Discount Cards ... and they can offer discounts wit

1
Cross Border Health Insurance

• Options that may affect Elderly Mexicans and
  Mexican Americans

2
Mexicans and Mexican Americans Employed in the
U.S.

• Standard Employment Based Plan
• Covers Employee and may cover dependents
• Services in Mexico generally only available on an
  emergency basis
• Usually have a gate keeper and even if on the
  border Mexican providers are not in the network
• Elderly beneficiaries are generally only covered
  if they are the worker or the spouse

3
Employer Based Plans cont.

• Mexico only HMOs and PPOs
• -Available in San Diego and Imperial Counties and
  to some extent in Los Angeles
• Available as a dual choice option from certain
  employers
• Care limited to network in Tijuana or Mexicali
  except care not available in Mexico or
  emergencies in US
• Mexicans who commute to the US for work or some
  with families on border choose these plans
• Access Baja, SIMNSA and one of the options of
  Salud Con Health Net are examples
• Elderly relatives are not covered
• Insurance law in Texas keeps such plans from
  being offered

4
Dual or Complex Option Plans

• Salud con Health Net permits enrollees to choose
  clinics in LA, services in Tijuana or both or
  have family members pick different locations
• Access Baja has an option where workers far from
  the border can sign up for the US plan and family
  members on the border choose Mexico plan
• Western Growers provides limited package for
  agricultural workers in Arizona and California
  and a more expansive package for workers and
  their families in Mexican border cities
• None of these plans cover elderly dependents

5
Health Savings Accounts

• For families that live in Mexico or on the border
  the availability of providers in Mexico at lower
  cost may reduce the chance that they will
  outspend the accounts.

6
Discount Cards

• These are increasingly offered to immigrants in
  the US and they can offer discounts with
  providers in the US or in Mexico (ie. Club de la
  Salud) This could include discounts for elderly
  relatives as well.

7
Mexican Programs for Mexicans in the US with
dependents in Mexico

• Instituto Mexicano del Seguro Social (IMSS)
  Family Health Insurance for Mexicans Abroad
• -Sold through consulates in Houston, Los Angeles
  and Chicago
• -Annual premium tied to age of nuclear family
  member
• -Pre existing exclusions and does not cover
  certain problems
• -Parents are eligible for enrollment
• -Low level of participation probably due to
  complexity and need to coordinate a lot of
  variables
• -Since family members can enroll directly it
  probably makes more sense to send the money to
  them directly

8
Mexican Programs Cont.

• Sistema de Proteccion en Salud (Salud Popular)
• Provides a package of benefits for those who sign
  up (free for the poorest and subsidized for most
  others)
• Being rolled out across the states
• Immigrants to the US and their families in Mexico
  are eligible
• Fairly low enrollment by paying eligibles so far

9
Private Health Insurance in Mexico to cover
Visits to the US

• Health Insurance coverage is difficult to obtain
  over the age of 55 without many restrictions if
  the person has not been continuously insured by
  that Insurer
• Only about 3 percent of the Mexican population
  is covered by health insurance
• Lack of coverage when visiting may be a limit on
  elderly relatives visiting in the US

10
Medicare, Medicaid and Medigap

• Medicare and Medicaid will not cover care in
  Mexico except in very limited circumstance
• Certain Medigap policies will cover medical
  emergencies abroad for trips of less than 60 days
  duration

11
A Proposal

• It would make sense to have one or more
  demonstration projects in which Medicare and in
  some circumstances Medicaid will cover care in
  Mexico for beneficiaries who have retired there
• This could have the impact of permitting many to
  retire to Mexico who otherwise would not be
  willing to