Healthcare Services in Mexico for U.S. Citizens

Mexico Health Care - Friday, July 18, 2008

by: Anna Kaplan

Total Title Insurance for Mexican Property

      Americans are worried about healthcare. There are more than 40 million without health insurance of any kind. Some obtain insurance through their employers, but they are paying more out-of-pocket and getting less. People over 65 are eligible for Medicare. The poor can apply for Medicaid.

      But many middle class, hard-working citizens cannot afford to purchase ever-increasingly expensive health insurance. Costs are out of control. Anyone watching the news during this presidential election year in the United States knows that health care reform is a large issue. Although the candidates running for president have plans, nothing yet has helped the average American.

      What may surprise some Americans is how far Mexico has progressed in certain areas of health care. At the current time, Mexico has a three-tier system. The first tier provides the poorest Mexicans with very limited care. The second tier includes government-run, social security institutions. One of these, IMSS, or Insituto Mexicano del Seguro Social, offers health care to people not covered by the other social security agencies. Americans living in Mexico can apply for IMSS health care. The third tier is private medical care, which is flourishing right alongside the other systems.

      Americans living in Mexico can simply pay out of pocket for medical care, because everything is much less expensive.

      An office visit with a doctor costs about $25. An overnight hospital stay is about $35. Prescription drugs cost half of what they do in the United States.

      Americans can buy international or Mexican private insurance. Or, they can enroll in the IMSS health plan. Anyone living in Mexico can apply, pay the fee, and be eligible for healthcare.

      But is the healthcare good? The answer to that question is yes. It is especially good in very large cities like Guadalajara and Mexico City, which have tertiary care hospitals that can match anything in the United States. It is more uneven in rural areas. Small hospitals do not offer all services. If you need specialized care or surgery, you may need to go to the nearest large city.

      If you plan on living in Mexico, you need to seriously consider your own medical and financial situation. Medicare does not pay for any services out of the United States. People in Mexico who maintain residency in the U.S. may use their Medicare, providing they can get back to the States. Medical care received in Mexico must be paid at the time, and will not be reimbursed by Medicare. If you need emergency transport back to the United States, you might have to pay anywhere between 15,000 and 25,000 dollars for an air medical transport. You may want to consider purchasing an air evacuation policy. Transport by ambulance is less, but still expensive. If you have a serious, chronic illness, you need to think carefully about a move to Mexico.

     Private American insurance is rarely accepted in Mexico. You also need to ask your insurer if treatment is covered outside of the country. Often it is not. Even if it is, you will have to pay your bills yourself if you are treated in Mexico. You can then try and get your insurer to reimburse you. As more Americans seek medical care in Mexico, some of the doctors and hospitals are trying to help with documentation for your insurance carrier. But it remains your responsibility.

      There are many Americans moving to Mexico who don’t have any health insurance. They may be unable to afford it, or be considered uninsurable because of preexisting conditions.

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For those who have moved to Mexico or spend most of their time there, joining IMSS makes sense. For somewhere between 200 and 250 dollars a year, you gain access to IMSS care. The paperwork can be difficult. You need an interpreter if you don’t speak Spanish, or you can pay someone to do the paperwork for you. You may only be able to apply during certain months of the year. You need multiple copies of documents: your current passport and immigration documentation, FM-2, or FM-3 or Immigrado status, your marriage license (if married), proof of residency (a lease agreement, or telephone bill in your name), and two or three passport-type photos. It is worth checking beforehand to make sure you have the right documents and enough copies.

After the paperwork, you have an examination by a physician and are entered into the system. Coverage begins anywhere from almost immediately to months later. There are exclusions, including preexisting conditions. Some illnesses and surgeries that are not covered the first year, are covered the second year, and still more in the third year. You can stay in the IMSS system as long as you pay the premium. If you have an emergency or a car accident, you will get medical care.

Consider the example of Catherine Jones, a registered nurse and breast cancer survivor. While living in San Felipe, Mexico, she enrolled in the IMSS program. She considers herself very fortunate. “I had (IMSS) from 2002-2006,” says Jones. “The process of getting the insurance in Mexicali was easy. Thank God that I had that insurance when I was diagnosed. I had no other insurance at that time. It literally helped to save my life. The doctor at the San Felipe clinic for IMSS referred me to Mexicali to have a physical and a mammogram. The mammogram showed probable cancer of the left breast. They referred me to an oncology surgeon. They promptly scheduled me for surgery.”

Jones continues, “I am a registered nurse with many years of working in the operating room and emergency room. I was impressed with the entire processing of me from the preop room through the surgery. As it turned out I had metastatic cancer. It had already gotten into 4 of my left axillary nodes. The surgeon did a beautiful job with the surgery. I had NO complications and they were fast at getting me set up for chemo, and after the chemo, radiation.”

Jones added, “I can't say enough for the treatment I received from IMSS. It does help to understand Spanish as not all the doctors and other medical personnel speak English. It is up to us to understand and speak Spanish if we expect to live in their country and have their medical insurance, which is so reasonable, compared with the US.”

     The quality of care at IMSS clinics and hospitals varies by location. In some places, the doctors and nurses do not speak English, there are long waits, and hospitals are overcrowded. However, many Mexican doctors, especially those located where a lot of Americans live, do speak English. They may have done part of their medical training the United States. Many doctors work for both IMSS and privately. But you don’t get to pick your own IMSS doctor.

     Costs are so much lower than in the United States that people who have IMSS often pay for private doctor visits. They use IMSS like catastrophic insurance. In fact, 25% of Mexicans with IMSS insurance still pay out-of-pocket for their care. One way to circumvent some of the problems with IMSS is to have your private doctor recommend you to the IMSS clinic or specialist that would be best for you.

     Americans going to Mexico can buy international health insurance. The cost depends on age, preexisting medical conditions, and what the insurance covers. Some choose to include emergency air transportation back to the United States, and repatriation of remains should that be necessary. There is no guarantee that a hospital will accept this insurance. You may still have to pay, and submit bills for reimbursement.

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Mexico’s private system is also available to anyone needing health care in Mexico, Mexican nationals and American expatriates alike, provided you can pay for it.

One option is to buy medical insurance from a Mexican company. The premiums are lower, and once you pay a certain amount, 100% of the rest of a hospitalization is paid by the insurance company. People who choose to buy Mexican insurance say that the companies are more reasonable about what is considered a preexisting condition, and give more personal attention. At the current time, you are required to pay about $500 for a specific illness, and then the rest is covered.

     Dennis and Sandi Flannigan’s experience shows how the American health system fails people. The availability of Mexican private insurance influenced their decision to move to Mexico. He says, “In 2003, my wife Sandi and I were covered by Blue Cross with a number (of) pre-existing conditions that made it nearly impossible to have any type of protection should some emergency arise. Our family doctor evaluated us and took every piece of information to the insurance companies. If you took glucosamine and chondroitin supplement as a preventative for joint problems, it was listed as ‘severe arthritis.’ Preventive aspirin programs were taken to mean high blood pressure. Sandi had had one migraine headache treated at the hospital. I had a visit that also put me in the 'High Risk' category. All vitamins and measures taken for preventive maintenance merely raise your rates.”

     He adds, “When our physician turned this information in, we had so many pre-existing (conditions) that we had to be state subsidized. By the time 4 years had elapsed in the States with no claims, our monthly premium was $1389.00 and going up every month. The care, affordability and quality of coverage was a main factor in our move here. My friends in the States basically cannot afford coverage. When a situation arises, it can make or break a family’s living style.”

      Flannigan applied for private Mexican insurance from Grupo Nacional Provincial, a company with more than 100 years in the insurance business. He was evaluated by San Felipe physician Dr. Abasolo. “When we arrived, Dr. Abasolo gave me physical which came out very positive with no preexisting conditions,” says Flannigan. “A rate for me at that time (was) about $143 a month with a company called GNP. Our business was welcome. We were treated with respect. Suddenly our lives had changed with the peace of mind now afforded us.”

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He explains, “What happens is, you pay the first x amount of dollars and they pay 100% of everything after that. That’s really desirable. We are allowed to go to the doctors of our choice. We have found hospitals, doctors, and accommodations to be among the finest anywhere.”

     One difficulty with Mexican medical insurance is that you have to pay the entire year’s premium up-front. There is no monthly billing plan. Of course, premiums do go up with age. This may be too much for some people. Also, Mexican private insurance does not really cover treatment elsewhere, like in the United States.

     But for many like Flannigan, this is the best possible option. He says, “Now, if something happens to me, I at least have coverage. It’s good coverage. I have good doctors. The hospitals are clean. I’m not so sure that I haven’t had better care (in Mexico). They are not running in and out like you are just a number, like (in) the United States. So I have been really pleased.”

     He describes a recent hospitalization for surgery. He says, “I had a herniated navel. I was diagnosed by Dr. Abasolo on Friday. I went to the hospital on Saturday and was back by actually Monday because I chose to stay an extra day.”

     There are some surgeries that can be done in San Felipe, but this procedure needed to be done quickly. They went to a hospital in Mexicali. While Flannigan says the hospital was not “cushy,” it was clean and he got very good care.

     “They have a little extra cot so your spouse can stay with you,” he says. “It’s wonderful. The people are so nice, even if you can’t speak Spanish. I speak enough now that I am able to tell them what I need.”

     During Flannigan’s first hospitalization, the person who sold him his insurance, Theresa Corona, came to visit him. “When was the last time you spent a stay in the hospital and had your Allstate Agent visit you twice?” he asks. “During my last stay, I was visited twice by a very caring Theresa to be sure that I was okay and everything was satisfactory.”

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      Flannigan’s experience points out some things about healthcare in Mexico which an American would not anticipate. Most hospitals expect a patient’s spouse to stay with them in the room, and there is a cot and space for that. If you have someone with you who is familiar with medical fees, together you can review your bill. You can request to have changes made if you feel you have been overcharged. You might just get your bill lowered. And Mexican doctors make house calls.

     Of course, not everyone has a positive experience in the hospital or with a doctor in Mexico.
The same could easily be said of hospitals and doctors in the United States. It does help to speak Spanish or have a translator with you. It also helps to be informed.

     There are a number of books and websites that gather information about health care in Mexico. MedToGo (www.medtogo.com ) is a site built by physicians to help people get the best healthcare they can, wherever they go. It is geared for travelers, expatriates, and so called “medical tourists” who go to Mexico to get elective surgery at low cost. Mexico Connect (www.mexconnect.com) also has information, some of which is free. “Mexico: The Trick is Living Here” author Julia Taylor offers her advice about many things including healthcare. You can read parts of her book at www.home-sweet-mexico.com.

     The situation in regard to healthcare in Mexico is changing rapidly. Medical tourism is on the rise. Companies are building beautiful, modern facilities to handle elective procedures, from gastric bypass surgery to hip replacements and cosmetic surgery. Even with the most up-to-date equipment and staff, hospitals in Mexico still cost significantly less than the United States. These new hospitals are also attracting wealthy Mexicans who used to go to the United States for treatment.

      One group building the hospitals is Star Medica. They already have facilities scattered throughout Mexico. They are building in other cities, including Puerto Peñasco. These hospitals will not just be for medical tourists. They will also be available to the people who live near them, giving Americans more access to upscale and up-to-date care.

     Mexico today is a place where a wide spectrum of healthcare is available for Americans. It behooves anyone considering moving there to think about their medical needs. As helpful as the information in this article, on the websites above, or from an insurance agent might be, the most important thing of all may be to talk to Americans who actually live where you want to go. They can tell you which doctors speak English, which services have actually worked for them.

     There are new developments on the United States side of the border. Some insurance companies are running pilot programs to let patients get their care in Mexico, and there are some Mexican private hospitals who are accepting American health insurance. There are researchers trying to find a way to make changes in Medicare. In 2007 a conference at the Lyndon B. Johnson School of Public Affairs, the University of Texas at Austin, took place, entitled “The Future of Health Care for U.S. Retirees in Mexico.” Perhaps the American government and insurers will take a serious look at the issue. Considering that healthcare reform is such a divisive issue in the United States, it may take time. Luckily there are still many options for healthcare south of the border.