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...

Speaking of Changes...

Word has it that the Paseo de Montejo is scheduled for a facelift. The Champs- Élysées of the Yucatán is soon to see a few miles of newly paved streets and other enhancements. This information comes from two reliable sources, a successful business owner a few doors down from the Remate and our über knowledgeable, reliable and Spanish teaching taxi driver, Juan Ortiz. We also noticed a building we had not seen before - a tall, sleek black stone and glass office-like structure that is a drastic departure from the typical architecture seen on the Paseo. I regret not snapping a photo, but to be honest, neither of us took our cameras out of the bag the entire time we were in Mérida. I think it is perfectly fine to incorporate a bit of modernity into an otherwise architecturally significant historical district. For example, in Norfolk, Virginia there is an attempt to make every new building look as if it has been here for 150 years -red brick, fluted columns, fake pediments. It ends up looking drab and boring and rather than complimenting the historical structures, dilutes the entire block into an uninspired landscape. The problem here, I think, is a long standing and rather staid architectural review board. Mérida must surely have a similar process to review architectural designs, particularly in the historical districts. Let's hope they exercise a restrained, yet creative vision for this lovely boulevard.

A Garage Sale in Mérida ...

We've been gradually eliminating some of the furniture we inherited (purchased) with Casa de las Lechuzas and replacing with pieces more in line with our tastes.  At times we have thought that we wanted to move to a more contemporary look after over 30 years of living in a house full of antiques and traditional furniture, but we always end up being drawn to the traditional.The previous owners of our home did an admirable job of decorating, using modern pieces and interspersing with a couple of antique painted and decorated Chinese cabinets. Their art works, which were mostly abstract or modern, did not remain with the house. About the only personal belongings we will bring to Mérida are some of our paintings. For that reason we have purchased very little art for the house. Other than a wonderful oil on canvas by a Cuban artist purchased at SoHo Galleries, there are a few inexpensive prints currently adorning our walls.

This trip we wanted to get some comfortable furniture for the studio/media room, but before having it delivered we needed to eliminate two rather large ultra-suede corner chaise lounges. Enter Yucatán Online Garage Sale, a Facebook site originated by TheYucatán Times. I took some quick photos, logged in to the site and easily posted the items for sale. Within less than an hour I was messaged by a potential buyer, who dropped by to see the furniture, paid cash on the spot and returned the next morning to pick up. I have, at various times, seen individual items and what appears to be the entire contents of a house for sale. It's quick and easy to find something you might like or to sell an item you no longer need.