Healthcare in Mexico for Expatriates, Visitors and Tourists

By Kent Paterson 

There are those who damn the government-run Mexican Social Security Institute (IMSS) healthcare system, and those who praise it. Susan Wichterman is among the latter.

The Puerto Vallarta resident was, in her own words, "very arrogant" about her personal health. But when Wichterman suffered a fall, she wound up getting treated by IMSS specialists in Guadalajara, where the former U.S. nurse underwent two surgeries that got her back into shape. 

Wichterman told her story at a recent Puerto Vallarta forum sponsored by the Costa Banderas chapter of Democrats Abroad.

Focused on healthcare for expats and tourists, Wichterman and other presenters told a theater packed with baby boomers from abroad that persons with a residency visa in Mexico are eligible for IMSS coverage for a premium that comes out to less than $400 per year, and gets a policy-holder a doctor and most treatments. 

According to Wichterman, the IMSS has both an upside and a downside. On a positive note, the IMSS counts on board-certified physicians and professional staff. Conversely, waits for services can drag on for months, English-speaking staff are scarce, and patients staying over in a hospital must supply their bed sheets. Wichterman recommended that expats with limited or no Spanish skills bring along a translator if using the IMSS' services.

"The IMSS is an adventure," Wichterman said. "Sometimes they are disrespectful to the gringos, but I can work with this." She recommended an IMSS policy as a possible "adjunct" to a comprehensive package of healthcare coverage, especially given the low cost. 

Witcherman's presentation sparked debate among the panelists about the IMSS. During the last year many IMSS staff in Mexico have publicly protested working conditions and shortages of medicine and equipment. Local hotel operator Paul Crist said his employees who are enrolled in the IMSS complain of long waits and prefer instead to use private doctors.

Separate from the Democrats Abroad event, the IMSS came up in a recent column in the PV Mirror, one of the English-language news sources published in the Banderas Bay region. 

Authored by Luis Melgoza, a former legal advisor to the Mexican Congress and the ruling PRI party, the column strongly advised readers not to get IMSS coverage. Melgoza cited a personal experience that happened on January 2, when his wife was checked in at an IMSS hospital in Puerto Vallarta suffering from partial facial paralysis.

The columnist wrote that his wife was quickly given emergency attention, but he was soon shocked by an understaffed facility and unsanitary conditions, including "divider curtains stained with dried blood and other bodily fluids, as well as blood still fresh on the floor." 

Melgoza contended that "this hospital is a disgrace and extends the myth of poor medical care in Mexico; singlehandedly defeating all the efforts to attract medical tourism to Puerto Vallarta."

Pamela Thompson, a private health care consultant in Puerto Vallarta, said at the Democrats Abroad forum that the IMSS has a mixed reputation, with the branch in Puerto Vallarta getting bad marks while the facilities in Guadalajara, Ajijic and San Miguel de Allende get better reviews. 

"Some of the best doctors are in the IMSS system, especially in Guadalajara," Thompson said, adding that many of the IMSS physicians maintain their own private practices as well as working for the government. She cautioned, however, that the IMSS initially precludes coverage for pre-existing conditions and members must wait a couple of years before treatment of previous health problems can kick in.

In a follow-up e-mail to FNS, Thompson said the IMSS is expected to implement changes that will include outsourcing urology, oncology and other "specialty" services to the private sector and require patients to pay out-of-pocket for the treatments, though at a discounted rate. 

A second, low-cost government-run health insurance system, Seguro Popular, is also available to individuals with resident visas.

In contrast to the IMSS, Seguro Popular is geared towards the regional, or general, hospitals in the country. Some controversy has emerged over the enrollment of expats – and low-income U.S. border residents – in a health care system designed for the poor and subsidized by the Mexican government. 

For her part, Thompson is critical of foreigners using the Seguro Popular alternative, especially in over-strapped hospitals like Puerto Vallarta's.

"I have friends who are nurses there and they had to repair a ventilator for a baby a few weeks ago with duct tape (for an example)," Thompson wrote. "When I have to transfer a gringo to the Regional Hospital I am so embarrassed – they are taking a bed that should rightfully go to a Mexican. But you need to understand, this is my own personal opinion. Even with Seguro Popular one needs to pay for items, albeit a small amount." 

A veteran of the U.S. healthcare system, Thompson outlined other healthcare options for expats, including private Mexican insurance with its age limitations. For tourists, she heartily endorsed a traveler's insurance policy that includes air evacuation services, which might be needed in an emergency situation.

Typically, she said, the insurance travelers maintain at home will not automatically pay medical costs in Mexico but may reimburse expenses.

According to Thompson: "These HMOs do not send payments outside the U.S. If Mr. Jones is retired, has Medicare and a supplement, comes here for vacation, and has a heart attack, he will have to pay everything out of pocket and submit for reimbursements to his supplement. They normally reimburse at 80% minus a US$200 co-pay. In reality, there is a time limit for coverage outside the U.S. for a supplement, but as of this moment not one has ever requested a copy of the date of exit from the US (except Kaiser – they absolutely require it)." 

Thompson added, "If Mr. Smith works for a large company and has an HMO and he comes here for vacation, gets sick and is admitted to a private hospital, most likely he will need to pay everything out of pocket and then submit for reimbursement."

A current change in Mexican health care could complicate matters for some tourists. The government is now licensing physicians over the Internet for authorization to prescribe controlled pain medications like barbiturates and opiates, and requires patient information to enter into a computer data base. 

The catch is that the prescription requires a CURP number (similar to a U.S. Social Security number), which is available to persons with resident visas but not tourists.

In comments to FNS, Thompson quoted a local doctor who said the new policy is easier for doctors but problematic for visitors. "Almost all my patients with regular prescriptions have a CURP number, but tourists are going to have to struggle...," Thompson quoted the doctor. 

In a vivid illustration of Thompson's point about air evacuation, a former U.S. resident told the audience at the Puerto Vallarta forum how his wife had a medical emergency and had to be flown to Seattle. Though the couple had Medicare coverage, they did not have a primary physician and scrambled to obtain one before the air transport company would agree to evacuate the wife. Without the Medicare coverage, the cost of the emergency medical excursion could have reached $44,000, the man estimated.

"Maintain that primary care physician relationship, because if you're gonna go back (to the U.S.) you're gonna need it," he counseled. 

But the speaker added that that he and his wife had made the mistake of dropping Medicare Part D and were soon socked with high medicine costs.

"Boy, that pharmaceutical industry in the U.S. …," he quipped, "… it's like bending over." 

The scenarios presented at the Puerto Vallarta forum painted a picture of expats, snowbirds and tourists having one foot in the Mexican health care sector and the other one in the systems back home.

The stories testified how foreigners can and must navigate systems on both sides of the border. With tourism picking up again and more baby boomers contemplating retirement in Mexico as an affordable alternative, interactions between expats and visitors and the Mexican system will only increase. 

Considering the ages of many expats and tourists, a huge issue of concern is the current inapplicability of Medicare – and its Canadian equivalent – in Mexico.

Paul Crist cautioned older people who relocate to maintain their Medicare Part B (and Part D) Coverage at home.  "Even if you are planning not to go back, you never know," Crist said. A former U.S. Senate staffer, Crist said Medicare beneficiaries who stop paying Part B but attempt to reenroll get socked with a 10 percent penalty for every year of dropped coverage. 

With the boom in the baby boomer population from El Norte now residing south of the border, Crist tried for a long time to get a Medicare pilot program started in Mexico that would channel direct payments to Mexican healthcare providers. Unfortunately, the hotelier lamented, the effort ran into a brick wall even though the proposal made "so much sense on many levels."

For now, he's resigned himself to no change in the status quo until the political composition changes in Washington. "We need a new Congress," he said to a round of applause. 

Expats, snowbirds and interested travelers who happen to be in the Banderas Bay region can find out more about healthcare in Mexico at the annual Medical Matters conference scheduled next month for the Marriott CasaMagna Resort in Puerto Vallarta.

Now in its sixth year, the February 15 event is organized by Pamela Thompson's HealthCare Resources. The medical consultant calculated that the all-day event last year drew about 4,000 people who checked out about 70 exhibits, listened to speakers, and visited with "all local healthcare providers." Admission to the event is free.

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Frontera NorteSur (FNS)
Center for Latin American and Border Studies
New Mexico State University
Las Cruces, New Mexico

Kent Paterson is the editor of Frontera NorteSur.  Reprinted with authorization from Frontera NorteSur, a free, on-line, U.S.-Mexico border news source.