It sounds almost too good to be true: a health care plan with no limits, no deductibles, free medicines, tests, X-rays, eyeglasses, even dental work — all for a flat fee of $250 or less a year. To get it, you just have to move to Mexico.
As the United States debates an overhaul of its health care system, thousands of American retirees in Mexico have quietly found a solution of their own, signing up for the health care plan run by the Mexican Social Security Institute.
The system has flaws, the facilities aren't cutting-edge, and the deal may not last long because the Mexican government said in a recent report that it is "notorious" for losing money. But for now, retirees say they're getting a bargain.
"It was one of the primary reasons I moved here," said Judy Harvey of Prescott Valley, who now lives in Alamos, Sonora. "I couldn't afford health care in the United States. … To me, this is the best system that there is."
It's unclear how many Americans use IMSS, but with between 40,000 and 80,000 U.S. retirees living in Mexico, the number probably runs "well into the thousands," said David Warner, a public policy professor at the University of Texas.
"They take very good care of us," said Jessica Moyal, 59, of Hollywood, Fla., who now lives in San Miguel de Allende, Mexico, a popular retirement enclave for Americans.
The IMSS plan is primarily designed to support Mexican taxpayers who have been paying into the system for decades, and officials say they don't want to be overrun by bargain-hunting foreigners.
"If they started flooding down here for this, it wouldn't be sustainable," said Javier Lopez Ortiz, IMSS director in San Miguel de Allende.
Pre-existing conditions aren't covered for the first two years, and some newer medicines and implants are not free. IMSS hospitals don't have frills such as televisions or in-room phones, and they often require patients to bring family members to help with bathing and other non-medical tasks. Most doctors and nurses speak only Spanish, and Mexico's overloaded court system doesn't provide much recourse if something goes wrong.
But the medical care doesn't cost a dime after paying the annual fee, and it is usually good, retirees and health experts say. Warner said most American retirees enroll in IMSS as a form of cheap insurance against medical emergencies, while using private doctors or traveling back to the USA for less urgent care. Medicare, the U.S. insurance plan for retirees, cannot be used outside the United States.
Program prompts relocation
The program has helped people such as Ron and Jemmy Miller of Shawano, Wis. They decided to retire early, but knew affording health care was going to be a problem.
Ron was a self-employed contractor, and Jemmy was a loan officer at a bank. At ages 61 and 52, respectively, they were too young to qualify for Medicare, but too old to risk not having health insurance.
"We knew that we couldn't retire without Medicare," Jemmy Miller said. "We're pretty much in Mexico now because we can't afford health care in the States."
The couple learned about IMSS from Mexico guidebooks and the Internet. They moved to the central city of Irapuato in 2006, got residency visas as foreign retirees, and then enrolled in IMSS.
The IMSS system is similar to an HMO in the United States, Jemmy Miller said. Patients are assigned a primary care physician and given a passport-size ID booklet that includes records of appointments. The doctor can refer patients to specialists, a bigger hospital or one of the IMSS specialty hospitals in cities such as Guadalajara or Mexico City.
In 2007, Ron Miller got appendicitis and had emergency surgery at the local IMSS hospital. He was in the hospital for about a week and had a double room to himself. The food was good, the nurses were attentive, and doctors stopped by three or four times a day to check on him, he said. At the end of it all, there was no bill, just an entry in the ID booklet.
The Millers may soon move back to the United States, but Jemmy Miller said they want to try to maintain the IMSS coverage. "If something big really comes up, we'd probably come back to Mexico," she said.
Different levels of care offered
IMSS is one of several public health systems in Mexico, each with its own network of hospitals and clinics. The program, which was founded in 1943, is funded by a combination of payroll deductions, employer contributions and government funds. It covers 50.8 million workers.
IMSS facilities are a step up from the state hospitals, but not as advanced as Mexico's private hospitals, which are often world-class, said Curtis Page, a Tempe, Ariz., doctor and co-author of a book about health care in Mexico.
Most patients seem grateful nonetheless. When Michael Kirkpatrick, 63, of Austin, fell off his motorcycle near his home in San Miguel de Allende, IMSS surgeons gave him a stainless-steel artificial hip.
There was no physical rehabilitation after the surgery, just a checkup a few weeks later.
"There was not the kind of follow-through and therapy that you would expect if you were doing this in the first world," Kirkpatrick said. "But it was satisfactory. The hip feels good."
Bob Story, 75, of St. Louis, had prostate-reduction surgery at an IMSS hospital in Mazatlán and discovered that patients were expected to bring their own pillows. It was a small price to pay, he said, for a surgery that would have cost thousands of dollars back home.
"I would say it's better than any health plan I've had in the States," he said.
By Chris Hawley, USA TODAY. Chris is Latin America correspondent for USA TODAY and The Arizona Republic
via USAToday