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Health Care for retired couple

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Mtvsolis
3/24/2016 13:26 EST

Hola a todos,
Does anyone www.CignaGlobal.com as health care? I just read their brochre and find the premiums for retired couple VERYhigh.

If not, please share how yiu do health care if yiu havent already. Getting well informed from yiur posts, gracias!

waltermboyles
3/24/2016 16:14 EST

We, too, found Cigna too high. But the longer we all wait to join the insurance pool, the higher the rates will be when we need it.
Here only 10 months, male 78 & female 63, fairly healthy, we are winging it.
The word on the streets is that public hospitals (rough edges, plain meals, flies, & all) are the best care, except maybe for V Pellas Hospital, which costs an arm & a leg, Gringo-style...testing for EVERYthing. Maybe that is better.
Self-insured, we pay $20 & less for an office visit, & are very happy with the attention & care we have gotten.
H2O 212F

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iguanalover
3/24/2016 16:41 EST

We don't have any insurance. Keep in mind that the system is very different here. A couple good things are that most drugs are over the counter, except narcotics which need a prescription and labs are self-standing, not attached to doctors so you can walk in and get tested. You get the results and take the letter to the farmacia and get your meds if needed. We both take one prescription drug and pay about 20% of what it would cost in the states.

We stay away from Vivian Pellas which is going on the US model and almost the same prices. There are plenty of alternatives.
Lots of people are going to the Nica health centers and hospitals with good results. Most of the doctors are Cuban trained and well liked. We are responsible for our own health and like it that way.

elduendegrande
3/24/2016 17:55 EST

there are many private hospitals that are better than the public ones, including baptist and integral. You pay cash, about 25% of US prices, but anything chronic or serious you should probably go home and hope you can get on some plan in time.

My experience with the VA is that they are good for free meds and annual blood work, but for serious medical care they are no up to Nicaraguan standards. Nicaragua's third-world doctors are much better than the VA's third-world doctors! Sign up for VA before you hit 65 to avoid being fined by obamacare part D.

KeyWestPirate
3/24/2016 18:47 EST

Why not sign up for a Medicare Advantage plan?

Mine costs me nothing except for modest co pays when I actually use it. I've been very satisfied.

Some Advantage plans have monthly premiums in high cost areas, but the last two places I've lived, Boise and Tucson,, there has been no monthly cost.

I'm very healthy, but the day will surely come when I have something that requires more than Nicaragua offers.

I've seen friends well treated by the Nicaragua system, and for free, but also watching a Nicaraguan friend with throat cancer fighting for an operation that will save his life. Access to diagnostic imaging is very limited for people using the national health system, there is a lot of guessing on the part of the doctors.
The capacity is there, and prices are a fraction of the cost in the US, but the Nicaraguan healthcare system doesn't have the budget for it

You don't want to be in that boat in Nicaragua (my friend with throat cancer).

novato1953
3/24/2016 23:37 EST

Until you get really sick, you rarely need first world health care. But after you get really sick, you don't want to be forced to settle for third world health care. It's a conundrum, especially if you don't how to say "heart attack" in Spanish.

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dturoff
3/25/2016 07:32 EST

If you are us citizen, and qualify for medicare:
1) establish plausible residency in Houston or Atlanta
2) get a Medicare Advantage policy (very low cost)
3) buy medical evacuation insurance (about $400/yr)
4) pay directly to be treated for minor stuff in Nica; get evacuated to US if something major

mate31658649
3/25/2016 10:10 EST

dturoff advise is excellent. For anything that isn't serious, go to a Nicaraguan doctor and pay the modest cost. For anything major, go to the states and use your medicare and medicare advantage plan.

timwood202000
3/25/2016 10:15 EST

What hospital are you referring to that has mostly Cuban trained doctors at a public hospital??

Tim Sewell www.NuevaVidaNicaragua.com

Mtvsolis
3/25/2016 16:28 EST

Thanks to all who replied. Looking into Medicare for USA citizen soon to retire in Nicaragua! I'm only 63!

Mtvsolis
3/25/2016 16:33 EST

Hello
Yes US citizens. Why Houston or Atlanta? We live in Los Angeles. Looking into Medicare Advantage
Thank you !

dturoff
3/25/2016 17:15 EST

Only because IAH and ATL are cheap, direct flights from MGA; anywhere would work, but in a medical emergency where time mattered, shorter flight time is better.

Also, the medical evacuation insurance policy I buy, goes only there without extra charge.

atz111
3/25/2016 17:55 EST

I think medical care/insurance her is least black and white issue on here. A lot depends on how much risk you are willing to take when it comes to dealing with a major medical event...both from your analysis of the care you would receive and the cost you can bear. On the first.....yep medical care here is pretty good and for most things...even a simple fracture or appendacitus you can get decent care here. free or very low cost and drugs are generally cheap as well. All his is not as great as some people make it sound. Some of the drugs are not all that cheap and if you had a plan you would save money. On the other hand if you need some specialized chemo or cardio drug for 5K a month....that you will not get here...so comes to how much risk. Same for some big time medical problem....again you hear about the great docs here but with a dire problem you are much better off in the USA....again risk.

The suggestion to keep the supplemental insurance part of Medicare if you are 65 or over is great advice. For me used to be 50 bucks a month and now 120...but IMO is money well spent. Simple stuff...do it here for 100 bucks. Serious stuff...get back and get treated. you need to read the fine print as some policies require you to be in USA 6 months or more per year. Not sure how hard they would check. You need a hard address so have a relative or something to establish your residency somep[ace which is as much about people not shopping states for the best (cheapest) policies as It is living abroad.

KeyWestPirate
3/25/2016 19:20 EST

Good point about the closeness of the arrival airport, but in fact, most plans allow you to be treated anywhere in an emergency. My old Humana Advantage plan from Boise allowed me $25K emergency care OUTSIDE of the country.

I had to pay up front of course, and submit receipts for reimbursement.

I like the emergency evacuation idea, but question how long it's going to take to get a plane down there ??

In terms of residency for insurance qualification, I suspect a driver's license, voter registration, an address (relative,, great, if not a quality mail service you can trust), and a phone number.

You can have the phone number of your choice for $35 year with Magic Jack.

Establishing a solid relationship with your primary care physician (PCP) is crucial. Once that relationship is in place, a phone call is all you need,, from Nicaragua, to make an appointment, to get referrals to specialists. With a long enough lead time,, you could get a lot of medical work packed into a couple of weeks.

Take your MagicJack along, and your telephone number travels with you.

atz111
3/25/2016 19:38 EST

The USA address/insurance is relatively easy to work around. I guess the issue is if you got into a big time cost thing and requirement was 6 months of the year in USA and that was not the case with you and they did a little checking they could decline. As I say, have to read the fine print as in some it clearly states that, others not. Mine is a bit ambigous and I surely do not want to bring it up as a question. And in any case, if you listed one like a PO box or mail service and they did homework on that would be the same thing with paying...I do not know if I am being too alarmist on that, but insurance companies are...well insurance companies. In my case, I went back several years ago for a big time heart check up (Nica doc said I was on deaths door and needed a "procedure") and it was really expensive...15K...and not a peep. I checked out fine. So that is one reason to have it....not all the care here is top notch. I do go back now and then and have a primary care doc I see once a year...good for the record and also physical. etc.

Emergency care is not an issue as mine covers anyplace with no limit if an emergency or"urgent care"...they define urgent cares as something that concerns you a lot and you think requires a doc to look at. Pretty nice deal.

Evac is the cream on that USA coverage. Mine is reasonable and evacs you anyplace you want to go, not just to the nearest hospital...so if you wait too long on that chest pain or have bad accident you can get back to States. How long the aircraft take to get there is not a real issue as to have to be stable to fly...this is not a medivac chopper out of a battle zone. Global Rescue is the company.

atz111
3/25/2016 19:38 EST

The USA address/insurance is relatively easy to work around. I guess the issue is if you got into a big time cost thing and requirement was 6 months of the year in USA and that was not the case with you and they did a little checking they could decline. As I say, have to read the fine print as in some it clearly states that, others not. Mine is a bit ambigous and I surely do not want to bring it up as a question. And in any case, if you listed one like a PO box or mail service and they did homework on that would be the same thing with paying...I do not know if I am being too alarmist on that, but insurance companies are...well insurance companies. In my case, I went back several years ago for a big time heart check up (Nica doc said I was on deaths door and needed a "procedure") and it was really expensive...15K...and not a peep. I checked out fine. So that is one reason to have it....not all the care here is top notch. I do go back now and then and have a primary care doc I see once a year...good for the record and also physical. etc.

Emergency care is not an issue as mine covers anyplace with no limit if an emergency or"urgent care"...they define urgent cares as something that concerns you a lot and you think requires a doc to look at. Pretty nice deal.

Evac is the cream on that USA coverage. Mine is reasonable and evacs you anyplace you want to go, not just to the nearest hospital...so if you wait too long on that chest pain or have bad accident you can get back to States. How long the aircraft take to get there is not a real issue as to have to be stable to fly...this is not a medivac chopper out of a battle zone. Global Rescue is the company.

atz111
3/25/2016 19:38 EST

The USA address/insurance is relatively easy to work around. I guess the issue is if you got into a big time cost thing and requirement was 6 months of the year in USA and that was not the case with you and they did a little checking they could decline. As I say, have to read the fine print as in some it clearly states that, others not. Mine is a bit ambigous and I surely do not want to bring it up as a question. And in any case, if you listed one like a PO box or mail service and they did homework on that would be the same thing with paying...I do not know if I am being too alarmist on that, but insurance companies are...well insurance companies. In my case, I went back several years ago for a big time heart check up (Nica doc said I was on deaths door and needed a "procedure") and it was really expensive...15K...and not a peep. I checked out fine. So that is one reason to have it....not all the care here is top notch. I do go back now and then and have a primary care doc I see once a year...good for the record and also physical. etc.

Emergency care is not an issue as mine covers anyplace with no limit if an emergency or"urgent care"...they define urgent cares as something that concerns you a lot and you think requires a doc to look at. Pretty nice deal.

Evac is the cream on that USA coverage. Mine is reasonable and evacs you anyplace you want to go, not just to the nearest hospital...so if you wait too long on that chest pain or have bad accident you can get back to States. How long the aircraft take to get there is not a real issue as to have to be stable to fly...this is not a medivac chopper out of a battle zone. Global Rescue is the company.

KeyWestPirate
3/25/2016 19:41 EST

Good solid advice from someone who's been there, thank you!

Mtvsolis
3/26/2016 00:08 EST

Now I understand! Gracias!

elduendegrande
3/26/2016 11:54 EST

Another reason to live in managua and get to know miami.
There are no medivac flights in Nic from the boonies to the capital.
Also, you may only apply for medicare B from within the uS and then it takes months to kick in but will be kept when you go abroad.

Ditto there are good docs and dentists in Nic, but there are also dogs. The good thing about paying cash is you choose your doc and are not stuck with HMO or VA deadbeats.

Choose wisely. I just went to my Nic dentist who said I needed a filling. I was up in the US shortly thereafter and went to my old dentist. She exrayed the tooth and said the decay was right next to the nerve and plan on a root canal and crown. I'l have it done in Nic for the cost, but I will find another dentist.

novato1953
3/26/2016 12:36 EST

On the flip side, so to speak, there's a credit card that pays to repatriate your body when you use the card to pay the airfare to get overseas in the first place, but only if you die after you clear immigration. Very 21st Century. This wasn't around in Ambrose Bierce's day, or we wouldn't have "The Old Gringo".

iguanalover
3/26/2016 17:26 EST

If you get Nica Nuggets look for an article on buying health insurance in Nicaragua. The gentleman who writes the newsletter and his wife just purchased policies. He stated that he would explain how and why they did it in another newsletter. There was talk among the expats about this and many reported that they are thinking about it because medical costs are going up. I was surprised by what expats said about rising costs. Some things have gone up over 100%.. It will be an interesting read.

atz111
3/26/2016 21:45 EST

The Nica Nuggets thing is not a good option at all unless people do not want to ever go back to USA for medical stuff. The high deductable policies like that one for "international" insurance (about the only ones affordable) do limit the $100,000 expense you might get in a serious illness but 5 or 10 k deductable is a hefty premium to pay for coverage. Consider the alternative...a medicare advantage plan in the USA...might be nothing or could be $150 bucks a month. covers drugs as well. The deductable is small...So for any big problem you go to states and get first class coverage that is paid for. OK...what about an emergency...well USA plans pay for emergency procedures not matter where you are, so you get that and again with a small deductable....mine is 200 bucks...they would pay thousands. Either way you still have to do the small stuff on your own unless it happens close to a trip home. But that is very manageable. all this nonsense about how expensive it is is balony. Yep, xrays have gone from 25 to 50 bucks...a docs visit is 25, not 15...setting a broken wrist is not 150...not 50. so more than in the good old days, but still very doable to pay out of pocket. Drugs are usuall not covered on the expat plans.....for routine stuff you buy here that is again not a problem as cheap for the most part. What if you need a specialized...1,000 a month ...drug....that is when the USA plan pays off again.

atz111
3/26/2016 21:45 EST

The Nica Nuggets thing is not a good option at all unless people do not want to ever go back to USA for medical stuff. The high deductable policies like that one for "international" insurance (about the only ones affordable) do limit the $100,000 expense you might get in a serious illness but 5 or 10 k deductable is a hefty premium to pay for coverage. Consider the alternative...a medicare advantage plan in the USA...might be nothing or could be $150 bucks a month. covers drugs as well. The deductable is small...So for any big problem you go to states and get first class coverage that is paid for. OK...what about an emergency...well USA plans pay for emergency procedures not matter where you are, so you get that and again with a small deductable....mine is 200 bucks...they would pay thousands. Either way you still have to do the small stuff on your own unless it happens close to a trip home. But that is very manageable. all this nonsense about how expensive it is is balony. Yep, xrays have gone from 25 to 50 bucks...a docs visit is 25, not 15...setting a broken wrist is not 150...not 50. so more than in the good old days, but still very doable to pay out of pocket. Drugs are usuall not covered on the expat plans.....for routine stuff you buy here that is again not a problem as cheap for the most part. What if you need a specialized...1,000 a month ...drug....that is when the USA plan pays off again.

cedelune
3/26/2016 22:20 EST

The blogger at Rewired and Retired in Nicaragua has a 2-parter on their own search for the best health insurance solution for them at:
https://retirenicaragua.wordpress.com/2015/11/04/part-one-lets-get-real-about-health-insurance-in-nicaragua/
and
https://retirenicaragua.wordpress.com/2015/11/12/part-two-lets-get-real-about-expat-health-insurance/
Well worth reading before making final decisions.

lucythecat
5/10/2016 14:16 EST

What do people do for health insurance if they are not 65 yet and can't get Medicare in the states yet?

atz111
5/10/2016 14:26 EST

A lot has been posted about this...many options and surely one size does not fit all. 1) There are expat policies...Cigna is a big one it seems. Expensive I hear. 2) Have a USA plan and have some residence there you can reasonably say is where you live. This is obviously for catastrophic stuff only as cannot go back to that locale for a sprained ankle. or even a broken one. But those policies cover emergency or urgent care anyplace...you pay at the treatment locale and they reimburse you after you submit claim. so, in essence you are covered. Some of these have restrictions on how long you van be out of the place of residence in a year..need to check that. 3) Depend on local health care which is inexpensive or free if you go to government facility. Risky. Much of the care here is good or very good and even at the pay for service hospitals the cost will be less than USA...not as cheap as it once was but you can get a broken leg repaired with all xrays, etc. for 500 bucks or less. But if something bad, you are likely in bad shape....not just because care might not be as good, but the charges do mount even in a cheap system and can you afford 20K for major procedure. it's one thing to say this would ave been 150k in USA and quite another to pay it out of pocket.

elduendegrande
5/11/2016 10:52 EST

Under 65?
Best bet, be independently wealthy. Other options:
1-buy an international policy
2- buy a nica policy
3- buy into the CR system if they are still available
4-buy a US policy
5-run bare and hope for the best.

A note on Nica policies- there are no laws forcing them to take bad risks, so you will be turned down for age and pre-existing conditions. Shop early and apply at more than one outfit.

Some friends (family of 3) in esteli have insurance thru Baptist Hospital in mga and seem to be happy with it.

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