Please help me understand health insurance

0POSTS

10 years ago

We are arriving Monday and I'm trying to get health insurance for our family but I'm having a heck of a time decoding the tables on the Triple S website. Can someone help me understand what a few of these things mean?

One thing that's in the chart is Hospitalización Level 1: $ 975, Level 2: $ 1.075, Level 3: $ 1.325. Can anyone explain what these levels are and what they mean? For example, Level 1, $975, does that mean that we'd pay a flat $975 for a hospital visit in Level 1? And again, what does "Level 1" mean?

Partial Hospitalization 40%

Primer Nivel de Cubierta (Individual / Familiar) $ 800 / $ 1,000

Coaseguro luego del primer nivel de beneficios 90%

Granted, I'm going off of google translate here, but I'm not seeing anything about a total deductible, max out of pocket, etc...I tried calling, but either something on their end or something on mine was making it impossible to carry on a conversation about this.

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GuestPoster550 Guest

0POSTS

10 years ago

OK, I've learned now that PR medical insurance doesn't really have deductibles. It just has a copay for everything essentially. But I still don't understand what partial hospitalization is, first level of coverage, or coinsurance after first level of benefits is...

Schuttzie Serial expat

824POSTS

10 years ago

I'm sorry I don't know, SpecialKev, but someone will come along and explain it, I'm sure. You must be getting excited and anxious for Monday. I wish you all the best!

victorlglass Serial expat

246POSTS

10 years ago

I recently received a personal email from President Obama asking if I would explain how health insurance works (haha!).

ReyP ViP

5509POSTS

10 years ago

I donk think Obama and the rest of the crew use ObamaCare plans. Maybe he wanted you to explain it to congress since they dont use it either.

Schuttzie Serial expat

824POSTS

10 years ago

LOL

sandrarduncan Serial expat

487POSTS

10 years ago

They have many triple-s facilities on the island. Where you can go and talk to someone. I have va insurance as a spouse of a disabled veteran .So I haven't needed to get insurance here

1 member reacted to this post

ReyP ViP

5509POSTS

10 years ago

I requested a Quote about 6 months ago from Humana, the cost depended mostly on your age.
Currently working I pay about 280 a month via work for a family coverage.
The quote was for after I retire at age 63, with my wife at age 57 (robbed the crib, yes) they quoted me at about 480 and the wife at 350 or so for a gold plan. So that is like 830 for both.

Once I reach 65 it will be a completely different plan since one will be Medicare + medicare advantage and the other regular (wife).

It would be helpful to me to hear about people 65+ in medicare and medicare advantage (full coverage) to hear what sort of cost are we talking about. Anyone on Medicare + medicare advantage with no other VET and no other private / work plan. What does it cost for a straight forward medicare + medicare advantage at 65+ age?

Schuttzie Serial expat

824POSTS

10 years ago

Those quotes seem really pricey, Rey. There must be other carriers that you could get more quotes from.

sandrarduncan Serial expat

487POSTS

10 years ago

#10

I agree .Pretty pricey for the horrible medical service you get on the island

ReyP ViP

5509POSTS

10 years ago

#11

I looked up at triple S and they had similar prices. The older you are the higher the prices, also depends if you go with Bronze, Silver, Gold or Platinum.

The prices I posted for me are Gold. The highest is Platinum, so I selected an estimate for Gold plan which is 1 down from that.

They all cover the same services, it is a mater of what is the maximum out of pocket (deductible) you have a year and the amount of percentage they pay for some of the services.

My biggest fear is something bad like cancer or a major operation that could put us 1/4 of a million or even a million in debt, which would completely ruin my retirement

. But it looks like these plans pay 100% after you have reached the maximum yearly deductible, if that is correct, I can breath a little easier. The older you get the more likely something will break, just like an old car, we only get so much mileage, LOL.

Another thing to consider is treatment in the mainland, some of the plans only pay 25% to 50% of the bill, which can add up to hundreds of thousands of dollars in debt.

tonie064 Contributor

181POSTS

10 years ago

#12

Sandra, you say that you have VA insurance as the spouse of a disabled veteran? What type of disability? The reason I ask is that my hubby is also a disabled vet with 20% disability and I don't get nothing. Is he 100% disabled? The reason I ask is that I go to the VA with him all the time and if I could get care there also, it would be good.

Where do you go for care- San Juan or Mayaguez since you are in Rincon? He goes to Arecibo for regular care and to San Juan for more intense care and xrays, etc.

I had to get my own Medicare insurance and I chose MCS which has worked out well for me. There is no additional cost beside what they take out for Medicare and there is no deductible. the co pays are not much and I believe that this coming year it will be even less.

Thanks for any info you can give.

Tonie

Dora787 Contributor

121POSTS

10 years ago

#13

tonie064 wrote:
Sandra, you say that you have VA insurance as the spouse of a disabled veteran? What type of disability? The reason I ask is that my hubby is also a disabled vet with 20% disability and I don't get nothing. Is he 100% disabled? The reason I ask is that I go to the VA with him all the time and if I could get care there also, it would be good. Tonie

Hi Tonie,

The insurance that Sandra is referring to is called Champ VA. The Veteran has to have a rating of 100% Permanent and Total Disability. Not just 100% but P&T also. In Puerto Rico at this time people with Champ VA can't receive care at a VA Facility they have to see a Private Doctor.

ChampVA Eligibility

sandrarduncan Serial expat

487POSTS

10 years ago

#14

My husband is 100% disabled .And only one place on the island accepted champva and its in San Juan. It's ridiculous considering many veterans and their families live here. I have fought with veterans administration about this .By law any place that accepts Medicare and or Medicaid is supposed to accept champva .And San Juan va is the only va that will allow dependents to get care there however they aren't accepting new patients for years .They really need to do something about this

tonie064 Contributor

181POSTS

10 years ago

#15

Thanks Dora. I had Champus when my hubby was in the service and in fact I used it for Maternity services for my second son.

My husband only has 20% disability and thus I do not qualify but that is ok. I am happy with the MCS that I have.

Thanks again and Happy Holidays to you and yours.

Tonie

tonie064 Contributor

181POSTS

10 years ago

#16

Hey Rey, how are you and yours? We are all fine. In answer to your question about cost for someone over 65(I can't believe that I am 65 but it is a fact, I know that I don't look like it, ha ha).

Anyway, before I turned 65, I called MMM and was told that there is no premium just what the government takes out of my SS for the Medicare which is $105.00 per month. I had to waiit until I turned 65 so I said that I would call back.

In the interium I went to the Social Security office in Arecibo to change my card since I still had it under my married name and since here they go by a women's maiden name, it had to be changed. Also to get a drivers' license i had to have a ss card in my maiden name as my birth certificate. I can't understand this but that is the way it is here. Do American women have to change their ss card or drivers license to their maiden name as we do????

Anyway, I went and got a new ss card and outside there was a rep from MCS and I spoke to him and he explained everything and said that there is no premium and that most doctors are included, etc. all the necessary malarky, so I signed up and received my card, etc and it was valid from a month before my birthdate.

In the meanwhile I received a call from MMM about coverage and I told them thaty I had it already because since i was waiting for a call which never came and I had the opportunity to get medical insurance which I did not have, I got MCS.

In the long run, I have been happy with it. They did not take it in the Centro de Salud de Quebradilla but I found a very good doctor right in town which I like and all the tests have been covered also. I have to pay some for my meds but it is not as much as if I didn't have insurance. They initially sent me the info in Spanish and I could read it but it is easier in English so I called and they sent me everything in English from then on. They also have English speaking rep if needed.

So before you pick a company, do your research and I believe that there isn't a premium with most companies but also the plan I have is not Platium, it is MCS Essential or something like that.

Good luck in your future retirement and how is the purchase of the farm going?

Take care and Have a Feliz Navidad and Prospero Ano Nuevo!!!

Tonie

ReyP ViP

5509POSTS

10 years ago

#17

tonie064 wrote:
Hey Rey, how are you and yours? We are all fine. In answer to your question about cost for someone over 65(I can't believe that I am 65 but it is a fact, I know that I don't look like it, ha ha).

Anyway, before I turned 65, I called MMM and was told that there is no premium just what the government takes out of my SS for the Medicare which is $105.00 per month. I had to waiit until I turned 65 so I said that I would call back.

In the interium I went to the Social Security office in Arecibo to change my card since I still had it under my married name and since here they go by a women's maiden name, it had to be changed. Also to get a drivers' license i had to have a ss card in my maiden name as my birth certificate. I can't understand this but that is the way it is here. Do American women have to change their ss card or drivers license to their maiden name as we do????

In the meanwhile I received a call from MMM about coverage and I told them thaty I had it already because since i was waiting for a call which never came and I had the opportunity to get medical insurance which I did not have, I got MCS.

In the long run, I have been happy with it. They did not take it in the Centro de Salud de Quebradilla but I found a very good doctor right in town which I like and all the tests have been covered also. I have to pay some for my meds but it is not as much as if I didn't have insurance. They initially sent me the info in Spanish and I could read it but it is easier in English so I called and they sent me everything in English from then on. They also have English speaking rep if needed.

So before you pick a company, do your research and I believe that there isn't a premium with most companies but also the plan I have is not Platium, it is MCS Essential or something like that.

Good luck in your future retirement and how is the purchase of the farm going?

Take care and Have a Feliz Navidad and Prospero Ano Nuevo!!!

Tonie

Hi Tonie,

That stuff is very interesting, including the part of changing the SSN cards to maiden name.
Before the MCS medicare plan, how much were you paying for you and your husband for medical insurance?

As to the farm house, they screwup the filing due to an error on the land division measurements. They have to re-measure the land and refile. Since the guy that measure has to re do it for free, they have not moved very fast. The date is in the air at this moment. The lawyer told me to just wait until they are done then set a closing date.

Thanks

sandrarduncan Serial expat

487POSTS

10 years ago

#18

Rey .Yup that's the way it is here regarding land. It's a nightmare. Towns don't even have records of who owns property. I know plenty of people who have been through this. That's why we chose to rent .No headaches with that. If there's an issue you just pack your stuff and move elsewhere with no worries of mortgages and fixing things when they go wrong. I am happy in Rincon .A 3 bedroom 2 bathroom in Rincon 10 mins to town ,beaches and grocery stores. Views on the ocean on both sides of the house with water included We have solar water heater and a cistern and only pay $500 a month

1 member reacted to this post

tonie064 Contributor

181POSTS

10 years ago

#19

Rey, sorry to hear of the delay in the closing but they say here, they do everything on "Puerto Rican time". In the end, it will be well worth it.

As far as insurance, I had United Healthcare in NY and I paid about $328.00 per month just for me on an individual plan. My hubby goes to the VA so he didn't have outside medical insurance. Here, he also goes to the VA and thus has no other medical insurance,

From the time, we got here in May 2014 until July 2015, I didn't have any medical insurance since United Healthcare was not taken here so when I went to the Centro de Salud, I had what they call Sliding Scale fee and it was based on my salary and/or ss. It was not ideal but it worked for the time being. I have to get some type of insurance for my grandson who is a student and right now, he is also sliding scale and since he doesn't work, his salary is "0". He also had United Health Care in NY.

Oh well what can you do, this is Puerto Rico and we have to contend with whatever system they have here.

Take care,

Tonie

ReyP ViP

5509POSTS

10 years ago

#20

If all they count is salary or ssn, it wont be bad as long as they dont ask about my RIA. My Ssn will be a little over 2000 a month as my only income if they dont ask about IRA.

Marion-Olga Contributor

147POSTS

10 years ago

#21

My daughter and I are insured with Servicios de la Salut Bella Vista in Mayagüez. It costs us $150 per month.
My husband is a Veteran and goes to the Veteran Hospital.

ReyP ViP

5509POSTS

10 years ago

#22

Marion you are probably fairly young that is why your cost is low. I am looking at 800-850 for my wife an I until I hit 65.
They charge more when we are out of warranty, LOL.

Marion-Olga Contributor

147POSTS

10 years ago

#23

I guess you are right. I am 40, my daughter 14! But this is no garantee for not getting an horrible illness!

ReyP ViP

5509POSTS

10 years ago

#24

Marion-Olga wrote:
I guess you are right. I am 40, my daughter 14! But this is no garantee for not getting an horrible illness!

No, but they just figure that my parts are more likely to wear out before yours does, so more replacement cost, LOL.

tonie064 Contributor

181POSTS

10 years ago

#25

Wow, Sandra, your house sounds perfect and the rent is so low. How did you find it? We got our house through Clasificados and it is a big house 5 bedrooms and 3 1/2 baths with a nice yard and 3 balconies. We also have a view of the water if we go on the upstairs balcony, ha ha. We pay $750 with no utilities but it is ok since our bills aren't that much.

Another advantage of our house is that we can walk into town , which we used to do before we had a car , are about 5 mins. away from one beach -Guacataca and 10 mins from another beach Puerto Hermina. We are in the middle between Isabela and Camuy and Hatillo so we can go either way to go shopping. I like it becasue it has a small town vive. We have been here for 1 1/2 years and may buy it eventually.

GuestPoster550 Guest

0POSTS

10 years ago

#26

Ha, and your deal sounds amazingly cheap to us! We have a 3 bed, 2 bath in Aguadilla. Nice yard, over a dozen fruit trees, enclosed garage, but no view of the water, no balconies, and we're paying $750 as well.

We moved in Dec and it was very difficult to find any suitable housing (Or realtors who would call us back) at all, so we still feel lucky to have found this place.

Bhavna Team

43459POSTS

10 years ago

#27

Hello everyone,

Sorry to interrupt but could we discuss/share on the subject launched by the OP : Health insurance

For accommodation prices, a new topic can be opened here : https://www.expat.com/forum/post.php?fi … mp;catID=7

All the best
Bhavna