Step aside Starbucks...

There is an up and coming purveyor of fine coffee in Mexico - Cielito Querido, a Mexico City upstart with a vision for future expansion to other cities in Mexico and the United States. As if to say to Starbucks, don't think you can best our heritage of world class coffee, they print a bold snub on their to-go cups that says "Aquí, le decimos chico, no alto." Here, we say small, not tall." (Thanks for the translation correction, Theresa.)  Their motto is "not on every corner, but in every neighborhood." Mérida is not mentioned in their list of expansion sites, although Cancun and Puebla are slated. Cancun... that resort city where droves swoop in to get sloshed on Margaritas and fry their bodies in the Caribbean sun.With prices running higher than Starbucks for a standard cup of coffee, I suppose they see Cancun as a safer bet. I'm not sure why I'm disappointed that our fair city is not on the list. There are plenty of places for a great expresso. The wonderful Cafe La bohème is an easy walk from our house and Ki' Xocolatl is just  a short stroll to the central plaza area. Any number of restaurants serve a decent cup of post dinner coffee or expresso. Or an invite to dine at home with these guys, who have a monster expresso machine in their kitchen! And, in a pinch, well... there's always Starbucks.

*Top Ten Reasons to Move to Mérida...

10.  US Politics

 9.   US Politics

 8.   US Politics

 7.   US Politics

 6.   US Politics

 5.   US Politics

 4.   US Politics

 3.   US Politics

 2.   US Politics    and (drum roll)...

 1.   Mérida,Yucatán is Awesome!


*I would like to say that this will be my last political rant but, sadly, I'm not making any promises.

Nobody Wants to Talk About This... part II

Searching the internet for international health insurance is a bit like surfing for hotel accommodations. The options are numerous, depending on what you want -budget, moderate, better or deluxe- though it's far more complex and confusing than simply choosing between a room with a basic mattress and low thread count sheets and a luxurious room with pillow-top mattress and 600-count Egyptian cotton linens.

A few of the insurance company names we recognize from the USA, such as Cigna and MetLife, offer policies for expatriates in foreign countries. There are options to include or exclude coverage in the United States, with rates considerably lower if choosing the latter. This makes sense as we have the highest health care costs in the world. There are companies based in Europe and Asia that offer various plans and rates, from basic emergency coverage at reasonable rates to executive plans with full coverage, low deductibles and high premiums.

One of the more popular companies, recommended by Yucatan Living, is International Medical Group (IMG).  They also have a link to a specific agent, with whom they are 'loosely affiliated' and disclose that they receive a commission when purchasing through this link. I received an online quote from this agent that cost almost as much as private health insurance in the United States.  Going directly to the IMG website, I received a quote that was considerably less. Deductibles range from $250.00 to $10,000.00 and the premiums decrease substantially at the higher deductibles. IMG appears to have a solid reputation in the expat travel and medical insurance field.

Another source is Healthcare International, located in the United Kingdom, which has plans ranging from 'Healthcare Emergency Plus' with a maximum annual treatment benefit of $500,000 USD, to the 'Healthcare Executive' plan with an annual maximum of $2,000,000 USD. I requested an online quote for the least expensive plan with a $2000 USD deductible. I was quite surprised to receive a quote of $1,174.18 USD annual premium. This is the least expensive rate, by far, of all the other sources and is about what I would pay per month for a private insurance in the US. This is a basic plan that covers pretty much everything, while in the hospital, at 100% of the cost (up to $500,000 USD, which would be a whole bunch of Mexican pesos). It does not cover annual health checks, vaccinations, or outpatient diagnostics or prescriptions. For women of child-bearing age, it does not cover normal pregnancy and childbirth or complications of pregnancy and childbirth. It does cover 100% of the costs of emergency medical evacuation and medical repatriation, and up to $3000.00 for repatriation of mortal remains. This policy is worldwide, excluding USA.

There are many other choices for expatriate medical insurance that one can check out by simply  Googling 'international medical insurance'. Word of warning: If you provide an email address, which some companies require to receive an online quote, you will receive a phone call or email follow up which you can ignore if not interested. These people are like carnival hawkers for insurance companies.

Another option, and perhaps the best, is to find a local insurance agent in Mérida and purchase locally.
I have no idea what rates are like, but I've heard that they are reasonable. The Healthcare International policy might be a good choice for a year, to have coverage while en route through Mexico and until there is time to research, in person, what is available in Mérida. That would at least grant some peace of mind to the not necessarily paranoid but cautious expat like me.

Nobody Wants to Talk About This... part I

I do. Health care and medical insurance in Mexico.  There are numerous sites and blogs where everyone speaks glowingly of the excellent and inexpensive care they have received from physicians and hospitals throughout Mexico. And we know that there is a burgeoning medical tourism industry for those wanting decent treatment at a fraction of the cost they would pay in the United States. Think dental care and plastic surgery. I've heard reports of an entire mouth full of crowns for about the cost of a root canal and crown that one would pay NOB. I've heard of people ending up in the Emergency Room with a broken arm or leg, and marveling at the kind treatment received and how they simply paid the reasonable cost in cash or credit card at the time of discharge. What I haven't heard is the story of an expat who has had the misfortune of a catastrophic illness while living in Mexico with, or without, major medical health insurance. I suspect that those younger expats, in their twenties, thirties or early forties, don't worry terribly about such things. Those of us closer to full retirement age just might be a bit more concerned about the what-ifs. Having spent a lifetime in the health care industry and seeing first hand the horrors that can occur in the blink of an eye - a car crash that requires multiple surgeries and days in an intensive care unit, or a stroke that will require weeks or months of rehabilitation - I think about these things.

In the United States, those with good insurance are lucky and those with no insurance cannot be denied treatment. Hospitals routinely write off millions of dollars in unpaid medical bills by those who simply do not have the means to pay tens of thousands, much less a hundred thousand dollars for the first rate yet costly care they received. I read somewhere that in Mexico an expat must pay the entire cost of treatment before they are allowed to leave the hospital. Paying for the cost of a broken limb, or a bout of colitis and dehydration, or an emergency appendectomy would not be so bad. Perhaps a few thousand dollars or less? A 2005 study from Ohio State University Hospital cited the cost of the first day in ICU with mechanical ventilation to be $10,794.00. Without mechanical ventilation the cost was around $7000.00. That's just the first day and ICU stays can last from a few days to weeks. The study is also 8 years old and you all know the cost of health care goes up, not down, each year.  I'm not sure about the cost of an intensive care stay in a Mexican hospital, but I found one international major medical insurance policy that paid up to $1500.00 per day. This means that it will likely cost more than that as most insurance does not cover the entire cost of a hospital stay. There is usually a co-insurance charge of up to 20%. Throw in a surgery, x-rays, CAT scan or MRI and the cost goes up from there.

I think the question for many expats is whether to risk paying for medical treatment up front and hope that the out of pocket costs don't wipe out our savings or to enroll in a decent international major medical plan that will cost several hundred dollars a year, depending on your age,  or a few thousand a year if you are approaching retirement age.

The other option is to enroll in IMSS, Mexico's free (socialized?) health care. Actually, it's not free, but the annual cost for coverage is around $300.00. I'm amazed that Mexico even allows foreigners to participate at such a low cost, especially when most expats are paying very low taxes or none at all to the federal government.

More on our options in part II...