Thursday, May 2, 2013

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...


  1. This is a great topic! You're right -- many expats enroll in IMSS (the federally subsidized workers insurance) or Seguro Popular (the federally subsidized insurance for the poor), as they are legally allowed to do. Unfortunately, these programs are overenrolled and underfunded. I have a hard time justifying adding to the pressure on an already overextended system. Talk to those Mexicans who have no other health care options about the waits for appointments, waits for regular care, waits and postponements for surgery or special tests, lack of available medicines, and one starts feeling pretty uncomfortable about the ethics of enrolling in the system, even though it is legal to do so.
    You're also absolutely right about the requirements for paying for private care before leaving the hospital -- for that reason, it's a very good idea to have enough money rapidly available in Mexico (through Mexican banks or investments) for such emergencies. You can pay most hospital bills with credit cards, but doctors almost always require cash payments. Even if you have health insurance that will later reimburse you, you will need to pay upfront for services. Or, of course, be sure that you have health insurance with a company with a local agent.
    I'm sometimes surprised (and disconcerted) to hear people talk about their remodeled homes, their trips abroad or regular vacations, and how they use the (almost) free IMSS health care services. But perhaps I'm in the minority for feeling this way....

  2. When we were in Merida in December, we made the trek out to Star Medica to discuss health insurance as they have several kiosks where representatives sit. However we were not able to see the rep from Star Medica as he was on vacation. Carlos talked to the other companies rep and it was surprisingly reasonable. This December when we are back we will go earlier in the month to talk to both. We are thinking that an IMSS enrollment as well as a catastrophic policy may make sense for us! Eagerly awaiting Part II!

  3. It's complicated but when you come back, ask around, there are plenty of people who have ended up in ICU. The stories vary, but no way did they pay what you do NOB.

    A normal stay in Clinica de Merida is around $1000mxn a day for a private room if I remember correctly.


  4. Interesting blog post. I look forward to reading part 2.