Episode #131 – Marc Miller contrasts the Mexican and the U.S. healthcare systems.
In this episode, Marc talks about their health insurance and healthcare experiences in Mexico. He sets the stage by explaining why health insurance has been a thorn in his family’s side for over 20 years, starting with Mrs. Miller developing an endocrine system tumor in the 1990s. She became uninsurable except through an employer’s group health policy. As long as she was on a health plan, her treatment was very affordable. But their circumstances changed. Listen in, to hear of the insurance benefits the Millers found by becoming expats in Mexico.
[1:35] Marc welcomes you to Episode 131 of the Repurpose Your Career podcast. Career Pivot brings this podcast to you; CareerPivot.com is one of the very few websites dedicated to those of us in the second half of life and our careers. Check out the blog and the other resources delivered to you, free of charge.
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[2:29] Marc has released three chapters of the next edition of Repurpose Your Career to the Repurpose Your Career review team. If you would like to be part of the review team, please sign up at CareerPivot.com/RYCTeam.
[2:44] You will receive new chapters as they become available. Marc is looking for honest feedback and would love to get an honest review on Amazon.com after the book is released.
[2:55] Marc’s plan is to release the book in mid-to-late-September and do a virtual and a real book tour. He will be in Austin, the NYC Area, and D.C. during the months of September and October. Marc would love to meet his readers and listeners.
[3:13] Reach out to Marc at Podcasts@CareerPivot.com if you’d be willing to give him some advice on venues or groups who would be interested in hosting an event.
[3:23] Next week, Marc will replay a webinar that Susan Joyce of Job-hunt.org fame gave to the Career Pivot Membership Community called Personal SEO: Being Found and Protecting Your Privacy. This should give you a good sampling of the quality material available in the Career Pivot Membership Community. List to the end for more.
[3:53] This week, Marc had planned to give an update on their expat journey, about healthcare experiences, resident visas, and finance processes, but the healthcare experiences ended up being such a big piece, that this episode is all about health insurance and healthcare in Mexico.
Now on to the podcast…
[4:16] Please see the show notes at CareerPivot.com/episode-131 with additional resources and videos, which are fairly considerable.
[4:35] In this episode, Marc will talk about health insurance and healthcare in Mexico. He sets the stage by explaining some health problems of Mrs. Miller that led to her becoming uninsurable except for an employer group health plan.
[5:16] In 2000, Marc left IBM and went to work for a successful tech startup. The Miller’s have always lived frugally. They paid off the mortgage and their son’s college education, so, in their mid-40s they were debt-free. They don’t buy expensive cars and have always lived within their means.
[5:53] Marc’s timing in career pivots has been impeccable. He started at Agere, his first tech startup, in January of 2000 and rode out the Dotcom Bust recession. He started at Lifesize Communications, in December of 2007 and rode out the Great Recession.
[6:16] Marc just turned 63, and his wife is 64. She will be 65 and eligible for Medicare at the end of the summer. Medicare is a big deal.
[6:40] Health insurance has been a thorn in their side. When Marc works for himself, he can’t buy health insurance for his wife. No one will insure her. When Marc left his last tech startup, at the beginning of 2011, they went on COBRA, paying about $1,100 a month. After 18 months, Marc enrolled his wife in the Texas Health Insurance Pool.
[7:20] High-risk pools are not wonderful, in Marc’s experience. There is a lot of bureaucracy and it is expensive. Marc got a private plan from BlueCross BlueShield of Central Texas. After the Affordable Care Act came out, the Millers both went on the Exchange, first Mrs. Miller, and then, Marc, when his plan was terminated.
[8:05] That was OK until October of 2016 when Marc received a premium notice that their plan was going up 50% to $1,800 a month. That’s when their journey into becoming expats started.
[8:28] Marc knew when President Trump was elected and Republicans came into power that there would be chaos in the healthcare world. The Affordable Care Act is flawed; it is fixable but nobody wants to fix it.
[8:44] 2017 was an interesting year for the Miller family. They went to San Miguel de Allende, where his wife developed what they later learned was anemia. They went to Ecuador, where his wife collapsed so they came home. They had been at 9,000 ft. Marc recorded CareerPivot.com/episode-29 from his wife’s hospital room.
[9:21] Mrs. Miller has been treated and the condition was resolved. In 2017, the Millers spent $25,000 on health insurance and healthcare and did not reach their deductible. In 2017, they took a policy from Central Health, the public health organization in Central Texas from Sendero Healthcare, for around $1,100 a month.
[9:54] If the Millers had the same plan this year, they would be paying over $1,600 a month, or $19,000 in premiums for a $7,000 individual deductible and $10,000 family deductible policy. This sets the stage for why the Millers are expats.
[10:20] In Mexico, you have a public side to healthcare and health insurance and a private side. In the U.S., you have insurance exchanges and employer plans, which are private plans. On the public side, you have Medicaid and Medicare. Most of us will end up in Medicare, but there are reasons to opt out.
[10:59] In Mexico, on the public side, the two most common ones are IMSS, about which Marc has little information, and Seguro Popular, which stands for Popular Insurance. Seguro Popular is roughly the Medicaid of Mexico. As an expat with a resident visa, you can sign up for Seguro Popular. It is largely free.
[11:38] Under Seguro Popular, you are required to go to public clinics, doctors, and hospitals. Your wait times will be significantly longer than if you have a private plan.
[11:53] There are a lot of economic refugees in Mexico. The Washington Post had an article about the millions of Americans coming to Mexico. About two million from the U.S. are in Mexico; about nine million civilian Americans are outside the U.S.
[12:19] Healthcare and health insurance are large reasons and major drivers for the migration. Expats living strictly on their Social Security usually sign up for Seguro Popular because it is inexpensive. You can buy private health insurance. Listen to CareerPivot.com/episode-115 where Marc interviewed Valerie Friesen about it.
[12:58] Valerie Friesen is from Blue Angel Solutions. She sold the Millers separate private health insurance policies for Marc and his wife with a $5,000 deductible. The combined premiums for the year come to about $2,000. The carrier is VUMI, a U.S. company. The policies are catastrophic policies. Regular healthcare is inexpensive.
[13:48] Marc tells about his wife’s experience with an endocrinologist during their March–April 2018 trip. Being a retired R.N., Mrs. Miller has high expectations for her care. She was thrilled. She learned things that no other doctor had told her. She has been being treated since 1992. The appointment cost 700 Pesos (about $36).
[15:09] The doctor sent Mrs. Miller to a hematologist for her anemia. The appointment was made for two days later. The hematologist spent an hour with her and told her things she had not heard from other doctors. Mrs. Miller also saw a dermatologist. Each of the three appointments was 700 Pesos.
[15:54] Mrs. Miller also had bloodwork, and teeth cleaning. In total, the Millers spent $150 for healthcare. Marc has had his teeth cleaned twice, paying 600 Pesos (about $30). In the U.S., Marc paid up to $200 to have his teeth cleaned.
[16:40] Expats can get confused dealing with Mexican healthcare. Marc recommends some videos about emergency room experiences: The Expats Mexico, Tangerine Travels First Visit, Tangerine Travels Second Visit, Retirement Before the Age of 59.
[17:20] You are responsible to pay your bills at the time of service. Your medical records are yours. Mrs. Miller was emailed her results within three days. You are in charge of keeping your records. Marc shares a case study for a head injury for about $100 at a private clinic. It would have been less expensive at a public clinic.
[18:40] There is pricing for locals, and sometimes tourist pricing, which is higher. You have to ask how much it will cost. Marc shares another case study where the patient forgot to bring her medicine. If you have medicine, bring it with you! Clinics may not have your prescription available.
[19:43] Credit cards are not readily accepted in Mexico but they are accepted in the healthcare system. Even for hospitalization, you pay at the time of service, which may be $2,000 to $3,000, U.S., and then you file an insurance claim for reimbursement. Mexico is a cash society, so be prepared.
[20:13] Getting medications is largely inexpensive, as long as what you have is common. Mrs. Miller takes a thyroid replacement medication that she cannot get in Mexico. The Millers will go back to the U.S. once a year and get a refill for a year’s supply. Marc’s research showed him that this is a typical solution.
[21:13] This usually means you are getting the medication outside of your insurance. Marc’s wife can get one of her medication in Mexico but at a hospital, not at a standard pharmacy. So she has been buying it in the U.S., as well. It costs her $400 or $500 for a year’s worth.
[21:54] The Millers will go back to Austin in September when Mrs. Miller becomes eligible for Medicare. You will need to get educated on Medicare. Marc explains Part A and Part B. If you do not sign up for Medicare at 65, or discontinue Medicare and re-enroll later, you will pay premium penalties,10% per year that you waited.
[22:47] There are a lot of expats who never sign up for Medicare or who cancel it, thinking they will never go back to the U.S. They sign up for Seguro Popular, instead. Most expats eventually do go back to the U.S. The Millers will sign up for Medicare.
[23:24] Mrs. Miller will also sign up for Social Security at age 65, even though it is about a year early. They looked at the numbers and decided it was a good decision. She will pay her Medicare out of her Social Security payment.
[23:47] When you get older than 69, you cannot always apply for health insurance in Mexico, especially with a private health insurance company. There are many factors to research. The plan the Millers bought from VUMI at Blue Angel Solutions does not cover them in the U.S. It covers them everywhere else in the world.
[24:27] A plan to cover the Millers in the U.S. would have tripled the cost. When the Millers go back to the U.S., they buy a temporary health insurance policy from VUMI. When this show airs, the Millers will be in New Jersey for a wedding. They are paying $167 for a policy to cover them for the five days they will be in the U.S.
[25:06] When the Millers went to Austin for three weeks, earlier this year, they bought a similar policy for over $300. Mrs. Miller also bought a negotiated policy when she went back to the U.S. for a vaccination.
[25:35] After Mrs. Miller enrolls on Medicare, her trips to the U.S. will be covered.
[25:46] In Mexico, some expats are not rich but have enough money to retire on. They enroll in Medicare but do not buy Mexican insurance. They pay all their medical needs out of pocket. If something bad happens, they plan to go back to the U.S. for it to be covered by Medicare.
[26:27] Some expats do not sign up for Medicare as it does not cover anything in Mexico and they never plan to go back to the U.S.
[26:39] However, there is a hospital being built in the area that will take Medicare Advantage plans. In general, Medicare is only for the U.S. Some people living on Social Security cannot afford $135 a month for Medicare.
[27:11] In CareerPivot.com/episode-119, Marc interviewed Queen Michele, who is in her mid-50s and she has no health insurance in Mexico. She is living on $1,100 a month, her teacher pension. Health care is very affordable and she’s taking the chance of not needing anything big.
[27:30] Other economic refugees sign up for Seguro Popular and the health care they get is very good quality, even better than they might get in the U.S. You do have to shop around for doctors. Many of the doctors are trained in the U.S. Many are trained at the medical school in Guadalajara.
[28:24] There are several hospitals in Guadalajara. There is one small hospital in Ajijic. A bigger hospital nearby just opened. Being an hour outside of a major city is an advantage. There are plenty of English-speaking doctors in the area. Mrs. Miller’s doctors are based in Guadalajara but come down to Ajijic every week or two weeks.
[28:53] Mrs. Miller has been very pleased. Marc will go soon for his physical exam. Mexican Health insurance and healthcare have solved a lot of problems for the Millers. Marc will not move back to the U.S., if ever, before he is eligible for Medicare.
[29:34] The healthcare system and the health insurance business is very broken in the U.S. right now. There is a proposal for Medicare at 50. CareerPivot.com has a link to a blog: “Could New Medicare At 50 Bill Save You Big Money?” This is not Medicare for All but would allow people to sign up for Medicare at 50 and pay the full cost.
[30:06] In many cases this is a good median solution. A Medicare specialist recommended the article to Marc for the website.
[30:59] It’s not until you experience healthcare outside of the U.S. that you realize just how broken the U.S. healthcare system has become. Check out the show notes with the additional resources and videos you may find useful at CareerPivot.com/episode-131.
[31:23] The Career Pivot Membership Community website has become a valuable resource for approximately 50 members who are participating in the Beta phase of this project. Marc is recruiting new members for the next cohort.
[31:37] If you are interested in the endeavor and would like to be put on the waiting list, please go to CareerPivot.com/Community. When you sign up you’ll receive information about the community as it evolves.
[31:51] Those who are in these initial cohorts set the direction. This is a paid membership community with group coaching and special content. More importantly, it’s a community where you can seek help. Please go to CareerPivot.com/Community to learn more. They are starting a group for bloggers, writers, authors, and publishers.
[32:26] Marc invites you to connect with him on LinkedIn.com/in/mrmiller. Just include in the connection request that you heard Marc on this podcast. You can look for Career Pivot on Facebook, LinkedIn, or @CareerPivot on Twitter.
[32:45] Please come back next week, when Marc gives you a taste of what’s available within the Career Pivot Membership Community in an interview with Susan Joyce of Job-hunt.org fame about personal SEO, being found, and protecting your privacy.
[33:02] Marc thanks you for listening to the Repurpose Your Career podcast.
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