IMSS first two year limited benefits workaround

[blankletmusic]

When I had IMSS you weren't fully vested in the program until the start of the third year with limited benefits the first two years. Assuming it's still like this, how do expatriates on IMSS work around this?

[Mostlylost]

The program is the same at this time. There are federal elections in June and things could change with a new administration (the example would be Seguro Social then INSABI now IMSS Bienestar during this administration) . When and if you decide to move to Mexico would be the best time to ask these questions. 

[RickS]

On 3/13/2024 at 12:23 PM, blankletmusic said:

 Assuming it's still like this, how do expatriates on IMSS work around this?

Take all this with a grain of salt..... an overview, not the gospel for all cases. 

First of all MANY expats at Lakeside do NOT use IMSS at all. Has something to do with income level IMO.  Some number of people use IMSS for their 'catastrophic coverage'. Those that do use it often pay out of pocket until all of their benefits kick in. Many expats pay out of pocket regardless of their coverage.... or lack thereof. Many expats purchase private insurance, some of which also choose a high deductible and pay for lesser medical needs out of pocket. (Keep in mind that medical care in Mexico, even in expat-heavy Lakeside, is 'cheap' especially when compared to the US.)  Private insurance has a threshold age....  70, 72, 75?... after which one cannot enroll. Some/all? policies can be continued even after a holder passes that threshold. 

Dental cost is extraordinarily 'cheap' compared to the US. A filling, a crown, a root canal, a bridge, dentures... even implants... can be paid for by anyone who has the means to actually be in Mexico to begin with!  And Lakeside has several very high quality dentists from which to choose.

 

 

[blankletmusic]

Thanks Rick, great reply indeed. I would likely buy IMSS as soon as possible for the more costly medical situations that require surgery, hospitalization, etc. and likely pay out of pocket for the more minor things at least until the start of year 3 when full benefits kick in unless I were able to find a private health policy that's affordable with decent coverage for the first two years. 

That may be easier said than done however (and costly along with the annual IMSS premium)......I'd likely stick with Plan A.

[Mostlylost]

On 3/14/2024 at 2:58 PM, RickS said:

Take all this with a grain of salt..... an overview, not the gospel for all cases. 

First of all MANY expats at Lakeside do NOT use IMSS at all. Has something to do with income level IMO.  Some number of people use IMSS for their 'catastrophic coverage'. Those that do use it often pay out of pocket until all of their benefits kick in. Many expats pay out of pocket regardless of their coverage.... or lack thereof. Many expats purchase private insurance, some of which also choose a high deductible and pay for lesser medical needs out of pocket. (Keep in mind that medical care in Mexico, even in expat-heavy Lakeside, is 'cheap' especially when compared to the US.)  Private insurance has a threshold age....  70, 72, 75?... after which one cannot enroll. Some/all? policies can be continued even after a holder passes that threshold. 

Dental cost is extraordinarily 'cheap' compared to the US. A filling, a crown, a root canal, a bridge, dentures... even implants... can be paid for by anyone who has the means to actually be in Mexico to begin with!  And Lakeside has several very high quality dentists from which to choose.

 

 

IMSS has absolutly nothing to do with your income.  You pay for the medical coverage if you are not employed as employers here must pay your IMSS for retirement and medical coverage. 

[RickS]

Mostly,  my income reference was about the 'ability to pay'.... the financial ability or desire of an expat to pay. Many expats choose IMSS because they do not have sufficient funds to pay for private insurance. 

[Mostlylost]

10 minutes ago, RickS said:

Mostly,  my income reference was about the 'ability to pay'.... the financial ability or desire of an expat to pay. Many expats choose IMSS because they do not have sufficient funds to pay for private insurance. 

Or private insurance is not available because of age restrictions.  Try to buy private insurance if you are 70 years old. If you can find a company to insure you it covers almost nothing. 

[RickS]

Meaning 'if you purchase after 70 the coverage is not good"? Even though the cost is high?

 

 

[blankletmusic]

17 hours ago, Mostlylost said:

Or private insurance is not available because of age restrictions.  Try to buy private insurance if you are 70 years old. If you can find a company to insure you it covers almost nothing. 

When you turn 70 (I'm 68) it appears that private health insurance is not a very good option any more. If that's the case, is it pretty much either using IMSS or paying with your own funds? 

Is using IMSS for the costly situations (hospital stays, surgery, etc.) and paying cash for the less serious situations (dr. visits, minor procedures, etc) what a lot of expatrates do?

[Mostlylost]

20 hours ago, RickS said:

Meaning 'if you purchase after 70 the coverage is not good"? Even though the cost is high?

 

 

Exactly.  It is expensive and does not cover a lot of things. 

[pappysmarket]

Insuring a 70 year old person against health costs would be similar to writing a policy on the Titanic...after it struck the iceberg. Most companies are not that stupid. IMSS like all national health insurance schemes relies on getting premiums from a large portion of the population that is young and healthy to pay the claims of those who need care. The problem is most young, healthy people don't want to pay a premium for something they are unlikely to need. So the government then must either compel participation or use general tax revenue to make up the shortfall. Or in the case of the US, just print more phony money and increase prices. This is the classic cause of inflation, too many dollars chasing too few goods or services.

[Jreboll]

Each one of us should research which disease are worth spending money on and which to just accept. There are some cancers that have a very low rate of survival no matter what you do. The doctor will tell you otherwise to squeeze money out of you. 

[Ferret]

Agree Jreboll. There are pointed questions that must be asked. Like "After I go through this chemotherapy (or whatever) how much time will it add to my life?" Between that answer and understanding whatever hell you will endure while taking the treatment, it comes down to quality of life not length of life.

[Natasha]

Blanket, you are making the HUGE assumption that IMSS will even take you!!!!!     HIGHLY unlikely. Then you're assuming there won't be a MAJOR wait time for costlier things...... and any pre- existing conditions ( such as you've stated you have), would be excluded forever anyway.

[Kiko]

On 3/17/2024 at 8:44 AM, Jreboll said:

Each one of us should research which disease are worth spending money on and which to just accept. There are some cancers that have a very low rate of survival no matter what you do. The doctor will tell you otherwise to squeeze money out of you. 

Yep, reminds me of a former Lakeside resident who moved back to Arizona with brain cancer.  In hospice, the Dr ordered another chemo treatment cause there was "money left on the table."   

[Jreboll]

My sister quit her job as a hospice nurse because there was a certain doctor who would rush terminal patients to the hospital as soon as they showed signs of worsening. Everyone knew what his real reasons were. 

[AlanMexicali]

4 hours ago, Natasha said:

Blanket, you are making the HUGE assumption that IMSS will even take you!!!!!     HIGHLY unlikely. Then you're assuming there won't be a MAJOR wait time for costlier things...... and any pre- existing conditions ( such as you've stated you have), would be excluded forever anyway.

IMSS will exclude you from joining for some chronic diseases. They have a 6 month, 1 year , 2 year and 3 year waiting period on other chronic diseases and treatments and operations needed, It depends on what condition you are in when applying.


From the IMSS website:

Exclusions to join,

Google Translation:

"• not subject to insurance people who have: malignant tumors, chronic degenerative diseases (late complications of diabetes mellitus), diseases: Hoarding (Gaucher disease), chronic liver disease, kidney failure: • Some pre-existing, such as illness chronic valvular heart disease, heart failure, sequelae of ischemic heart disease (arrhythmia, angina or myocardial infarction), chronic obstructive pulmonary disease with respiratory failure, among others
• chronic systemic connective tissue diseases, addictions like alcoholism and other substance abuse, mental disorders such as psychosis and dementia; congenital and acquired immunodeficiency syndrome or Human Immunodeficiency Virus positive of diseases (HIV)"
 

[blankletmusic]

On 3/18/2024 at 3:57 PM, AlanMexicali said:

IMSS will exclude you from joining for some chronic diseases. They have a 6 month, 1 year , 2 year and 3 year waiting period on other chronic diseases and treatments and operations needed, It depends on what condition you are in when applying.


From the IMSS website:

Exclusions to join,

Google Translation:

"• not subject to insurance people who have: malignant tumors, chronic degenerative diseases (late complications of diabetes mellitus), diseases: Hoarding (Gaucher disease), chronic liver disease, kidney failure: • Some pre-existing, such as illness chronic valvular heart disease, heart failure, sequelae of ischemic heart disease (arrhythmia, angina or myocardial infarction), chronic obstructive pulmonary disease with respiratory failure, among others
• chronic systemic connective tissue diseases, addictions like alcoholism and other substance abuse, mental disorders such as psychosis and dementia; congenital and acquired immunodeficiency syndrome or Human Immunodeficiency Virus positive of diseases (HIV)"
 

Is this an all inclusive listing of disqualifying pre-existing conditions? I don't suffer from any of the above and am 68 years old and healthy.

[Mostlylost]

11 minutes ago, blankletmusic said:

Is this an all inclusive listing of disqualifying pre-existing conditions? I don't suffer from any of the above and am 68 years old and healthy.

No it is not. Also it could change with the next administration in October. 

[blankletmusic]

1 hour ago, Mostlylost said:

No it is not. Also it could change with the next administration in October. 

Sounds rather complicated but likely the better option for the bigger medical issues after age 70 than private insurance ( based on the previous posts of insurance after age 70 being expensive and not covering a lot).

[ibarra]

Here are several articles that you might find beneficial:

https://www.expatden.com/mexico/imss-health-insurance/

https://www.expatden.com/mexico/health-insurance-in-mexico-for-expats/

https://www.mexperience.com/how-to-access-the-mexican-healthcare-system-imss/

 

 

[blankletmusic]

3 hours ago, ibarra said:

Here are several articles that you might find beneficial:

https://www.expatden.com/mexico/imss-health-insurance/

https://www.expatden.com/mexico/health-insurance-in-mexico-for-expats/

https://www.mexperience.com/how-to-access-the-mexican-healthcare-system-imss/

 

 

Thank you, Ibarra for the informative and helpful information.