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Seguro Popular and Preexisting Conditions

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TOELSNER
6/29/2017 16:14 EST

Does anybody have experience with Seguro Popular and preexisting conditions? Earlier this month I had a successful abdominal aortic aneurysm repair but I am concerned that I will not be able to successfully get SP because of this surgery.

On the other hand, would it be possible to get SP with the specific exclusion for this condition? I had a custom designed stent put in that should last for at least 10 years so the only thing I will need are yearly CT or ultrasound tests.

Unfortunately I will only turn 63 in December so I am still 2 years out for Medicare.

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MonicaRixPaxson
6/29/2017 17:06 EST

Seguro Popular doesn't eliminate on the basis of pre-existing conditions (nor age). (With IMSS there are delays in coverage.) SP has no exclusions like that. They will interview you for financial information (basic questions like whether you rent or own, have a refrigerator or whether your floors are tile or dirt, etc.) but by USA and Canadian standards, the annual payment will be very modest. Also, there are equally modest charges for some surgeries or treatments. Where it may fall short for some people is that the coverage is not comprehensive. Covered treatments and medications are based on an extensive and growing menu design to provide the most needed treatments for the most people. But there are sometimes conditions that fall outside of their menu (dialysis for example). People often tell me that it covered everything for them. But if you are the exception, I think you need to know that there is a small the one thing you need isn't on the menu. So, if you feel that it is likely that you may have to deal with complications from your abdominal repair, you may want to inquire during your enrollment process or review the menu to see if likely procedures are included, but the condition itself will not be excluded.
There are other things you will want to know about public care in Mexico that expats frequently do not anticipate: wards vs. private rooms, no tv, no phones, no pillows, no call buttons. The list goes on. So, while typically the medical treatment is good to excellent, you should learn about the differences in the culture and how treatment is delivered. With Seguro Popular and IMSS, these are often the critical factors in whether public care is going to work for you or not and not so much the money, etc. Location makes a difference too in the age of the facilities and how burdened they are with patients. —Monica Rix Paxson, medical researcher and author, https://www.amazon.com/English-Speakers-Guide-Medical-Mexico-ebook/dp/B06XRG93J4/

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Retiree2
6/29/2017 17:57 EST

IMSS will exclude you from joining for some chronic diseases. They have a 6 month, 1 year , 2 year and 3 year waiting period on other chronic diseases and treatments and operations needed, It depends on what condition you are in when applying.


From the IMSS website:

Exclusions to join,

Google Translation:

"• not subject to insurance people who have: malignant tumors, chronic degenerative diseases (late complications of diabetes mellitus), diseases: Hoarding (Gaucher disease), chronic liver disease, kidney failure: • Some pre-existing, such as illness chronic valvular heart disease, heart failure, sequelae of ischemic heart disease (arrhythmia, angina or myocardial infarction), chronic obstructive pulmonary disease with respiratory failure, among others
• chronic systemic connective tissue diseases, addictions like alcoholism and other substance abuse, mental disorders such as psychosis and dementia; congenital and acquired immunodeficiency syndrome or Human Immunodeficiency Virus positive of diseases (HIV)"

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TOELSNER
6/29/2017 18:15 EST

Thanks, Monica. This helps. But I am also reading horror stories about people who are expected to pay for emergency room visits before they can be treated for events that required them to go to the ER. Do people handle this with private insurance policies?

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MonicaRixPaxson
6/29/2017 18:52 EST

It is very hard to say what's going on without digging deeper. I'd be interested in knowing more about horror stories because it is important for me to understand what's happening in order to help people stay off the rock. But without details it is hard to know if the problem was the result of basic misunderstanding (thinking that the private hospital was actually a public hospital) or thievery, or that the care that was needed wasn't on Seguro Popular's menu of covered procedures, or what was going on. So please point them my direction. I'd love to know more.

You ask if people handle this with private insurance policies? Yes and no. No, in the sense that few hospitals in Mexico accept an assignment of benefits. So if you are at a private hospital, expect to pay out of pocket and then file a claim against your insurance. (There are some tricks to reducing the likelihood that you don't become some back-office manager's cash cow, so don't be quick to give over your credit information.)

For Mexicans, this is just a fact of life and the whole family may be called on to pitch in a share to bail grandma out of the hospital. Yes, there probably are a few that do take assignments and will file the claim for you (American hospitals are a likely bet), but you are going to need to visit before you need care and discover this in advance. I recommend that you actually go to your local hospitals and ask if they take insurance, what kind they take and if they bill the insurance company.

It is pretty easy to be part of a horror story simply because you made assumptions based on your experience elsewhere. It is quite different here. That's why I wrote the book. :) —Monica Rix Paxson, medical researcher and author, https://www.amazon.com/gp/product/B06XRG93J4/

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expattobe26
2/11/2018 19:55 EST

Can you get coverage in Mexico's national health insurance program if you are HIV positive? What about coverage of HIV medications?

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MonicaRixPaxson
2/11/2018 23:00 EST

Seguro Popular will cover pre-existing conditions including HIV. Some medications are covered, but not all. I can't recall the names of the meds, but included that information in my book. I think getting meds reliably shipped could be a problem, but typically getting the Mexican version isn't. However, it may be found under a different trade name. There is also a chapter on finding your medicine in Mexico that may be helpful if there is something that you need that Seguro Popular doesn't provide. In any case, I think that you'll get the care you need in Mexico either for free or at an affordable price. —Monica Rix Paxson, medical researcher and author, https://www.amazon.com/English-Speakers-Guide-Medical-Mexico-ebook/dp/B06XRG93J4/

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kentcoguy00
2/11/2018 23:13 EST

The most popular HIV med here is Atripla......a cocktail that is quite effective and is no charge if you have Seguro Popular........

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kentcoguy00
2/11/2018 23:16 EST

I came to Mexico 2 years ago with a history of a ruptured brain aneurysm and 2 heart attacks....my doctor (who is GREAT) found Mexican equivalents for all my meds....there is no charge through Seguro Popular......and if I need to purchase them, Walmart is very inexpensive........

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expattobe26
2/12/2018 00:06 EST

Thank you. I am still stunned by this good news about getting health coverage with HIV, including meds. It seems too good to be true.

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larryoinpdx
2/12/2018 14:14 EST

Hi Monica - I will buy the book when I get my next SS check - my spouse asked if there was an age limit on Segura Popular. Thanks in advance.

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larryoinpdx
2/12/2018 14:17 EST

Please forgive my inattention to detail - I just read the whole post, and Monica answered my question before it was asked.

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MonicaRixPaxson
2/12/2018 14:48 EST

I believe the age limit is 150 years. Just kidding! No age limit with Seguro Popular. —Monica Rix Paxson, medical researcher and author, https://www.amazon.com/English-Speakers-Guide-Medical-Mexico-ebook/dp/B06XRG93J4/

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Rodrigo1974
2/13/2018 13:57 EST

let me be brutally frank,if you'd be so kind. i myself and several upper middle classed mexicans whom i am friends with wouldn't rely on the social security medical coverage. you need some sort of expatriot medical coverage that will cover you immediately upon entering a hospital with a life threatening event, period. you need to investigate and get the answer to this question. i can tell you horror stories, but it's too time consuming. you get the point, i hope. promising but not delivering is all too common here. i can tell you about a gentleman down in the yucatan who was fighting for his life but because he had a quality expatriot medical insurance plan, was able to convince someone with the company to fly a medical helicopter to him and to save his life in the process! you can never be too careful. social security is a last resort, not even as good as medicaid in the u.s.a.

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expattobe26
2/13/2018 15:09 EST

I understand. I believe for most Americans that the advantage to using Seguro is for prescription drugs. You can't have medications sent to you in Mexico from the U.S. You have to go to the states about every 3 months.

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MonicaRixPaxson
2/13/2018 22:16 EST

I agree entirely that public medical solutions in Mexico are not for everyone. I think a lot depends on one's personal economy, expectations, and location. Rodrigo1947 is right that most upper-middle-class Mexicans would avoid public medical care in the same way that they would not typically use the Metro in Mexico City. They can afford better solutions and Mexico certainly has those. But there is much to consider here and it is difficult to speak in generalities since those considering Mexico may come with very modest incomes, or with sufficient money to pay out-of-pocket for private care.
Personally, I favor what I call blended solutions that typically involve two or more forms of coverage. One of those could either be Medicare or Major Medical through private commercial insurance (with evacuation insurance). Or for others with good local service that might be IMSS or Seguro Popular as the fall back coverage, I try to outline the pros and cons of many solutions, but I do warn people that although public solutions are in Mexico is nearly universally available, and Serguro Popular will cover pre-existing conditions and doesn't have age limits and medications are free or nearly so, people need to be aware that the realities may not meet their expectations. I've heard both bitter complaints and rave reviews about public healthcare in Mexico. The only real solution is to gain as much knowledge as you can and make the best decision for your circumstances. —Monica Rix Paxson, medical researcher and author, https://www.amazon.com/English-Speakers-Guide-Medical-Mexico-ebook/dp/B06XRG93J4/

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inky313
2/13/2018 23:45 EST

in my experience Seguro Popular is more used as a more of a back up plan in the event of a major unexpected issue. Most of the people I know just pay out pocket for minor, or even major stuff.

A visit to a Dr. for minor stuff costs under $3.00, a specialist around 30 to. 100 and once I had a 4 hour surgery and 10 days in a hospital, total bill was under 6 grand. This was a private smaller hospital, it would have been double in the fancier bigger places with more english spoken. Keep in mind you HAVE to pay in full before they release you so make sure to have funds available for emergencies.

If all you are concerned about is getting your scripts filled just bring copies of your old ones down, make a drs appt. to find out what drugs are available and how much they will cost.

It is good advice to buy some sort of travellers insurance for the first few months until you get settled just to make sure you are covered until you get your residency visa.

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kikipt
2/14/2018 00:12 EST

I know people who are HIV positive who use Seguro Popular. The waits at the clinics can be long, and it is not always convenient, but it is very affordable, and they get all the meds they need without being bankrupted.

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kikipt
2/14/2018 00:21 EST

For every horror story I have heard about socialized medicine in Mexico, I have also heard one or more stories of people whose lives were saved by the system, often with conditions that would not be treated in the US because of insurance company policies or denials. I know of people who were treated for life-threatening emergencies by Seguro Popular free of charge. The system is far from perfect, but there are more plusses here than I see with the system in the US, which is prohibitively expensive, profit driven, prone to accidents, addictions, etc. It is true that wealthy Mexicans prefer to use private or even foreign medical options, but this is just as often a matter of snobbery. Those same people will fly to Miami to pick out a wedding dress when they could get the same gowns here in Mérida for less money. It says more about class consciousness than anything else. It should be pointed out that the doctors we have encountered here actually listen attentively and patiently to their patients and most still make house calls. When was the last time you saw that in the US?

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expattobe26
2/14/2018 05:53 EST

Thanks. For me, it will be a matter of getting medications in Mexico that would still be too expensive to pay for out of pocket. I plan to keep Medicare in the U.S. and use the prescription drug coverage when possible -- but that probably won't be a regular alternative. In addition, due to having HIV my insurance options beyond Seguro are limited.

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expattobe26
2/14/2018 05:59 EST

A question for everyone on this thread. Do SP facilities and service tend to be better in locations where there are large numbers of expats, in large cities?

This is an unpleasant question to ask because of the implications for people with few options. The ugly reality is that in many countries around the world (U.S. included) is that people with more have better services even with universal health care services.

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MonicaRixPaxson
2/14/2018 13:07 EST

Mexico has made every effort to fulfill their promise of universal healthcare. The amount of money invested in new hospitals and clinics for the public system and the speed they are building has been very impressive. Nevertheless, officials have to make choices about where to build and it is typically where it will serve the most people. So there is no intention to underserve people in rural areas, but rather to serve as many Mexicans as possible. To the extent that expats are in cities, they will find more IMSS and Seguro Popular facilities. In less populated areas there are likely to be clinics or smaller hospitals that may not be full-service (maternity hospitals for example). There are also programs where doctors and nurses visit rural areas on a regular basis to provide essential care such as prenatal, pediatric visits and vaccinations, breast exams, and so on. Personally, I use the public system and I am one who can say that Seguro Popular has indeed saved my life twice by giving me antivenom when I reacted to scorpion stings. I was not charged anything for medicines that would literally have cost tens of thousands in the USA. I agree that one of the reasons that some middle-class Mexicans scorn public medicine is simply a matter or snobbishness and that is going to be true for some expats as well. But you can't browbeat people into being grateful for a public medical system that offers so much to so many. So, I favor getting an education about what's available and make choices in keeping with your personal values and budget. —Monica Rix Paxson, medical researcher and author, https://www.amazon.com/English-Speakers-Guide-Medical-Mexico-ebook/dp/B06XRG93J4/

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Dharmagranny
2/14/2018 13:18 EST

MonicaRixPaxson, I give your last message a two thumbs up. The Seguro Popular has saved me thousands ovr the cost of using private hospitals, and the care has been the same or better. The only caution I have for people using SP or IMSS is that you really need to speak Spanish or bring a bilingual friend with you for office visits and tests, but many of the staff in urban areas (such as Puerto Vallarta) speak very good or adequate English.

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expattobe26
2/14/2018 14:18 EST

Huge thanks to you and Monica.

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