What are your health care options while living in San Miguel de Allende?

Most U.S. and Canadian health plans, do not cover any of your health care needs, while traveling to or living in Mexico.

Medicare Benefits Extended Into Mexico?

Yes it’s true! The US government has been approached by numerous expat groups such as the Puerto Vallarta based chapter of Democrats Abroad and the bipartisan group of American Citizens Abroad (ACA) with the intent of promoting, Medicare for expats, living abroad.

They argue that not only have these Medicare recipients paid into the fund over a lifetime, but the cost to the US taxpayers will be significantly reduced because rather than returning to the US for expensive and long term medical care, the majority of these expats will merely elect to have their medical care provided near their foreign residence at a fraction of the cost.

The newly appointed US Ambassador to Mexico, Carlos Pascual, has been following the current efforts to establish a demonstration project for the initiation of Medicare in Mexico as a pilot program. In fact, Ambassador Pascual recently accompanied President Obama to a North American Summit in Guadalajara where one of the topics covered was Medicare in Mexico as reported by the Guadalajara Reporter.

What are your options until then?

One option is International Health Insurance

International Health Insurance has many benefits.

1. It will cover you almost anywhere in the world
2. It will cover almost all of your medical expenses, emergency and otherwise. For example:

• inpatient treatment
• emergency medical evacuation & medical repatriation,
• repatriation of mortal remains
• life-saving organ transplants,
• outpatient physician & paramedical fees
• outpatient X-Ray, laboratory tests,
• prescribed drugs, vaccinations
• hospitalisation cash benefit,
• well child care
• day surgery/treatment
• psychiatric, drug & alcohol abuse
• pregnancy & childbirth, complications of pregnancy
• eyeglasses & contact lenses
• chronic diseases (including cancer, heart disease & HIV/Aids)
• preventative & general dental care, dental crowns, bridges, dentures & implants
• Non-Western & Alternative Medicine (including chiropractic, osteopathy & acupuncture, etc.)
• annual Health Checks
• Prescribed Medical Aids
• Death of Close Relative- In the event of the death of a close relative (spouse, parent, child, brother or sister)
  100% of costs of a round trip airline ticket to attend a funeral up to maximum US$5,000 per person.

Some of the cons of international health insurance:

You must purchase these plans before your 75^th Birthday. ( Note ; if you have purchased this plan before age 75, as long as you pay the premium you are covered.)

Most of these plans will not cover you while you are in the US. Make sure you have additional coverage, such as Medicare or travel insurance that covers you while in the US.

Some carriers have a network of hospitals and doctors. If you go to one of the network facilities, you don’t have to pay out of pocket. Otherwise, you pay up front, save your receipts and you are reimbursed.

Be sure to choose one that carries an “A” rating.

Also be sure to read the fine print in your applications for medical coverage. When speaking with a representative of the insurance company, they will tell you that certain procedures are covered, but sometimes fail to mention how much they will pay for a certain procedure. This can be a problem when you think you are fully covered, have the procedure completed only to find out that the insurance company will only pay X amount of dollars for said procedure when in fact the hospital charges 3 times that amount. This can leave you with a substantial bill.

Another option is Mexican Social Security or (IMSS)

The Mexican Institute of Social Security provides affordable health insurance for all residents of Mexico regardless of their nationality. If you have a valid FM-T, FM-3, or FM-2 visa, you can apply for enrollment. Enrollment can only be applied for during the months of January, most of February, July,  August. The cost is from $100- $300 dollars per person per year, depending on your age.  The application process can be intimidating so I recommend that you hire an agent to complete the paperwork for you. The cost is $50 to $75 USD. There is a questionaire requiring you to disclose any preexisitng conditions. Be truthful!!

• Two photocopies of your current passport and immigration documentation
• Copies of either your FM-2 or FM-3 (expatriate visas)
• Duplicate copies of your marriage license (if applicable)
• Two copies of a most recent utility or telephone bill in your name or a renter’s lease agreement in your name
• Three passport-type photographs

Once you are approved,  It can take about 6 to 9 months for coverage to be activated after acceptance. Once accepted, you are a life member as long as premiums are paid. You are assigned a primary care physician who will certify your health during a general exam.

If any further treatment is needed, your assigned physician will refer you to a specialist within the IMSS system.

Any treatment that you receive at the clinics or the hospitals, from general practitioners or specialists, will be covered completely by your IMSS insurance. If medication is prescribed, that medication will be free from the IMSS pharmacy within the hospital or clinic. If the medication is not available from IMSS, you may have to buy it yourself at a privately-owned farmacia (pharmacy). The cost of medicine at these pharmacies is relatively low.

Emergencies are covered immediately. There website in English is http://www.imss.gob.mx/english
IMSS has about 1500 clinics and 264 hospitals across Mexico.
If you can’t speak Spanish, either learn or be sure to take an interpretor with you.

Benefits of IMSS

For hospitalization, generally IMSS has superior equipment to that in private hospitals and clinics. Some surgeons with private practices work at IMSS,  a day or two a week.
Cost is a major advantage of availing oneself to IMSS. Another is the quality and extensiveness of the hospital’s surgical and related equipment. Since some physicians perform surgery through IMSS, coverage might be the way to go, using private doctors for diagnosis and treatment, and just hanging onto IMSS as a safeguard in the event of serious illness. Alternatively, one can enroll, use IMSS initially, and make one’s own assessment that first year.

Cons to IMSS

The downside of depending on IMSS for all your healthcare is that you have no control over the doctors or specialists that you see for your problems. Sometimes the wait to see a doctor or to receive medication can be  long. As a general rule, Mexicans tend to prefer private health care to the state-run system. More than 25% with IMSS pay for their medical expenses out of pocket. Be aware that the social security level of healthcare is not what you are used to in most industrialised countries, ie. using mayo jars for urine specimens, paper sheets not being changed between patients, overhearing private conversations. Costly and long-term treatments are often not covered by the system, so many Mexicans and most foreigners prefer to take out private health insurance as well if they can.

There exclusions based on pre-existing conditions (though some are waived after 2 years):

• Cancer
• Diabetes
• Liver Disease
• Heart Disease, previous arrhythmia, heart attack or valvular disease
• Lung Disease, chronic bronchitis or emphysema
• Neurological disease, stroke TIA’s, peripheral vascular disease
• Drug or alcohol addiction
• HIV or history of AIDS
• Psychiatric illness
• History of accident that requires continued treatment

In addition you cannot receive treatment within the 1^st year of receiving benefits for:

• Surgery for vein disorders
• Gyn surgery for any condition except cancer
• Lithotripsy for kidney stones
• Surgery for hernias, sinuses, nose, hemorrhoids, rectal fistulas, tonsils and adenoids or any operation that is considered “elective” rather than required

An additional option is private Mexican health insurance

Mexico has excellent private insurance companies, just like U.S. companies, though the costs are significantly less. Often times these companies are located on the hospital grounds. The rates vary, depending on your age and preexisting conditions. Note you cannot apply for a new private health insurance policy after your 65^th birthday. For more information contact informacion@gnp.com.mx or visit their website www.gnp.com.mx (Spanish only)

So what’s the bottom line?

In conclusion, one of the reasons Mexico always ranks high as a destination for people to retire, is their high quality health care system as well as their opt-in national insurance plan, IMSS. Most of the doctors and dentists have received at least part of their training in the U.S. or Europe and many go there for continued training. Also many U.S. and European Doctors train in Mexico, especially Guadalajara.

Most large to midsize cities have excellent hospitals. And one huge plus is that healthcare costs are at least half of what they are in the US and prescription drugs, manufactured in Mexico are about 50% less than the exact same drug found in the U.S.

It seems most expats, when they are sick,  pay for out of pocket to visit a private doctor. They use the IMSS for major illnesses or accidents and or they carry an International Health Insurance Policy. List of International Health Insurance Companies. To be safe, I would carry an international insurance policy and have the IMSS for back up. If you find the IMSS to adequate for your needs, then drop the International policy. Though if you want the option to be airlifted back to the US for any medical emergency then you can carry insunace for emergency medi-vac.