Retired with pre-existing conditions

Hi gudgrief!

I hope other members will be able to help you soon!

Regards
Armand

gudgrief wrote:

When I first moved to Mexico, I looked into the touted $300/yr insurance.  On paper, my pre-existing conditions are excluded.  talking to the few other expats in the area, I found that very often the prescription meds you need are not available and you have to go buy them from a private pharmacy.

I've also found out that a complete cardiological work up including blood, xrays, EKG's can run around $800-1000US and the prescriptions meds I take cost around $160US/mo.

Does anyone know how strict Seguro Popular is about enforcing the restrictions on pre-existing conditions, the quality of service and the availability of meds like Crestor and Plavix(Iscover)?

Is anyone in a similar situation and is it useful to consider maintaining an address in the US and signing up for Medicare and Medigap?

Thanks.

Seguro Popular:
More than a  1,400 diseases that covers the Popular Health Services are related with specialties such as orthopedics, traumatology, rheumatology, rehabilitation, stomatology, gynecology and obstetrics, pediatrics, dermatology, mental health, addictions and emergency services. In addition to actions of prevention and health promotion, as well as care for communicable diseases, chronic-degenerative and general surgery.

Many times we have heard situations of people diagnosed with a serious illness, or diabetes, hypertension, problems with the heart and even cancer, without medical services of social security or sufficient economic resources to pay for your care in private hospitals; in these cases the alternative is the Popular Health Services.

gudgrief wrote:

When I first moved to Mexico, I looked into the touted $300/yr insurance.  On paper, my pre-existing conditions are excluded.  talking to the few other expats in the area, I found that very often the prescription meds you need are not available and you have to go buy them from a private pharmacy.

I've also found out that a complete cardiological work up including blood, xrays, EKG's can run around $800-1000US and the prescriptions meds I take cost around $160US/mo.

Does anyone know how strict Seguro Popular is about enforcing the restrictions on pre-existing conditions, the quality of service and the availability of meds like Crestor and Plavix(Iscover)?

Is anyone in a similar situation and is it useful to consider maintaining an address in the US and signing up for Medicare and Medigap?

Thanks.

Seguro Popular website: Continued

"In an interview with SUMEDICO Gabriel Cuts Gallo, deputy director of the Popular Health Insurance, said that any person even if you record a state of advanced disease can join this service for medical care, where there are no limits for registration. "From birth until the third age there is not a limitation, nor in the pre-existence of diseases, if a person is sick with cancer can apply for membership and will be granted".

"We know that people with higher income insurance major medical expenses and other advantages in private hospitals, as a fourth to a single patient; the permission to be with the several families; and even services such as television and that is why the Popular Health Insurance is not their first choice, it is understandable; but if it should be clarified that we have a very high technical quality of medical services, similar to that of any private institution", stressed the official.

In this context, he said that the care provided through this system is in first-class clinics, but also in specialty hospitals as well as on the network of the National Institutes of Health, which have international recognition for its high level of quality."

"He clarified that the Popular Health Insurance covers 100 percent of the attentions in the health service centers and 90 percent in general hospitals and the national institutes of health, this represents the attention of 1,400 diseases."

"He emphasized that this system of medical care covers, to date, the diseases with a greater impact by the gravity of the population, such as the various cancers in children; the breast and cervical in women and the testes in men, as well as cardiovascular disease. Another service that must be highlighted is the supply of antiretroviral drugs for people with the Human Immunodeficiency Virus (HIV/Aids)."

Is Seguro Popular the national health service or some other organization and are you saying it will cover people without any other health care plan for pre-existing disorders like High Blood Pressure, diabeties, arthritic hip & knee etc?

Here's what I understand.

Seguro Popular is a government program for people who don't pay into the Social Security system which, in Mexico includes healthcare.

Yearly premiums are based on income and you get service from Social Security staff and facilities.  Pre-existing exclusions are exclusions forever.  Whether that's put into force depends totally on the doctor who does your intake exam.  I have enough against me, I didn't want to take the chance.

a couple of people I know have Seguro Popular and are satisfied.  Nevertheless, they do admit there's a lot of bureaucracy and it might take three visits to your primary care physician for something simple like a yearly check up plus other red tape.

One of them told me the following:

You have to go in to make an appointment, can't do it over the phone.

You have to check in with administration on the day of the appointment even though the doctor's office may be in another part of town.

You see the doctor and he orders lab tests.

You have to make an appointment with the lab in person.

You go in and you get your tests.

You have to amke an appointment to pick up the results.

You have to make another appointment with the doctor to have the results reviewed and interpreted.

And so it goes and most of the above may be inaccurate.

As long as I can afford to get my medical care in the US, I'll do it that way.

jllesq007 wrote:

Is Seguro Popular the national health service or some other organization and are you saying it will cover people without any other health care plan for pre-existing disorders like High Blood Pressure, diabeties, arthritic hip & knee etc?

Yes it is the bottom of the rung of the three systems of socialized heath care in Mexico funded and administer by the Federal Govt. The IMSS [Instituto Mexicano Seguro Social] is the largest and tax paying citizens y dependents for no charge or immigrants with Fm3 or FM2 status are invited to join for about $300.00 US year.

The second is ISSSTE [Instituto de Secretaria de Seguro Social de Trabajadores del Estatado] which is the State and Federal employees and their dependents or spouses personal separate Hospital, Emergency rooms, Ambulance service and clinic system.

The third is Seguro Popular which is for everyone else and has the largest coverage in Mexico and called Secretaria De Salud.

Anyone can go to get medical care there. All you have to do is go to the largest clinic and ask to see a Trabajador Social [Social Worker] They will ask about your financial situation and if you have no extra money you can be enrolled and no one is charged for services or Medicine if they stock it. You will need an FMM, FM3 or FM2 and a local address. If you are too sick to go through all that you can go to a Secretaria De Salud clinic to wait and see a Dr. and pay $65.00 pesos for a consultation, stitches set a broken arm Etc. and they will give you the medicine if they have it and a prescription if they don't.

gudgrief wrote:

Here's what I understand.

Seguro Popular is a government program for people who don't pay into the Social Security system which, in Mexico includes healthcare.

Yearly premiums are based on income and you get service from Social Security staff and facilities.  Pre-existing exclusions are exclusions forever.  Whether that's put into force depends totally on the doctor who does your intake exam.  I have enough against me, I didn't want to take the chance.

a couple of people I know have Seguro Popular and are satisfied.  Nevertheless, they do admit there's a lot of bureaucracy and it might take three visits to your primary care physician for something simple like a yearly check up plus other red tape.

One of them told me the following:

You have to go in to make an appointment, can't do it over the phone.

You have to check in with administration on the day of the appointment even though the doctor's office may be in another part of town.

You see the doctor and he orders lab tests.

You have to make an appointment with the lab in person.

You go in and you get your tests.

You have to amke an appointment to pick up the results.

You have to make another appointment with the doctor to have the results reviewed and interpreted.

And so it goes and most of the above may be inaccurate.

As long as I can afford to get my medical care in the US, I'll do it that way.

Yes that is how patients have to  deal with their system exactly how your friend told you. An X-ray will take several days to pick up. You carry your blood work, other lab work reports, MRI and X-rays etc. waiting at each area for sometimes hours, sometimes 15 min. and take these with you around the circuit when you finally pick them up, sometimes in several locations, depending if you are at a Hospital general or a clinic until you are seen and diagnosed. The wait I experienced took 1 day and another 1/2 day. You will not be able to leave the waiting rooms unless someone stays to hear them call your name. It is customary to give your seat up to older or sicker people. They regulate the people allowed in the general Hospital with appointment cards and the waiting room rarely have the whole family, they wait outside the hospital grounds, but this depends on the mood of the security guards at the gate of the property. They realize it could be an all day affair.

If you are in a hospital usually you can have a test or x-ray done that day if it is not late afternoon. The wait is longer in the last part of the day and might be more convenient to make an appointment first thing in the morning. Don't expect to make an appointment at 2PM and not wait for everyone that came in there from a Dr. request that day. You wait first come first serve [going early puts you up in the line]. I know this is not fair but it is the way it is done. You are advised at all stops to ask who is the patient in front of me and if someone shows up after you and tries to go before you get up and say I was here before they were, thank you.

You make an appointment with the DR. requesting tests that day and calculate how many days it will take to do your legwork and they put that date in your appointment card. All clinics have an administration office once you have an appointment card there is no need to return to the same clinic you stared with, this will save a trip. I feel if your friend just went to the large Hospital General [Secretaria De Salud] and stayed there where there is usually 50 or more consultorios with specialists and bypassed the larger clinics when he knows a test is needed. There you would need to be registered first.

Hello:

I´m a Mexican guy, and always worried about people who use the IMSS health service. Worried, because it really sucks. There´s nothing to do really with the bureaucracy there... I really hate it... Please people get private insurance... not even I as Mexican would use the IMSS service.

I do not agree with your assessment of the situation, however would have 15 or more years ago. By the way, we were not really trying to convince anyone of anything except giving out information and my experiences with Seguro Popular have been on par with the HMO I belonged to in San Diego. The IMSS was something I also knew about for over 30 years as most of my ex in laws worked [retired now] for them. I have 4 good friends who are IMSS DR.s in Mexicali still working.