Medical Tourism Providing Health Coverage Beyond Borders

July 30,2010

Going for a check-up at the doctor’s office can be a bit like going to school – it can be a daunting experience at first, but you leave learning new things that you’ve never heard of before. Now imagine getting that lesson in a foreign country, communicated in a different language and in a different cultural environment. You might feel uncomfortable and confused, which is how many non-native English speakers can feel at the doctor’s office.
But there are options to make the doctor’s office less intimidating for non-native English speakers. Health plans are always seeking ways to help consumers feel more comfortable accessing care, and several California health plans offer cross-border coverage options to those who live or work near the Mexican border. These cross-border health plans can make consumers feel more comfortable going to their doctor and ensure they get the right care that they need.

How does a Mexico cross-border health plan work in California?

Cross-border health plans work the same way as traditional U.S. health plans. Members who sign up for a cross-border health plan have co-pays and choose their network healthcare provider from within the cross-border service area, which is generally the two major gateways into Baja California, Mexico – Tijuana and Mexicali.
Additionally, members covered under cross-border plans can still receive care in the U.S. if the service is not available in Mexico. For example, one major carrier allows members who need special transplants, such as heart and lung transplants, to have the procedure done in the U.S. through a bi-national referral process. It comes with no additional cost than what is outlined in the member’s plan. However, being referred for care in California does not guarantee the member’s entrance into the United States. They’ll have to make sure they have the proper paperwork filed with the U.S. Immigration and Naturalization Services (INS).

Why Should Brokers Consider Selling Cross-Border Coverage?

The demand for cross-border coverage continues to grow. Nearly one million people cross the border to Mexico to seek healthcare in a year, of which half are Mexican immigrants. An estimated 150,000 are insured through private health plans in the U.S and Mexico, according to a 2009 research article: “Heading South.”
Many seek cross-border health plans because they feel more comfortable going to a doctor in their native country. However, an additional selling point is that the cost of cross-border coverage plans can be significantly lower than traditional U.S. plans—by as much as a third of the cost. For example, the average monthly HMO premium for an individual under a U.S. plan falls in the $300 range while the same premium to receive care in Mexico is about $100 under one major carrier’s plan. Typically, the general cost of medicine in Mexico is about 50% to 60% lower than in the U.S.

What Should Brokers Discuss With Clients When Advising Them On Cross-Border Coverage Plans?

There are many factors to consider when talking to your clients about a cross-border health plan. First, brokers should make sure their clients are comfortable with receiving care in Mexico. Affordability alone doesn’t make sense if a client isn’t willing to cross the border for coverage.

Second, it is important to look out for certain eligibility requirements outlined by health plans. For example, to qualify for a one particular plan, employees and their dependants must live or work within the service area, which is approximately within 50 miles of the Mexican/U.S. Border. Enrollees can be Mexican citizens, U.S. citizens, or U.S. resident aliens or employees, who live or work in the plan service area, but receive salary and benefits from a California employer.

Third, brokers should take the time to compare costs with traditional health plans to show their clients how much money they can save with a cross-border coverage plan. A price list of office visits and hospital procedures can help a client determine if this kind of plan makes sense for their employees.
Finally, talk to your employer groups about how offering a wider variety of health plan options that suit their employee needs can give employers a leg up on hiring and retaining their workers.

Is It Safe To Receive Care In Mexico?

The old adage that “you get what you pay for” isn’t always true. Rates are lower in Mexico because healthcare typically costs less. Mexican hospitals are regulated under Mexican law. Its healthcare system is ranked 61 out of 191 countries by the World Health Organization. The organization also ranked the U.S. at 37.
Health plans contract with providers that meet quality standards. This holds true for cross-border provider networks too. For instance, with the plan we mentioned, all network physicians are licensed to practice in Mexico and are in good standing with their local medical society, and network hospitals are licensed by the state of Baja California and certified by the Mexican National Commission on Hospital Certification. Members who have the plan also have the same rights as any other HMO member in California. For example, members have the right to a second opinion and the right to file for grievances and medical appeals with the Department of Managed Healthcare.

What Lies Ahead For Cross-Border Coverage?

Cross-border coverage is a niche market in California; it’s not for everyone. But it’s an option to consider for members who live or work in the U.S. and have ties to Mexico or prefer to seek health services from Mexico. Today, the demand for cross-border coverage continues to build as companies seek workable healthcare solutions and alternatives to current offerings. It’s too early to tell how healthcare reform will impact cross-border coverage in California, but there could be a tremendous opportunity to save on healthcare expenses if individual coverage mandates are followed and those living near the Mexican border are willing to receive health services in Mexico. In the near term, we can expect to see cross-border programs expand across the state to meet members’ needs, and give previously underserved populations a health lesson they can understand.