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Full Time Canadians & Health Insurance


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#1 BettyfromToronto

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Posted 04 December 2012 - 07:39 PM

We are retiring in Cozumel in 2014 and I am wondering what full time Canadians do for health care. We are not interested in living in both places to keep our OHIP.

I am hearing "pay as you go" or "get insurance for only the big stuff" but that may be tricky as there seems to be exclusion clauses for pre-existing health items like high blood pressure, cholesterol, cancer, etc.

Any advice would be greatly appreciated.

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#2 Coz2wonder

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Posted 05 December 2012 - 08:47 AM

I purchased AXA health insurance and it was the best investment I ever made.

However, there is one thing to be aware of prior to even considering purchasing private health insurance, and that is your age.

I found out recently that private health policies have age limits. Some insurance carriers have age limits to purchase of 53, some can not be purchased at age 65 and above.

On this site, if you use the search option you will find lots of information regarding types of health insurance available to you.

To qualify for private insurance, you also have to reside a total of 6 months on the island (within each calendar year).

As for pre-existing conditions, you would work with your agent to discuss all of that.

You do have another options and that is the public health insurance that is offered. There is no age limit. I'm sure those who have chosen this option will chime in.

As for pay as you go...I much prefer to pay my $500 usd deductible for a major incident, then what could turn into thousands of dollars in medical care, and follow up treatments (including prescriptions).

You just don't know when something simple can turn into something major incident, and that is why I carry health insurance.
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#3 Coz_Aholic

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Posted 05 December 2012 - 07:50 PM

http://www.expat-blo...c.php?id=192599




http://rollybrook.com/health.htm

Many use IMS or Seguro Popular Insurance which is very inexpensive. Some will have nothing but bad to say about them, but unless they have actually used it themselves, take what is said with a grain of salt. I personnally know many who have used both insurances, some combined with self pay for the simple stuff...and they have been happy with the care recieved. The specialists used in both programs are the same ones used with expensive insurance or self pay. Check your messeges.
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#4 Coz2wonder

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Posted 05 December 2012 - 08:21 PM

thanks goodness no one said anything negative about ANY health insurance.

Public health care is an OPTION, and because of someone age may be the ONLY health insurance that can be purchase.

It comes down to informed choices.

If you have information that can add to the discussion regarding public offering, then those details would be appreciated.
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#5 Coz_Aholic

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Posted 07 December 2012 - 09:52 AM

Yesterday I had my first experience with Seguro Popular.

I arrived at my assigned clinic on Ave 40, (just a few blocks from my house) at 7:30 and there were 3 other people waiting outside on the sidewalk. An employee came and opened the gate and let one lady in who was there for a lab or something other than the doctor.

At 5 minutes to 8 the clinic door was opened to let us in. I approached the desk and handed my insurance papers to the clerk along with a note in Spanish explaining that I was concerned with a lump on my leg.

She gave me a slip with my return appointment for 12:00 and told me to I would need a copy also of my paper.

I returned at noon and immediatly was weighed, measured, and had my vital signs completed. I then proceeded to wait about 30 minutes for the doctor.

The doctor spoke some English, more than enough for my exam and first visit. He spent nearly an hour with me reviewing all of my medications, looking them up in his formalary, making comparisons as to what Seguro Popular has and what needed to be purchased outside. He reviewed my health record with me, asking lots of questions about past treatments, etc.

He then examined my leg and explained what he believed it to be. He wrote an RX that they can not fill and I have to get outside. He then had the clerk schedule a return appointment to recheck it in 1 month, telling me to return sooner if it were to grow or get worse in anyway.

I was extremely pleased with my care. The staff was wonderful, I have never had a doctor spend so much time with me, even when I was diagnosed with a life threatening issue. The clinic is clean and well run.

My cost for this insurance??? Nothing, as my SSA is not counted, but even if it had been the premium would have been very low.
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#6 Coz2wonder

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Posted 07 December 2012 - 10:21 AM

found the document I was looking for that explains the benefits, and cost for IMSS (public health insurance)to the general, and expat community.

http://www.yucatanex...-insurance.html

When I fist came to Cozumel, my employer provided IMSS insurance, I did use them once. I had no complaints.

I can say that I am very happy with my private insurance. Yes, I am willing pay $1,800 dollars a year for medical, eye, prescription, and dental under my policy. International coverage is about $2,200 a year.

It comes down to your expectations, and budget.

Nothing wrong with private or public, it's a personal choice (or age).
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#7 BettyfromToronto

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Posted 07 December 2012 - 06:37 PM

Great stuff.

Coz2wonder: We will be 57 & 58 so that may be an issue. Was that $1800 for one person? Or a couple? I am okay if it is for a couple. Is there an AXA website for Cozumel. I did a search and got everywhere else around the world

Coz_Aholic: Great play-by-play. Is Seguro Popular public heath care or just another option that is cheaper than private. So much to learn.

Health care is the only unknown for us. I am willing to pay $2K a year for the both of us if it covered everything including our pre-conditions and prescriptions.

So much more research to do.

Thanks everyone. I will check out all of these links.

Betty
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#8 Coz2wonder

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Posted 07 December 2012 - 07:07 PM

Betty, you would qualify for some private insurance based on your age. For my age group (were older) $1,800 per year, per person. My husbands is more because he's covered worldwide.

I would consult with an agent to discuss what your options are, and what is best policy for you prior to your arrival on the island.

Also, you will need to have an FM2 or 3 to purchase public health insurance.

On pre-existing condition, restrictions may apply to both types of health insurance.

You may want to take a look at the site I found that described the benefits, costs, and pre-existing conditions described with the public policy.

AXA insurance is only one of a number of private insurance available. I choose AXA based on the research I did by going to the hospital, and clinics and asking the accounting department which insurance they found easiest to work with for them, and for me. They recommended AXA.

In my experience what they said is true. I submit my receipts quarterly for my medications, and doctors appt's and am reimbursed within one week of submission.

This is one of those things that you want to take your time, investigate and check out the options, and facilities before deciding which is the best choice for you both.

My agent is Irma Cantarell (speaks excellent English)who handles all of our insurance (health and auto). You can email her at: irmacantarell@netscape.net
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#9 Coz_Aholic

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Posted 07 December 2012 - 09:53 PM

Seguro Popular is a public insurance. There is no co-pay or deductable and no exclusions for pre-existing conditions. It also covers some dental like fillings and extractions. You do need to be a resident with FM3 or FM2, or the new papers. Tourist (180 days) are not covered.
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#10 DebB

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Posted 07 December 2012 - 09:57 PM

Seguro popular does not cover everything but it does cover a lot. And pre-existing conditions are covered. Here's the link for more info:
http://www.seguro-po...=272&Itemid=286
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#11 Charles

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Posted 08 December 2012 - 06:26 AM

I have personal experience with IMSS. I have experience with Centro de Salud, CMC (whatever they call themselves now) and clinica San Miguel too. I have had one overnight in IMSS and an overnight and most of a night in Clinica San Miguel. My wife was in Clinica Villanueva for five nights and I was present much of the time.

IMSS is terrible, plain and simple. Yeah Patricia, I've been there and done that and I could make a long list of personal experiences and those of friends that would border on shocking. IMSS in the event of an emergency, you're in an automobile wreck, would probably bring in the same "specialists" you might see in private clinics. For regular treatments, diagnostics, reliance on obsolete equipment, IMSS is a very poor choice. In certain places, IMSS could be considered to be of decent quality and even close to outstanding. For anything serious the difficulty is in trying to stay alive long enough to be properly diagnosed and then transferred to a facility that could provide treatment.

Merida has long been considered a center for quality medical care, close to state of the art equipment, advance care capabilities, first class for Mexico and might be considered almost as good as Canadian hospitals in medium to large cities. When the U.S. Merida Consulate had job openings, for the benefit of U.S. citizen employees, it was classified as "third world post" and in the event of illness or injury, they promised immediate air evacuation to either Miami or Mexico City. For years people from many countries traveled to Merida for elective or non-urgent surgeries. It was more economical than in their home countries, but people came because of the reputation for quality.

Medical facilities have improved in Cancun in more recent years. Cancun would be superior to Cozumel, but would be lacking in many areas compared to Merida. Premium care would exist in Mexico City,especially in the private sector, but I believe even IMSS can do heart transplants there.

Betty, Do you speak Spanish semi-fluently? How much time have you actually lived in Cozumel and you are certain you will not be spending significant time throughout the year in Canada? You'll be discarding one of the more superior health care systems that has minimal cost. I have seen too many people that didn't adjust, or for one reason or another, they figuratively crashed and burned within six months. Some had family situations that caused a change in expectations and they left Cozumel.

I question that if you have sufficient income to legally qualify to move and live in Mexico, you don't want to spend more than $2000 a year for two people. I exist on medications that cost about $125 per month from Mexico. They are mostly European made, they would cost in the U.S. $6-700 dollars minimally. Some Mexican made medications are not considered cheap at least by Mexican standards. When I was under treatment by IMSS, the best doctor would write me a prescription to be filled for FREE! at their pharmacy with the empty shelves. He'd be polite and say that the medication didn't really work that well (at all?), but that was the best he could provide. On the back of the prescription he would then recommend a moderate priced drug which could actually help some or if I could afford it, a third drug which would be expensive that would actually work and was the best thing for treatment.

There is Farmacias Similares which carry many generic medications mostly made in Mexico. They even have a doctor on premises for consultas, some scheduled times for free or $50 pesos other times. If you want cheap, it's available, but is real limited. Most recently marketed drugs are brand name only and brand names won't be particularly cheap. For many conditions, treatment is basic and the generics are sufficient. For anything serious, with potential to be life threatening, most people with the means would want to have the best, most appropriate treatment. Health care costs in Mexico have climbed steadily in the last five to ten years. They remain a fraction of the costs in the U.S.

There are some things that people take for granted in most countries, pain medication for example, that in all reality just does not exist. There are other diagnostics and medications that might be standard in Canada or the U.S. that will not be easily obtained. My opinion is that Paula's quoted prices would be inexpensive, maybe a good value. I doubt you could obtain treatment and coverage equal to Canadian quality without spending significantly more. Personally, if I needed real treatment, I go straight to Merida. Your options are too limited on the island.

I wouldn't touch a free health care system intended to benefit the poorest and most marginalized. There's always the Cruz Roja for a number of minor things at minimal cost. That's funded by donations vs government funding. And I have paid mucho into the IMSS system, my wife significantly more of which we'll never be able to access any benefits.
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#12 DebB

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Posted 08 December 2012 - 08:37 AM

Pay as you go costs for excellent local treatment of minor ailments are very reasonable here. These may be for physicals including ECG, chest x-ray, walk-in lab tests, a broken bone that doesn't require surgery, dental and eye exams, treatment of infection, etc. Some tests, injections and treatments are free or almost free under subsidized programs if you know when and where those are offered.

But a catastrophic event should be insured. And the first decision you need to make is whether or not you want to return to your home country if your condition allows it. In other words, do you want to be covered for medical evacuation? If so, you have no choice but to buy private insurance.

The second decision is whether or not you want access to private vs. public hospitalization down here. Either way, you need to scope out the facilities available and face the reality that you may not end up being treated in Cozumel. Some treatments are not available here at all. And Cozumel has only two hospitals with ICU's (IMSS and CMC). The CMC has but one bed. If it's occupied and you need it, you can't have it and will be refused admission. If you are not in the IMSS system, you can't use that hospital at all.

The IMSS and Seguro Popular are separate entities. Seguro is connected to the Centro de Salud/General Hospital system. It has a very nice, large, full-service hospital in Playa del Carmen. However, with either of these insurance schemes, you will be in a primarily Spanish-speaking atmosphere.
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#13 Kandy

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Posted 08 December 2012 - 11:26 AM

Deb:

I could be wrong, but I don't think my evacuation insurance requires medical insurance. It's through AARP and is called MedJet Assist. It's about $400 per year for both my husband and I and covers the full bill if we have to be life-flighted out. It will even take us to the hospital of our choice in the states. What I don't know is if it's available to Canadians.
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#14 BettyfromToronto

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Posted 08 December 2012 - 04:45 PM

Thanks Coz2wonder. Is Irma Cantarell located in Cozumel? I couldn't find a webiste for AXA Cozumel.

Charles: No I do not speak Spanish. If you read my original post it says we will retire in 2014 so no we don't live there..yet. As for money; we are coming with a lot of cash (in the bank) plus our RSPs and government pensions which will kick in at 65 yrs old so I think we have more than enough money to qualify. Its just that we don't really pay now for health care and if we were to go to Hong Kong (as originally planned) health care is subsidized as hubby was born there. Maybe $2K per year is low. Also we have no kids or parents that would force us back to Canada. If we "crash & burn" as you say then we can always sell and go home but we don't plan to. We hate the winters there.

DebB: We will not be coming back to Canada for any medical treatment. If we want to keep our free medical care (called OHIP in Ontario) we can only live out of country just under 6 months. We do not want to have to own two places and be forced to stay in Canada 6 months of the year. It is a permanent move and we will be applying for our permanent residency. If we go home and re-apply for OHIP there is a 3-month waiting period.

We have just over a year to go and a few more vacations to Cozumel to do the research. I appreciate everyone's comments. During our next visit in January we have a friend organizing a happy hour with fellow Canadians where we can pick their brains so I hope to know a lot more after that.

Betty
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#15 Coz2wonder

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Posted 08 December 2012 - 05:09 PM

Betty, Irma resides, and has her office on the island.

You will know better once you scout out the facilities, and available resources. Keep drilling down into how all of these systems work, then you will be much more comfortable with your choices.

I can appreciate not wanting to return to 6 months of snow, wind and COLD weather.

Mukluks are not required dress code here! B)
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#16 DebB

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Posted 08 December 2012 - 06:39 PM

Hi, Kandy.

Insurance is pretty darn tricky. Especially for those of us whose primary residences are down here. You may want to review your policy carefully to make sure that it is what you think it is.

If you get sick at or too close your Cozumel home, travel insurance policies won't help you. MedJetAssist's standard policy is designed for travelers and requires initial hospitalization 150 or more miles from home. Also, there are usually travel time limits on these policies -- they cover trips up to a specified number of days.

MedJet is available to residents of the US, Canada & Mexico.

For US & Canadian citizens who live here full time and want the option, an international medical plan that includes evacuation/repatriation to another country is the way to go.

Betty:

Though you're planning to abandon your provincial insurance, you may find it preferable to leave Mexico for treatment at some point. And this discussion is educational for all of us!
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#17 BettyfromToronto

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Posted 08 December 2012 - 07:38 PM

Thanks Coz2wonder. If I e-mail Irma should I say she was recommended by "Coz2wonder"? Will she know who that it? LOL

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#18 BettyfromToronto

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Posted 08 December 2012 - 07:49 PM

DebB: I guess if I was really sick I could go home but I could easily die in the 3 months I have to wait to re-instate my free health care. I am a breast cancer survivor of 24 years and there is no chance of a new cancer (including ovarian) as everything was taken out (LOL) but a re-occurrence of the first cancer is a 15% possibility an it would hit the brains, bones, liver or lungs which is pretty much fatal. So I guess if that came back that would pretty much be it. I'd rather die lying out by my pool in the warm sunny weather in Cozumel than in Ontario.

Betty
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#19 Coz2wonder

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Posted 08 December 2012 - 07:49 PM

Irma wouldn't have a clue...My name is Paula Anton
islandgirl@ecozumel.net

I have some info for you regarding an option for TV. Shoot me an email and I will be happy to share it with you.
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#20 BettyfromToronto

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Posted 09 December 2012 - 12:32 PM

Thanks Paula. I'll send you an e-mail now

Betty
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