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Medicare in Mexico ?


ARIBOY

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As far as I am aware, Medicare in Mexico is illegal  ( unless it is an emergency and  you are away from the US for under 60 days)

There are local seminars given locally  that suggest that  they can handle Medicare insurance at lakeside even for  temporary and permenente residents.

If anyone has attended such seminar (which I have not) can you please advise your perspective  ?

Also, if you are a resident, and have used this approach, again,please share your experience.

Much appreciated

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At one time, there was a company that "accepted" MEDICARE here, but let's just say that the methods were questionable (for obvious reasons, I can't say any more). Since MEDICARE outside of the US is a flat "no," I would love to hear how these seminars would suggest how they could LEGALLY pull off this juggling act.  Below is taken directly from the MEDICARE site:

Medicare may pay for inpatient hospital, doctor, and ambulance services you get in a foreign country in these rare cases:

  • You're in the U.S. when a medical emergency occurs, and the foreign hospital is closer than the nearest U.S. hospital that can treat your medical condition.
  • You're traveling through Canada without unreasonable delay by the most direct route between Alaska and another U.S state when a medical emergency occurs, and the Canadian hospital is closer than the nearest U.S. hospital that can treat the emergency.
  • You live in the U.S. and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat your medical condition, regardless of whether an emergency exists.
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52 minutes ago, Tingting said:

At one time, there was a company that "accepted" MEDICARE here, but let's just say that the methods were questionable (for obvious reasons, I can't say any more). Since MEDICARE outside of the US is a flat "no," I would love to hear how these seminars would suggest how they could LEGALLY pull off this juggling act.  Below is taken directly from the MEDICARE site:

Medicare may pay for inpatient hospital, doctor, and ambulance services you get in a foreign country in these rare cases:

  • You're in the U.S. when a medical emergency occurs, and the foreign hospital is closer than the nearest U.S. hospital that can treat your medical condition.
  • You're traveling through Canada without unreasonable delay by the most direct route between Alaska and another U.S state when a medical emergency occurs, and the Canadian hospital is closer than the nearest U.S. hospital that can treat the emergency.
  • You live in the U.S. and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat your medical condition, regardless of whether an emergency exists.

They "suggest" that if you have a mailing address in the US that you use for Social Security,  you can get a Medicare Advantage Plan that will cover you for "emergencies" while traveling abroad. I am pretty darn sure that people who live here and have either a temporary resident visa or a permanent resident visa are committing fraud when they get a MAP using an address in the US that is not their primary residence. 

The hospital on the Libramiento has you see a doctor at their facility near Superlake and no matter what the problem it is coded as an emergency and you're sent to the hospital. This, and the above info, we learned directly from the facility.

If you wonder why prices are so outrageous at both local hospitals,  I believe this explains a lot. 

 

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Yes, it does explain a lot! It appears that the hospital has partnered with a group that overcharges US hospitals and MEDICARE. It explains why the normal billing has doubled and then some at that hospital (gotta get some of that lovely gringo cash!). What a pity as that hospital started out so promisingly. Another hospital used to use them and then booted them out (about the only good thing I can say for it). Just to give a personal example:  when hubs had to see a specialist, they charged our insurance TWELVE times the going rate for a specialist. I am not exaggerating when I say that it was approximately $9600mxn for a normal $800mxn appointment. We immediately submitted letters stating that we no longer wished to be a part of their plan. Of course, our insurance never queried it because it was either cheaper than or close to what they would pay in a US facility. Of course, they also appeared to be using US addresses, so...

FWIW, we did NOT know any of this until I one day happened to actually open up an Explanation of Benefits online and saw what was occurring. Yes, my fault for not bothering to check, but it never dawned on me that they were that bold.

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3 hours ago, Tingting said:

Yes, it does explain a lot! It appears that the hospital has partnered with a group that overcharges US hospitals and MEDICARE. It explains why the normal billing has doubled and then some at that hospital (gotta get some of that lovely gringo cash!). What a pity as that hospital started out so promisingly. Another hospital used to use them and then booted them out (about the only good thing I can say for it). Just to give a personal example:  when hubs had to see a specialist, they charged our insurance TWELVE times the going rate for a specialist. I am not exaggerating when I say that it was approximately $9600mxn for a normal $800mxn appointment. We immediately submitted letters stating that we no longer wished to be a part of their plan. Of course, our insurance never queried it because it was either cheaper than or close to what they would pay in a US facility. Of course, they also appeared to be using US addresses, so...

FWIW, we did NOT know any of this until I one day happened to actually open up an Explanation of Benefits online and saw what was occurring. Yes, my fault for not bothering to check, but it never dawned on me that they were that bold.

I used to be more involved at the American Legion and there was one older Vietnam vet who was beside himself with worry. Back when the one place was a fairly small clinic in Riberas, I believe that they were the only place that accepted Tricare and this vet had received care there. He was being pressured by this place to pay a number of bills that Tricare hadn't paid in what they considered to be a timely manner. When he started looking through the bills, it was apparent that they had billed for appointments he never had, procedures that weren't done, and not just once or twice. 😡

It really chaps my cheeks that systems set up for seniors and veterans are being ripped off and that those of us who aren't participating in it are ultimately paying the price. 

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To the OP, Ariboy..... your first paragraph pretty much sums reality up.  Beware of ANY other 'story'!

Yes, there are 'some' who would suggest otherwise. Some that advertise otherwise. Some that have seminars 'explaining' how. One that even has had a US-based 'Insurance Broker' speak locally explaining the process. Again.... beware.

I spoke.... actually emailed back and forth.... with that US-based insurance broker, based in California, earlier this year. Pretending to be interested.  To my surprise he was pretty straight forward in our conversation by pointing out that this 'opportunity' was FOR AND ONLY FOR EMERGENCY SITUATIONS WHILE VACATIONING outside of the US. Generally on a reimbursement basis with your carrier. He did mention that one 'medical provider in Mexico' would handle the insurance billing for you. When I pressed him he acknowledged that it was a provider at Lake Chapala where he was 'on retainer' and had given seminar(s). I did not divulge that I had connections with Lake Chapala. 

There is more to this story but I'll spare you the details. Suffice it to say that this 'opportunity' does not exist unless of course one is willing to subject themselves to possible Medicare insurance fraud. 

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