What if US health insurance "worked" in Nicaragua?

There is an interesting article titled Medical Travel: If Bill Gates Wanted to Do Something Good for the World in Truthout that offers a good start on a question. While the article is about the idea that someone with a lot of money could start an insurance company that encouraged cost-effective health care, we can ask the same question about Medicare.

Right now, Medicare covers your health care in the US (more or less). What that means is that if you need to have your gall bladdar removed or some such thing and you live in Nicaragua you have a choice of travel to the US or not having the surgery being covered by Medicare.

Does this make sense -- either for you personally or financially? Even if you elected to go to the most expensive private hospital in Nicaragura or Costa Rica, the cost would be a fraction of that in the US.

The article goes on to offer some price comparisons not for the developing world but with Spain, Argentina and Chile. The article suggests this has more to do with corruption than anything logical.

However providers of medical care in the United States, drug companies, medical equipment suppliers, doctors and others who benefit from high prices, are far more powerful than steelworkers or textile workers. As a result, the trade deals we have been writing over the last three decades have not been designed to facilitate medical trade.

The article goes on to suggest that if there was really a free market for medical care -- that is you could pick having it performed in some place other than the US -- it would create a downward pressure on US medical costs. In other words, US medical care might be forced to become cost-competative with other countries offering medical services.

Comment viewing options

Select your preferred way to display the comments and click "Save settings" to activate your changes.

Slightly off-topic (late) addition

In case anyone cares.

The following may give a bit more perspective to this issue: The Dream of Moving Abroad in Later Life, With Good Health Care http://www.nytimes.com/2014/02/22/your-money/the-dream-of-retiring-abroa...

Or not. Your call, I guess.

No Sniveling!

How ACA is inspiring real changes

An article titled Love It or Hate It, Obamacare's Spurring Interest in the Pathology of Health Care makes the point that "Obamacare" has inspired people to take a serious look at what is wrong with US health care.

Vermont's reform is mentioned and now how Maine has become serious about reform.

The media frenzy surrounding the troubled rollout of the ACA since early October has provided commentators (including myself) many opportunities to point out publicly that although the functionality of the ACA’s websites fell short in many states, the underlying problem is not bad software. It is the expensive complexity baked into the law. That level of complexity can only be justified by politics — the perceived need to preserve a central role for private health insurance companies, despite their widespread unpopularity, as a means of financing health care.

While the article goes on to talk about the savings of just expanding Medicare, that is just one of the ways to simplify the system. If the goal is to provide health care in a cost-effective manner, covering international services should certainly be considered.


I returned to Ecuador about six weeks ago.

Shortly after that, I heard about a plan that was shopped around but never implemented, possibly due to poor marketing (they didn't get enough subscribers to start up the business). Let's call the proposed business The Company.

Business model essentials:

  • Medicare subscriber designates The Company as the Medicare provider of record
  • The Company collects $1000/month ($12,000/year) from Medicare, per subscriber
  • Subscriber, in Ecuador, is able to receive medical care, in Ecuador, from local doctors and hospitals
  • Subscriber's bills are paid for directly by The Company (not by Medicare)
  • No claim is ever submitted to Medicare
  • The annual limit for services, in Ecuador, is something like $5000, which pays for a lot of care here
  • Once a year The Company pays to fly Subscriber to Miami for a physical exam
  • The Company keeps the difference between what Medicare pays for Subscriber ($12,000) and Subscriber's charges
  • This difference is The Company's profit
  • Since Subscriber's charges are limited, The Company's profit is guaranteed

Apparently this would all be legal. I'm hoping that they try again to get this going.

No sniveling.

I like it.

I like it.

US overcharges

An article by Ralph Nader titled Medical Price Gouging talks about waste in the current US-based system offering some real numbers. With the kind of numbers offered, even price gouging by the Nicaraguan medical industry would amount to huge savings.

Americans spend more on health care than anywhere else in the world. One would hope and wish, at the least, that this enormous expenditure would provide a quality of healthcare above and beyond that found in the rest of the western world. The reality is that the results on average are no better than in France, Germany, Canada and elsewhere, which manage to provide their quality treatment without all the overcharges.

Bill Gates got rich

because of circumstances, not because he was trying. It could not do it if he tried. As many people in the US that got to make a lot of money, they are made into god like figures until they believe it and think they can change the world. They are not god and are not better than anybody else trying to change the world. Henry Ford came to mind. He tried and made a fool out of himself. He would have also killed the Ford Motor Co. if not removed from power by the 1940s.

The US has the worst health care of planet, if nothing else becausse it is the most expensive by far, about 30% more expensive than the next developed country. Probably about 1000% more expensive than underdeveloped countries.

The health insurance system does not work, and government regulations don't work either. In the US has simply created a health provider market, and they get rich at the expense of the patients.

I live in the US but go to Nicaragua and outsource health care as much as I can. As I can buy from farmacies without presciption. In the US I was told by that my stomach endoscopy for instance, would cost me US $2400 out of my pocket, and that was with insurance and $1000 deductable. I went to Nicaragua and had it done for $200. No insurance, and only dealt with the Doctor. Other parties like anesthesiologist or clinic was all included.

I hope the Nicaragua health system never becomes what the US healh system has become. It is one reason, not the only one, why I will go back to Nicaragua in retirement.

Health Care and Health Insurance

Something that all to many usanos seem to miss is that health care and health insurance are not one in the same. I have never wanted health insurance, just health care. But, in the US you pretty much need health insurance to get health care.

The basic thing wrong with that model is that you now have two entities that are trying to make a profit off of your health needs. That is not the way to reduce costs. I offer the "Canada model" as an alternative.

In Canada, the government (at the provincial level) is the "insurance company". They are not there to make a profit. They negotiate fees with private doctors. For example, the negotiated price for the procedure you mention might be $500. There is no requirement that all doctors offer it but, if they do, they can only charge $500. The fees are negotiated in order to minimize cost while still insuring the quantity of service needed.

When I did my homework on this, the overhead cost for dealing with insurance in Canada was about 5%. In the US it was 25-30%. In Canada you still have doctor choices, just not insurance provider choices.

The US pretty much optimizes income for doctors and insurance companies. Canada tosses out the insurance companies. In Nicaragua, health care is rather Libertarian with a low-level safety net.

When you come back to Nicaragau you will also find that;

"Many Nicaraguans got to make a lot of money, they are made into god like figures until they believe it and think they can change the world"...


I see this type everytime I go on the Panam. They are the ones passing on curves in luxury cars with an ``M`` on the license plate!

``Socialism works fine until you run out of other peoples` money``

Margaret Thatcher

You Can Get

some level of MediCare support out of country, if you elect to sign up for a Medicare Advantage plan.

My Humana plan provides for $25K reimbursement for an out of the US emergency medical need. . . .

Cost varies by state (by the cost of medical provision in that state). In idaho, it was free (I paid the monthly prescription insurance of $28 that was bundled with it). It's deducted from your bank account monthly, perhaps the same one you direct deposit you SSI into. Medicare gives $775 monthly to Humana; it's up to Humana to manage my medical care within that figure.

I have never used it, so don't know how it works in practice. A call to Pellas' insurance coordinator might provide enlightenment. I'm moving my US base to Tucson this year; Humana Advantage is available in most major markets but not in many rural areas.

It's clearly not a solution for someone with a chronic condition, but I assume that if I had a medical emergency like a car accident (and could get to Pellas before I bled out,, no guarantees here) the plan would reimburse me for the Pellas charges. That might happen some day: on the way back from CR last week late at night I encountered another large, dark truck going about 5 MPH in my lane on the Pan Am -without tail lights.

If I saw something coming, like Dengue, I would get on the next plane to Miami, Houston, or LA, and head for the closest brand name hospital's emergency room. I'd load up with Advil and decongestants so I looked normal as I got on the plane.

"...Bill Gates Got ...

rich . . ."

Off thread,,,, but, Bill Gates was presented with an opportunity and ran with it.

I see a lot of Nicaraguan returnees just doing things right. They are the ones who managed to acquire some wealth in the US, and returned to invest it. They do things differently from Nicaraguans who haven't had the opportunity to travel.

People respond to these differences in attitude (that translate most immediately into customer service), and put money in the returnee's pockets. The other hotels in Jinotega wonder why the Hotel Cafe is always full ???? It's not price, the rooms are small, but there is a welcoming attitude on the part of the staff. Rebecca and hugojose will never figure it out, but others do.

I deal with an upstart fereteria owner in Condega who treats me like a human being, rather than deal with the larger, more established one around the corner from my house. The next door owner is nice enough, but he's rarely there, and his employees have great difficulty hiding their annoyance at being distracted from their MAJOR occupation, watching soccer and telenovelas. The other guy takes the time to work with me, and everything I need shows up the next day on his re-supply truck.

OK, just trying to figure it

OK, just trying to figure it out. Yes, I live here full-time. For some purposes, I have an "official" (don't know what that means) address at my son's house in PA. I could move that to my daughter's house in FL. It would seem to me that this service offered in NIC would only be legal for those that lived in FL most of the time and were visiting NIC.

health insurance

Why would it work in Nicaragua? It doesn't work in the US. Tort reform will never happen. The paperwork required by the paying agency would be a quagmire/nightmare. I plan to file a 2555 tax form for 2014. I am casting myself adrift from any congressional concern at that point, free fall. I looked into the Affordable Care Act but it doesn't apply to me as a soon to be ex-pat. I filled out the form, (2hours and 2 phone calls that were very helpful) I wanted to support President Obama but didn't qualify because of the 2555 form. In my opinion, if it's not fixed, don't screw it up further. You have what you have.

Charles Slane

Thinking more about the CR model

Again, in Costa Rica there are hospitals that are US-related. For example, one is related to Baylor University and I was told they train their staff in CR as they do in the US. I don't know about the legalities of malpractice suites and such in Costa Rica but, again, with a real single-payer health care system, this gets a lot simpler.

Let me toss out an idea. If you could use Medicare outside the US but it was subject to local laws, complications could be eliminated. In the case of a real single-payer system like Costa Rica, Medicare could just work with them (like any US-based insurance company). With the potential huge savings, this could easily be justified.

Maybe Things Are Not So Sweet In CR Either

Another opinion - Who Knows?
University of Costa Rica (UCR) will explore what it describes as the crisis facing Costa Rica’s public health system, known locally as CCSS or, more commonly, the “Caja.”
Production of the film, titled “La Caja de Pandora” (literally, Pandora’s Box) was led by Professor Pablo Ortega who has worked on other social and environmental documentaries, such as “Costa Rica, SA.”
The investigate documentary, produced by the UCR Media Laboratory for Investigative Documentaries, analyzes the depth, origins, and future effects of the “crisis” facing the CCSS.
“[The film] is an effort to provide the public a clear picture of the process of deterioration of one of the most successful models of [social security and public healthcare] in the world, and to show that this process [of deterioration] has continued, despite what authorities of the institution tell [the public],” Ortega told the El Pais newspaper.

Health Care

A friend pointed out an ad in La Prensa for Medicare in Nicaragua. We called and were told that one needed to have a Florida address. Does anybody know if this is legal? The company is called Golden Health Medical Center and has phone numbers in Nicaraua and Florida. NIC 2265-2730 / 2265-2610 / 8560-5319 and FL 305-559-0278.

Try claiming when you need to.

You are effectively lying about your address.

You do not live in Florida if you live here full time or if you are from another State.

Especially if you are going to claim non residencefor IRS, ergo Obamacare purposes!!

You sign and submit that claim and it could be Insurance fraud.

Golden Health Medical Center (GHMC) says: Retirees must have an official address in the area of ​​insurance coverage with which we work in the United States, in this case in Florida.

The American citizen can move to any country, but must have an official residence there.

Not an address..."an official residence"

AT most presentations they will tell you a mail box is OK.....not so.


So as I am not Assuming anything.....this is from Medicare:

Medicare coverage outside the United States is limited.

In most situations, Medicare won’t pay for health care or supplies you get outside the United States (U.S.). The term “outside the U.S.” means anywhere other than the 50 states of the U.S., the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. This fact sheet explains some of the exceptions that would allow you to get coverage outside the U.S. under Original Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance).

When does Medicare cover health care services in a foreign hospital?

There are three situations when Medicare may pay for certain types of health care services you get in a foreign hospital (a hospital outside the U.S.):

1. You’re in the U.S. when you have a medical emergency, and the foreign hospital is closer than the nearest U.S. hospital that can treat your illness or injury.

2. You’re traveling through Canada without unreasonable delay by the most direct route between Alaska and another state when a medical emergency occurs, and the Canadian hospital is closer than the nearest U.S. hospital that can treat your illness or injury. Medicare determines what qualifies as “without unreasonable delay” on a case-by-case basis.

3. You live in the U.S. and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat your medical condition, regardless of whether it’s an emergency.

Remember, in these situations, Medicare will pay only for the Medicare-covered services you get in a foreign hospital.

Doesn't make sense

It would seem that your address isn't important but the address of the doctor/clinic/hospital is.

North American Price Insane

Many complain about Nica corruption but what about the insane corruption in North American health care including Canada. Cost of a hip replacement at a private clinic in Spain first world 8000.00 euro my aunt just had one. Cost in Canada and US up to 10 times more. Why? Other peoples money is paying for it.


I know a woman

that had a hip replacement in Jinotepe US$ 2.800 I think.

Veterans medical care

Is available here in Nicaragua, but only after jumping through some hoops. You need to register with the proper VA department and keep all receipts and then everything that is considered directly related to your disability is reimbursed to you. The VA decides what is related or not. Then a government check is mailed to you. No direct deposit is available.

I have tried it once and I received a check for $50.00. I was surprised it got to me, as I have had so many things sent to me simply disappear in the mail.

While the option does exist, the system seems to be anything but user friendly. I doubt I will use it again.

1st Capt. Ron

(Title by Miskito Alan)

Its an Op Ed, not an Article

and if it had not started with

"Bill Gates, the man who got incredibly rich by gaining a near monopoly"....

you and now us would not be reading it.

It would require a massive change in the legal system, a change that will never happen for fear of losing even more ground in a knock on effect.

That's my Op Ed.

Assume == ass of yoU and Me

Here is what got me to read it: this tweet

What if Americans could get #healthcare in other countries covered by their insurance? http://www.truth-out.org/opinion/item/21189-medical-travel-if-bill-gates... … @deanbaker13

The URL only appeared up to /2... Thus, it had nothing to do with Bill Gates and everything to do with covering medical costs outside the US.

Please explain what you mean by "legal system change". To me, I only see the need for Medicare to say they will pay up to the US normal price (what they would cover) for non-US services.

As an example of how this could work, look at Costa Rica medical plans. First, the insurance company is the government. Thus, no private profit motive. If you enroll in their standard plan (very much like a typical US plan where they would pay 80% for in-plan doctors and 70% for any other up to what is "typical" in Costa Rica) you have a plan that works anywhere. When I enrolled it cost me around $40/mo. If I went to a US doctor it was covered. It is just that 70% of Costa Rica prices might be only 10% of US prices.

You can spilt hairs about the Bill Gates comment if you like.

The litigation oriented legal system of the US (and Canada to a degree) has helped increase costs from anything from a procedure, a drug, a diagnosis all the way through to surgery and recovery.

The Doctor wants good remuneration for that exposure. He pays a very healthy insurance personally as well as the hospital paying theirs too. Those insurance companies employ even more lawyers on the other side to defend all the claims from the patients who, seeing as they are paying Cadillac prices, expect Cadillac service or they "want your house and first born child" as compensation for the error and omission.

That's what I meant.