insufficiency /Insuficiencia renal
· Retinopathy /Retinopatia
· Neuropathy /Neuropatia
· Peripheral circulatory insufficiency /Insuficiencia circulatoria periferica
20. Heart disease? /Enfermedades del corazon
21. Liver diseases? /Enfermedades del higado
22. Chronic nervousness or psychiatric diseases? /Enf nerviosas o psiquiatricas cronicas
23. High blood pressure? /Presion arterial alta
24. Rheumatism or arthritis? /Reumatismo o artritis
25. Tuberculosis? /Tuberculosis
26. Stomach ulcers? /Ulcera del estomago
27. A.I.D.S.? /S.I.D.A.
28. H.I.V. positive? /V.I.H. positivo
29. Genetic diseases (from birth)? /Enfermedades congenitas (desde elnacimiento)
30. Chronic bronchitis? /Bronquitis cronica
31. Vascular accident or embolism? /Accidente vascular o embolia
32. Deformations or movement impairments due to accidents or illness?/Deformaciones o limitaciones de movimiento por accidents o enfermedades
33. Addictive alcoholism (frequent)? /Alcoholismo adictivo (frecuente)
34. Addiction to toxic substances? /Adiccion por sustancias toxicas
Altholugh a bit dated, I hope this is helpful. Best advice AND salutation, of course:
Your Good Health!
djh
Its all just stuff and some numbers.
A day spent sailing isn\'t deducted from one\'s life.
Peace, Love, and Music
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Hook
Elite Nomad
Posts: 9010
Registered: 3-13-2004
Location: Sonora
Member Is Offline
Mood: Inquisitive
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Naturally, we've considered IMSS.
But only for the small stuff. In most cases,we're willing to pay out of pocket for the small stuff down here. It's pretty cheap. So, we have passed on
IMSS.
We arent trusting of IMSS for the big stuff down here.
I guess everyone has their own personal definition of small stuff and big stuff.
[Edited on 12-14-2009 by Hook]
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ncampion
Super Nomad
Posts: 1238
Registered: 4-15-2006
Location: Loreto
Member Is Offline
Mood: Retired and Loving it
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Retired two years ago and exited from our group coverage. Went with Blue Cross. Did have to pay a 25% increase due to my back surgery a year befor
and my wife's hip replacement 5 years ago. Not sure why you are having such a hard time getting coverage. I know that some people run to the doctor
for every ache and pain as long as they have insurance coverage - never a good idea. Still three more years till Medicare eligable, but the policy we
have is reasonable considering our ages and the statistical likelyhood of needing medical care. We did take a high deductable so the "small stuff" is
on us, but have an HSA to help with that.
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Barry A.
Select Nomad
Posts: 10007
Registered: 11-30-2003
Location: Redding, Northern CA
Member Is Offline
Mood: optimistic
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As a Fed. Govt. retired employee, now over 65 so on Medicare as primary ins., my retained Government Blue Cross Group insurance which is now
secondary, costs me $357 per month. My medicare Part B costs me an additional $386 per month for my wife and I, for a total of $743/ month. (just
for perspective purposes)
Barry
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BajaNuts
Super Nomad
Posts: 1085
Registered: 5-11-2008
Location: eastern WA, the DRY side
Member Is Offline
Mood: no worry, no hurry....it's all good!
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When we first started out in business and we weren't making any money, we used the Washington state Basic Health plan. It started out around $38 for
family of 3, and ended up a few years later around $180/month.
Then, after we submitted our yearly income statement which showed that we'd actually made a profit the year before, they dropped us! We had about 15
days to find insurance.
Our current full-coverage/low-deductible (no other choices) policy is $807 a month!
We've looked at other policies, and have yet to find one with the full coverage as the one we have for the dollars. It's through a trade union, of
which hubby is a member. There are others out there for less monthly premiums, but they have high deductibles and less benefits.
And so we pay.......every month..........through the nose.........it gives me nose-bleeds just thinking about how much we spend on insurances of all
types.....
'course, after this last year in business, I think we're eligible for the state funded low-income policy again!
Good luck, Ola~, the Cobra is a good temp thing to give you some more time to figure it out and in a year, when they ask for/receive you're care
records, you will not have used ANY of the benefits because you are in such GREAT shape...and ALL the companies will be clamoring to have your policy!
Well, that's the way it works in night-night books anyway......happily ever after!
[Edited on 12-14-2009 by BajaNuts]
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oladulce
Super Nomad
Posts: 1625
Registered: 5-30-2005
Location: bcs
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| Quote: | Originally posted by ncampion
Retired two years ago and exited from our group coverage. Went with Blue Cross. Did have to pay a 25% increase due to my back surgery a year befor
and my wife's hip replacement 5 years ago... Not sure why you are having such a hard time getting coverage. We did take a high deductable so the
"small stuff" is on us..
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Interesting ncampion, only Blue Shield of South Dakota (our first application) offered to provides us insurance along with some exclusions on the
policy. Unfortunately, the exclusions included treatment for any future cancer of any kind for me and no digestive disorders for my
husband because of a bile duct procedure he had 6 years ago. Neither option was something we could live with.
None of the other companies gave the option of having exclusions on the policies or having riders applied and paying higher premiums. Health Net
rejected us for the chiropractor visits. We told them it was merely for sports conditioning and we could easily live without it but they said it was
all or nothing- no exclusions or customization of the policies. Same with Blue Cross for me- surfer's ear surgery was an automatic rejection from
them. I'd happily accept a policy that excluded any future surfer's ear surgery, but the answer was simply "DENIED".
After the first 2 rejections, we contacted a broker recommended by Pescador. He provided the analogy that if a truck driver and a professor both apply
for insurance who do you think will get it? The truck driver, according to him because the professor will divulge way too much, provide specific
details of his history, and will tend to access his health insurance more frequently. His advice was to fill out the applications like a truck driver
and not like the RN and paramedic we were and to only put down any "big stuff" in our recent medical history, although he couldn't officially tell us
to omit anything on the apps of course.
So we attempted that on the next application and did not use medical jargon to describe surgeries , and omitted a few dermatology visits from 3 or 4
years ago etc. But we weren't comfortable leaving off everything for fear that the company could come back years later and audit the application and
refuse to provide further coverage if they discovered we left something off. BigWooo was obligated to relate his on-duty injuries which took up a
whole page and made the broker exclaim "you guys are killing me", even tho they were work comp. Finally Blue Cross accepted him but denied me due to
the Surfer's ear surgery.
On the Blue Shield and Aetna apps that are currently being reviewed I tried to speak truck driver and kept the medical history to a minimum. It will
be interesting to see what happens.
All policies we've applied for have had $2500-3500 deductibles.
Barry i had no idea that medicare supplementals cost so much. There's something to look forward to.
Thanks for the Imss info djh. I think I'm with Hook on this one though- I'll pay for the small stuff locally and we have Medjet evac insurance for any
major events.
Nuts, bummer they don't offer more options so you could customize your policy to try and lower your premium.
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k-rico
Super Nomad
Posts: 2079
Registered: 7-10-2008
Location: Playas de Tijuana
Member Is Offline
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oladulce,
You may want to look into (carefully) United American Insurance Company if you have no luck with the major insurers. They cover people the majors
reject, for a pretty penny.
http://www.unitedamerican.com/
Your surfer's ear story is so bizarre and given my experience with the whole mess, believeable.
[Edited on 12-14-2009 by k-rico]
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wessongroup
Platinum Nomad
Posts: 21152
Registered: 8-9-2009
Location: Mission Viejo
Member Is Offline
Mood: Suicide Hot line ... please hold
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and isn't that the american way
| Quote: | Originally posted by k-rico
Another tip, something I learned the hard way. Insurance companies know about every prescription you have filled whether or not insurance paid for
them. Going back how far I don't know, but I think at least 20 years.
They know this because every prescription filled by a pharmacy in the US is recorded in a database. An insurance agent I was working with told me
this. I'm not sure what the "key field" (programmer talk) is that ties the prescription to the individual. Names are ambiguous, names and addresses
less so. Of course a social security number is unambiguous.
This tidy little system prevented me from being able to buy insurance I could afford.
[Edited on 12-14-2009 by k-rico] |
Correct and on point... but, now
You really wouldn't want these folks to lose money..  .... oh, my god.. a
Company in the United States that would have to face the same obstacles that the working stiff faces, financial ruin... Never!!!.. and there is still
support for these (Large Major international Corp's).. oh that's right, it might cause a problem with the "economy" if we don't provide them with all
the information to make " risk based decision" on one's health..
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Barry A.
Select Nomad
Posts: 10007
Registered: 11-30-2003
Location: Redding, Northern CA
Member Is Offline
Mood: optimistic
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OlaDulce said: "Barry i had no idea that medicare supplementals cost so much. There's something to look forward to."
To be clear------We do not have any Medicare Supplimental Ins. tho we are talking semantics here.
My Medicare Part B premiums are on an income-adjusted basis----i.e. the more your income, the more you pay. Normal minimum payments are $96.50 a month
each person.
We (and everybody over 65) automatically have Medicare Part A (hospitalization) which has no "direct" premiums.
My retained Fed. Govt. Health Ins. that I had as an employee becomes secondary to Medicare when you reach 65, but the premiums you pay stay the same
as if it were primary. (go figure???)
In the final analysis, after paying my premiums, I pay nothing for health problems, except that for prescriptions I do pay a healthy co-pay ($85, I
think) for non-generic prescription drugs, $0 for generic, and we pay the full amount for non-prescription OTC drugs like everybody else.
Relatively speaking, I think our plan is "fair", tho I do think that a personal Medical Savings Acct. would over time be a better option cost-wise, at
least in our case, coupled with some type of catastrophic coverage from a private source, or Govt. source (like Medicare Part A).
Barry
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Sallysouth
Super Nomad
Posts: 1835
Registered: 10-9-2003
Location: Capo Beach
Member Is Offline
Mood: missing Baja...
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Hi gang,I hope I am not hijacking this thread,but my Dad is going down for 6 months and was wondering if he can get Aricept down there.He has a
prescription and can get meds here from the VA but not sure he can take all 6 months down with him.Any advice? thanks, Sally
Happiness is just a Baja memory away...
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bajabass
Super Nomad
Posts: 2016
Registered: 10-4-2006
Location: La Paz,BCS
Member Is Offline
Mood: Want to fish!!!
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This insurance thing has become a nightmare in the U.S. Sure glad I married that pretty young doctora from Ensenada. About 3 years ago, I needed a
Kidney biopsy to determine a problem. I had no insurance. The wife now, girlfriend then, got in touch with one of her teachers from the university in
Ensenada. A room in the newer hospital in Ensenada, a ultrasound tech, the needle, the doctor, and the pathology. 300.00 bucks, total! Easy 5K here. I
tell my wife I married my retirement AND my medical plan! 
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arrowhead
Banned
Posts: 912
Registered: 5-5-2009
Member Is Offline
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| Quote: | Originally posted by Sallysouth
Hi gang,I hope I am not hijacking this thread,but my Dad is going down for 6 months and was wondering if he can get Aricept down there.He has a
prescription and can get meds here from the VA but not sure he can take all 6 months down with him.Any advice? thanks, Sally |
I don't think you can get more than 90-days supply at a time from the VA. At least I've never been able to. If your dad has VA, there is nothing
cheaper for medications than them, even in Mexico. The VA mails medications to a home address and you can imput your refills on the internet. So the
only thing your Dad has to do is get somebody to open his mail and forward the medicine to him. By the way, I know what aricept is for, I hope he is
not traveling alone.
[Edited on 12-16-2009 by arrowhead]
No soy por ni contra apatía.
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norte
Super Nomad
Posts: 1163
Registered: 10-8-2008
Member Is Offline
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isn't part B optional? and for Social Security recipients
and are our a civil servant retirement (CSRS) employee?
might be you are talking apples and oranges here (people, you and I can't have what he has if he is a CSRS retiree. gov't dole person) They get
free health care... and what extra he is paying for must be his wife.
| Quote: | Originally posted by Barry A.
OlaDulce said: "Barry i had no idea that medicare supplementals cost so much. There's something to look forward to."
To be clear------We do not have any Medicare Supplimental Ins. tho we are talking semantics here.
My Medicare Part B premiums are on an income-adjusted basis----i.e. the more your income, the more you pay. Normal minimum payments are $96.50 a month
each person.
We (and everybody over 65) automatically have Medicare Part A (hospitalization) which has no "direct" premiums.
My retained Fed. Govt. Health Ins. that I had as an employee becomes secondary to Medicare when you reach 65, but the premiums you pay stay the same
as if it were primary. (go figure???)
In the final analysis, after paying my premiums, I pay nothing for health problems, except that for prescriptions I do pay a healthy co-pay ($85, I
think) for non-generic prescription drugs, $0 for generic, and we pay the full amount for non-prescription OTC drugs like everybody else.
Relatively speaking, I think our plan is "fair", tho I do think that a personal Medical Savings Acct. would over time be a better option cost-wise, at
least in our case, coupled with some type of catastrophic coverage from a private source, or Govt. source (like Medicare Part A).
Barry
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