IMSS

gringal wrote:Simpsca........that is good information, but you still haven't answered the question of what insurance is available to those over 70.
I have a good friend to whom this is the all important question, so please do not ignore it.

As my old mum used to say: "if you stand around long enough on the planet......and are lucky......you'll get old". We all will.
Having to return to the States for medical reasons alone is not a desirable option for those who have lived in Mexico and love it.
Insurance companies crunch the numbers and have no qualms about denying coverage to the senior seniors.

Gringal - Each Insurance company has it's own age limit and reason to refuse because of pre existing conditions. Their Insurance is similar, including International and Catastrophic Illness. Segurous Monterrey age limit is 69, but I believe AXA is 64 (not sure). I have Segurous Monterrey with Edgar Cedeno Cadenas which after my 2 experiences believe to be the best. The best thing about Segurous Monterrey is that it's a NO LIMIT policy, except for the $ 50,000. USD in the US. You're not over 70 so don't worry about it.

Everyone can take any deductible they want, thus lowering premiums. My deductible is $ 22,500. pesos. If someones premiums might be too high and they want to use the Policy for a Major Medical policy and can afford it, they could take a $ 50,000. or $ 100,000 pesos deductible.

Segurous Monterrey refused my cousin because he had a pacemaker. My pre existing Epilepsy is not covered, but so what, I can afford to pay out of pocket for one week in a GDL hospital, if I need a medication change.

Everyone who wants private insurance needs to read the fine print as to what/what is not covered, hospitals you can use and where the deductibles apply. And buy the policy from a qualified, trustworthy agent like Edgar Cedeno or Jesus Tejada.

"You're not over 70 so don't worry about it." (John)

If you'll re-read my post, John, you will notice that my concern is not for me, but for my friend who is over 70 and can't find private insurance. at any price, with any deductible.

Anyone have the name of an insurance company to suit the actual situation? I would appreciate hearing about it and can pass it on.

If not, maybe it's time to quit bashing IMSS and the people who sign up for it, many of who have no other alternative.

Yes, some people are cheap, and if they have to experience an IMSS hospital, they will probably be the loudest to complain; like the guy I know who complained that HIS doctor of choice wasn't taking Medicare patients in the U.S.

Some people are fatalistic and/or in denial and believe they will cross over the rainbow bridge without the inconvenience of long term illness. Good luck on that one.

So, when we discuss health care, lets' be realistic. All choices are not open to everyone. Some people drive the best of cars; some use a bicycle, and some are forced to walk. Such is reality. It's what we live in.

CanuckBob wrote:I would love to hear what everyone is paying for their private medical insurance (including deductible) and who they are using.

We could make a comparison with what WE pay in BC.....ours is...
after paying in for 45 years or 3 months, $109 a month for two, plus 80% drugs cost paid.

I self-insure, so my insurance cost are 0, and, of course, deductibles are also 0. By dropping Part B 10 years ago, I have saved enough to more than pay all my medical costs in México including 4 days in the hospital, follow-up doctor visits and US$125 per month med costs. I'm still about US$2500 on the plus side.

I am 63 and am paying 35,000 pesos ($2,916 US) last year (basically $250 US per month); for a 6,000 peso deductible (3,500 pesos if I use an in network hospital which are really good ones ) plus 10% coinsurance - unless it is an accident (fell and broke arm) then no co-insurance. I have no exclusions.

I have had Seguros Monterrey New York Life with an agent that comes to LCS two days per week. I have had them for 10 years. Had 4 hospitalizations, premium has gone up with my age, not procedures.

All in for a week in the hospital of pneumonia and breathing therapy every 6 hours, plus 2 IV antibiotics plus reimbursement for post hospital meds - antibiotics were 935 pesos per shot for 5 days. All in my deductible and co-insurance which I charged on a US credit card was $657 US. I figure with 3 surgeries and 1 case of pneumonia over 10 years I have probably broken even. I will look at higher deductibles at renewal.

But I think Rolly is correct in that if you put your money away you can self insure most things. One thing I would not want to self-insure (or go through at all) is open heart surgery. A friend in Guadalajara has private insurance in the US - has to pay out of pocket and gets reimbursed. His quadruple by-pass cost over $100,000 US. I am not sure I would put myself through that, but fortunately that is one problem I do not have.

And I agree with johninajijic that a good insurance agent is very important and he lists the two best as I have heard. When I had pheumonia I obviously didn't have time to get insurance company approval, so I called Edgar from my cell phone and told him the problem. He said go to San Javier, Seguros Monterrey New York Life has an office there. I did, the insurance company representative came to my room with the forms, my doctor filled them out and I only paid deductible and co-insurance mentioned above.

Some of us don't have the resources for private medical insurance and IMSS maybe the choice for something catastrophic. It is not my first choice but at least now I have something available when the time comes (hopefully).

Abrria wrote:I am beginning to think that having IMSS as a backup is not a bad idea. Have any of you used any of the local "facilitators" to go through the application and if so whom do you recommend?
Gracias por su ayuda.

Arriba, I realize we have gotten off topic and are now answering Bob's question about premiums, etc. To answer your question, my friend used Mago in Chapala and had no problems. She even told him to go in and show his papers to be sure they were in the local system in Chapala. When he moved to the Jocotopec jurisdiction, she registered him there, and changed him back to Chapala when he moved again.

Several people in the Jocotopec area who used other facilitators (I don't know who) were registered in the Chapala office, which I understand can be a problem if you do not live there.

Like Rolly, I am self -insured. IMSS is the backup, in case I'm found splattered all over the street...my card will hopefully be on my person.

Is anyone going to answer the question of where someone over 70 can get private insurance??? The avoidance is becoming fascinating. LOL. Really!

Try Lloyd's Of London... If they'll insure Barbra Streisand's nose, they insure anything!!

gringal wrote:Like Rolly, I am self -insured. IMSS is the backup, in case I'm found splattered all over the street...my card will hopefully be on my person.

Is anyone going to answer the question of where someone over 70 can get private insurance??? The avoidance is becoming fascinating. LOL. Really!

Tell your friend to try BUPA, a British company that comes to LCS, but I don't knoow what days.

I very much doubt, ANY insurance company will insure her due to age. They've already crunched their numbers and know it's not worth it.

Exactly true, John.

I've heard that the BUPA cutoff is 65, but it's worth checking.

I guess that at 70 plus .........some folks are grateful that there is an IMSS.

Life is a pre-existing condition, si? And, the longer you stick around, the more severe the condition!

Maybe the Soylent Green movie was closer to future truth than fiction? ( For those who don't know the reference: at 65, you were obliged to enter the chamber of permanent sleep, after which you were recycled into the food supply. Solved all sorts of social problems.)

The policy (Seguros Monterrey New York Life) states that the age limit for new policies is 69 years of age. It further states that there is no age limit for renewals.

This is from IMSS in PV. (Via Mexconnect).
You must show birth certificate.
You must have original ID (passport, FM3)
You must be able to prove that you live in Puerto Vallarta year round (full-time).
Two photographs
Official questionnaire filled out.



No physical exam required BUT should you be untruthful about pre-existing conditions and symptoms arise and you are treated, you will be dropped from the IMSS immediately.
You must not have any of the following pre-existing conditions:

Allergies or Asthma
Chronic blood disease
Cancer-Tumors
Diabetes with renal insufficiency, retinopathy, neuropathy, insufficient circulation.
Heart disease
Liver disease
Chronic psychiatric disease
High blood pressure
Arthritis Rheumatoid
TB
Stomach ulcers
AIDS
HIV Positive
Congenital diseases
Chronic bronchitis
History of cerebral vascular disease
Deformities
Alcoholism
Drug addiction

Rolly wrote:I self-insure, so my insurance cost are 0, and, of course, deductibles are also 0. By dropping Part B 10 years ago, I have saved enough to more than pay all my medical costs in México including 4 days in the hospital, follow-up doctor visits and US$125 per month med costs. I'm still about US$2500 on the plus side.

Rolly going from memorys, did you not write a few years ago about attempting to join IMSS, and you were unable to?

CanuckBob wrote:So if you have an existing policy with one of these private insurers they cut you off at 70? Or is it only if you try to start a policy after 70?

You can get a policy with Segurous Monterrey even if you're 69 years old. They cannot cancel you after that for any reason. The policy is non cancellable. Only if you try to start at age 70 or after.

cane wrote: Rolly going from memories, did you not write a few years ago about attempting to join IMSS, and you were unable to?

Yes. I was refused because I have a permanent tracheostomy for sleep apnea. I think the clerk was wrong to refuse my application, but I didn't fight the refusal because I didn't really care.

Looking back, I think I am better off by not going to an IMSS hospital when I had a pulmonary embolism and almost died. I got excellent care at a commercial hospital

Got so many appropriate answer here. Thanks for sharing this post. ....

When I applied for my IMSS last October I didn't have to fill out the long health questionnaire; there was a very short form asking:
Do you exercise
Do you smoke
Do you drink

I did have to go to the Chapala office for a quick exam. I did do this using my attorney; we had to go back twice but then I got my card. My attorney told me that with the changes that were enacted last year you DID NOT have to have any lab work, etc. done before, only after the visit to the clinic if the doctor wanted tests. She told me that it was the director at the Chapala office who was saying you had to have certain tests done BEFORE applying. We'll see how things pan out this year.

johninajijic wrote:

CanuckBob wrote:So if you have an existing policy with one of these private insurers they cut you off at 70? Or is it only if you try to start a policy after 70?

You can get a policy with Segurous Monterrey even if you're 69 years old. They cannot cancel you after that for any reason. The policy is non cancellable. Only if you try to start at age 70 or after.

Seguros Monterrey/New York Life sold me an unlimited "non-cancellable" major medical policy when I was only 59 back in 2001 when we first arrived at Lakeside. This was the then LCS group health plan and was represented to me as forever non-cancellable by their then agent. About a year later they cancelled the group health plan and offerred all LCS policy holders in its stead a much inferior individual policy* and, not only that, when I refused that inferior product they dishonored their commitment to cover a minor cataract operation they had previously approved unless I relented and bought that inferior policy. The LCS board was incensed that this unilateral move had been made by the company and represented to me that there was no way New York Life could have gotten away with that in the United States but told me there was nothing they could do about it in Mexico.

Now, in all fairness to Seguros Monterrey, their agent should have never sold a group life policy to a society of old goobers as these group policies, in retrospect, can only make sense statistically if the members of the group have varying propensities to become seriously ill as is not the case with the ancient LCS membership and they were experiencing, according to the then LCS medical director, a very heavy and expensive case load. That doesn´t change the fact that they should have applied proper underwriting standards before offering the product and should have never allowed their agent to state emphatically to potential customers that the policies underwritten under the group plan were not cancellable UNDER ANY CIRCUMSTANCES once contracted. That was a misrepresentation by their then agent and, as it turned out, group plans were, indeed, cancellable at any time at the sole option of the insurance company no matter what their agent represented to the customer. Apparently the LCS board was unaware of that fact and, as the then medical director admitted to me, "We really didn´t understand medical insurance."

The reason I bring up this ancient history is that John is once again touting this company which is fine and is his right but the reader needs to know that when an insurance agent tells you that, as long as you are 69 years of age or younger and have signed up with their proffered health plan it is never cancellable, you should take that representation with a huge grain of salt. You should also bear in mind that with any company agreeing to underwrite you no matter how ancient you become before croaking, your annual premiums will certainly skyrocket over time and you will need to increase your deductible to keep those premiums within reason.

Now, after Seguros Monterrey, through their succesor agent, treated me so rudely and defaulted on their commitment to cover the cataract operation expenses unless I committed to their inferior coverage, I paid for the cataract operation out-of-pocket and signed up with ING (now AXA) and my experience with them, which includes a major and dangerous gall bladder operation in a terrible hospital in Chiapas, has been excellent. I am now 69 and have been with them since I was 60. I have been assured that I will be covered for life with no chance of cancellation because of my age and I certainly trust AXA far more than I would ever again trust Seguros Monterrey/New York Life. However, after my unfortunate experience with the latter company, I would emphasize to the reader that any policy is cancellable and any claim may be denied no matter what an insurance agent/salesman tells you so hold on to that Medicare card just in case and keep some cash reserves in the bank for emergencies. Perhaps you´ll want to sign up for IMSS as a backup despite their financial woes although we don´t really trust them so have never done that.

I don´t know about the rest of you but no matter what health insurance company I use or, for that matter, if I were to sign up for IMSS, I equate making a major claim with tossing the dice. Just be careful when reading John´s continued breathless endorsement of a particular insurance company over others and remember that you are on your own when choosing a carrier and cannot look to John for recompense if the product he endorses does not perform as originally seemingly agreed. Have you ever attempted to interpret the fine print in an insurance policy no matter by whom it is issued? Do you actually think John has read and properly interpreted that insurance contract or is making his endorsement based on more frivolous criteria. I would say that the most important factor in choosing an insurance company is the quality and responsiveness of the agent with whom you will need to deal when things go bad. You decide but, by all means, shop around and keep John´s glowing endorsements whether for insurance companies, restaurants, service providers or contractors in perspective as he tends to express his opìnions categorically and, it seems to me, often based on limited knowledge. That is no criticism of John as his lists are often quite useful; just a caveat for the reader to consider.

* By "a much inferior product" I mean, the company offerred me an individual major medical policy which, on the surface, appeared to be equal to the policy they had just cancelled but coverage was limited to $600,000 Pesos (about $52,000USD) per incident so clearly the proffered new policy was a hugely inferior product. What was the point in having a limited "per incident" policy which could leave the policyholder in dire straits if the costs of his/her specific illness exceeded $52,000USD - a distict possibility even in Guadalajara.

Great post Hound dog. Nothing could me more true. I am relieved that AXA, which I also have has been good so far.
I might add that AIG has a travel plan, which they also do not honor. My husband became very ill in Canada, their office in Argentina refused to pay. After months of hearings in Guadalajara at their watchdog agency, and a final "discovery" we were told that we had an excellent case. The result, we had to hire an attorney ourselves. Now who do you think would have won?

Most insurance companies have contingency plans which they will use to slip out from under their stated policies. Buyer beware, and only slap cash down after you have heard from other satisfied customers.

We carry AXA and our agent (very important) is Jesus Tejeda. I became very ill in Chili, we had travel insurance but needed to return to Mexico. He was there to take care of everything, even made sure that an ambulance was there to take me to Del Carmen (hospital) and doctors were waiting for my arrival. By the time I arrived I was in septic shock (one step before death) and because of all this efficiency, today I’m doing well. Thanks Jesus.

P.S. Forgot a very important issue, they paid for everything (other than the deductible) and continue to pay for rehab. Mucho dinero! (Yeah, my Spanish is really poor.)

Wow, that is amazing Parker and a good referral, expecially for your agent.

Parker wrote:We carry AXA and our agent (very important) is Jesus Tejeda. I became very ill in Chili, we had travel insurance but needed to return to Mexico. He was there to take care of everything, even made sure that an ambulance was there to take me to Del Carmen (hospital) and doctors were waiting for my arrival. By the time I arrived I was in septic shock (one step before death) and because of all this efficiency, today I’m doing well. Thanks Jesus.

P.S. Forgot a very important issue, they paid for everything (other than the deductible) and continue to pay for rehab. Mucho dinero! (Yeah, my Spanish is really poor.)

Thanks for that, Parker. In my posting above, I emphasized the need for a good local agent and, in that regard, I was also referring to Jesus Tejeda, AXA´s outstanding agent stationed in Guadalajara who frequently visits Lakeside and, (Gasp!) religiously responds to his clients´ needs (including e-mails and voice mail messages) with utmost dispatch.

I´m not just spreaking here without experience. We not only carry our major medical insurance policies with AXA and Jesus but our automobile insurance and two homeowners policies - one here and one in Chiapas. Three years ago, I became seriously ill and at death´s door in San Cristóbal de Las Casas where the hospitals are generally well below standard and there are few really outstanding physicians. I had to have a major gall bladder operation and on an emergency basis so I had no time to return to Guadalajara or Mexico City. Therefore, I, of necessity, had that operation in the grimy and mismanaged Colonial Hospital in San Cristóbal, the only hospital in that city with the facilities necessary to perform this most serious extraction. That hospital was utterly filthy and not one on AXA´s approved list, their record keeping was attrocious in an area where facturas are hard to come by since cheating the tax man seems to be a universal endeavor among all parties including hospitals and other health care providers. I had to pay up front for this operation and had receipts for services rendered by various medical specialists and laboratories and the hospital that were, shall we say, rudimentary in many regards in comparison with what one would expect from one of AXA´s fine Guadalajara hospitals and well regarded physicians. Jesus went to bat for me with AXA and, despite the marginal Chiapas bookkeeping, saw that the company reimbursed us appropriately for these major expenses.

Then a couple of years later, one of us had an automobile accident near Tapachula, Chiapas right on the Guatemala border in an isolated region on the slopes of the Tacaná Volcano. We were faced with authorities along the border of questionable integrity and repair shops in Tapachula with whom we were totally unfamiliar. Jesus, in concert with AXA´s local agent in Tapachula took care of us in every respect even though we, of necessity had to return to San Cristóbal while our car was being repaired and return for it a week later.

In both of these instances, we have the services of an outstanding local agent, Jesus Tejeda, to thank for getting us out of muddled situations in remote and poverty- stricken Chiapas. When shopping for insurance, just remember, it ain´t the discounted premium or warm smile and firm handshake of the agent you choose when times are good that counts but the person who knows you and will come to your aid when you are in dire straits on some Chiapas backroad a couple of meters from the border with Guatemala or you are having your gall bladder removed in some Chiapas charnal house.