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Medical insurance

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manzanas
1/1/2017 17:21 EST

Any recommendations? Yes google and I have a love hate relationship. I can see the ratings, but it doesn't tell me much on the processing time for claims, what exactly to expect when dealing with certain insurance companies.
Any of you that have purchased Expat Medical Insurance, or have a medical plan within Mexico would love to know how it worked for you.

Thank you!

MsAlex
1/1/2017 21:02 EST

I've written at least a couple of thousand words on this subject of health insurance on this Forum. So what I'm going to do is give you a few "cut and paste" samples. I've tried to fix the dollar amounts mentioned to more closely resemble current exchange rates. You can read through it and find the parts you're most interested in, or you can search for posts on this forum that have talked about medical insurance in the past.

What I've also recommended previously is that when you move to Mexico, take a look at the very best hospital you might go to (close to where you will live). Look for what insurance companies have offices IN that hospital. Pick one of them. (FYI: In Mexico the patient can't leave the hospital until the bill is paid in full. That's why insurance companies have a presence. They have to filter through and figure out what's covered, so that you're presented with what you owe.)


6/16/2014 10:41 EST (and updated)

Do you need truly "international" health insurance, or health insurance in Mexico (specifically).? Big difference. In Mexico, we have coverage with MetLife Mexico. MetLife provides all sorts of insurance coverage in the States -- but does not provide health insurance in the US. In Mexico, In Mexico MetLife is very big, and the company has offices inside virtually all the larger hospitals (all I've seen, which is several). They have offices there so they can serve their clients when they are hospitalized. (In Mexico, you cannot check out of the hospital until the bill has been paid, which is why it is good that they are there, on site!)

The thing about medical insurance in Mexico is that it gets more expensive as you age. We bought our policy 7 1/2 years ago, when my husband had just turned 60 and I was 55. At that time it cost something over $2000 US per annum. The yearly charge goes up between 12 and 15 per cent each year.

[Here's an edit: We paid about $4,500 in 2016, with an exchange rate at the time of 18 pesos to the dollar. As I said, it is now closer to 20 pesos to the dollar.]

Obviously this is a whole lot cheaper than coverage in the US, but the key is the fact that we bought the policy when we were that young. If you come into the system at an older age, I am sure the policy will cost more. 

The way that policies in Mexico work is also different than the typical structure in the US. In Mexico, you pay a one-time deductible per DIAGNOSIS (not per year). If the problem is due to an accident, the deductible is only 500 pesos (now about $250 US) -- and believe it or not, your doctor can write up virtually anything to qualify as an "accident". (My husband went in for hernia surgery, which we presumed was no "accident". Our agent however told us that had my husband had the surgery within 30 days of the diagnosis, he would have been able to cover the surgery as an "accident" -- so they obviously have some different practical definitions of what constitutes an accident!) The deductible for a diagnosis that is not an accident is 10,000 pesos ($800 US).

My husband experienced a chronic illness in the first year we moved to Mexico. That illness is now covered with no further deductible as long as we have that policy. (What would have been the cost of medications for him alone, is more than the cost of the policy for us, so obviously it has been a great deal.)

Absolutely essential to getting reimbursed in Mexico: You absolutely MUST have a formal receipt called a FACTURA for either drugs or any medical service. For prescription drugs, you have to have the Factura emailed to you (a new rule as of this year), plus you must have the register receipt. Not getting Facturas is the #1 reason anyone would have trouble with this system. This is a must.

Also, FYI, the MetLife policy gives us emergency travel coverage for up to 2 months at a time traveling outside of Mexico. This includes travel to the US, but note that it is only for life-threatening situations, car accidents, etc. and it is only if you have been outside of Mexico for less than 2 months.

If anyone wants a reference to our terrific MetLife agent in Guadalajara, who works directly for MetLife -- not an "agency" -- please contact me directly, but be advised that he does not speak English. (I speak Spanish with him.) I know that various agencies have English speaking representatives however. I'm sure you can find one.

Just as MetLife has processing offices in hospitals, the other company I've found to have such offices is Seguros Monterey. I believe Cigna is also here, but I haven't seen them in as many hospitals.

Another alternative is to buy catastrophic coverage in Mexico. One company which offers this is Boomer's Insurance, which offers an insurance product through a company called Best Doctors. While many are happy with this policy, just one word of caution about this one: Because they are not a Mexican corporation, if you wanted to sue them for any reason for their services in Mexico, my understanding is that you wouldn't be able to. This situation may have changed, or may change in the future, so please do your own due-diligence.

Other than getting the catastrophic-only coverage for Mexico, what many, MANY, MANY expats do is "self insure" for their needs in Mexico, and plan to go north to use Medicare, should something serious arise. Medical services are so cheap here compared to the States, it becomes obvious as to why people do this. For example, a typical price for an appointment with a top specialist in a metropolitan area is 500 pesos ($25 US), sometimes 600 pesos ($30). Your "local doctor"/GP outside the big city is typically 200 to 300 pesos ($10 to $15 US). Hospital stays are likewise MUCH lower than in the US. (prices adjusted for current exchange rate 1/2027)

Some people who pay such costs directly, feel more comfortable to also have a special medical air-evacuation policy. My opinion about that is that such policies are expensive and provide a false sense of security. I'd like to know the statistics on what percentage of policies are ever used. I bet it is infinitesimal: They won't fly you to a hospital in the US unless your situation is "critical enough" -- but hey -- what are the chances that if you're "that critical" you might not be better off to stay in Mexico in your delicate condition? And the policy doesn't pay anything unless all the planets have aligned: You must be critical enough to qualify for medical air-evacuation, but not too critical whereby the time to fly there and the delicacy of your condition would make it unadvisable. 

Borne out by our personal experience: absolutely top-notch medical care IS available in Mexico, particularly in the larger cities. As long as we have coverage here in Mexico, we have no qualms whatsoever in getting our medical care here.

Alex

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manzanas
1/1/2017 21:12 EST

Alex, Really appreciate it! Thank you, will definitely take your adivise on checking the local hospital.

:-)

MsAlex
1/1/2017 23:04 EST

There was a typo in my last post in this thread when I spoke of what the deductible is for an accident. I said that it was 500 pesos. That amount is now close to $25USD. (In the post it says $250. Big difference.)

Happy New Year everybody,

Alex

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