Part One: Let’s Get Real about Health Insurance in Nicaragua


Ron in our tiny Moyogalpa hospital

Ron in our tiny Moyogalpa hospital

I was in the U.S. visiting my mother when I received a picture of Ron in our tiny Moyogalpa hospital. Robinson said, “Don’t worry, Debbie. We are all helping Ron.” What??? I was frantic with worry. See my post, Love in the Time of Cholera

Chances are greater if you live in Nicaragua, or are visiting for long-term, that you will contact a tropical disease. We have had Dengue, food poisoning, Chikungunya, and maybe Cholera ( it wasn’t specifically identified, but Ron had all of the symptoms). I had a severe UTI infection that could be resolved with antibiotics without a visit to the doctor or a need for a prescription. This is where Dr. Google comes in handy for self-diagnosis, but what about a catastrophic accident or a life-threatening illness?

This is going to be a long post and I will take you through our search for health insurance options in Nicaragua and/or worldwide. So, let’s get started.

Let’s Get Real About Health Insurance in Nicaragua

I. Vivian Pellas Discount Plans

In 2012, we bought the Silver Discount Plan at Vivian Pellas Hospital in Managua, Nicaragua. We had the discount plan for two years, but it didn’t meet our needs for catastrophic events or a severe illness or disease. There were many procedures that were excluded, so it was back to the drawing board to find a health insurance plan that would meet our needs and would be accepted at Vivian Pellas Hospital and other private hospitals in Managua.

See my post Health Care for Expats in Nicaragua

More information about Health Care Club of Vivian Pellas Hospital

II. National Health Insurance Companies of Nicaragua

Since we have residency in Nicaragua, the process of applying for national health insurance should be easy, right? There is a catch! I went to the INISER Insurance company in Granada to fill out an application for health insurance. The first question the insurance agent asked me was, “How old are you and your husband?” I replied that we were both over 60 years old. Her response was, “Sorry. We do not insure anyone over 60 years old.”

You have to be kidding me! I shook my head in disbelief and asked her if there were any Nicaraguan National Health Insurance companies that would cover us in Nicaragua. “Nope,” she replied. As I was leaving, she ran to me with a brochure. Excitedly she announced, “We have burial insurance and we can cover all the costs of your vela (wake) and burial.” Alrighty then…back to the drawing board.

Here are a list of the National Health Insurance companies of Nicaragua. Note that they do not insure anyone with a pre-existing condition and the insurance premium is per person. From my understanding, if we would have purchased the national health insurance before we turned 60 years old, we would have been able to continue to renew a policy. In addition, the premiums are very expensive and the deductibles are high.

III. International Health Insurance Companies

I contacted two International Health Insurance companies for information. I will go through each of these companies in detail. Both companies are based in Central America and both insurances can be purchased with a passport only. My first question after looking through the premium rates and comparing them to companies that offered international health insurance in the United States was, “Wow! The premiums are so much cheaper if purchased in Central America. What is to prevent permanent residents of the U.S. from buying health insurance abroad to save on the cost of insurance?”

The answer was that to buy this international health insurance, you must have a residence and/or address in Central America in their service region. The health insurance can be used in the U.S. but, the deductibles are calculated differently and the insurance is only good in the U.S. for 180 days in a year.

A. Blue Cross/ Blue Shield of Costa Rica

I found a post on an expat forum advertising Blue Cross/Blue Shield through a new company in Costa Rica. I contacted Freddy Pacheco and he sent me the following information for three plans: Humanus, Sanitas, and Regius.

1. A sample of the medical benefits for the Sanitas Plan in English. The other plans are in Spanish. If you would like a copy of them, please ask and I will include them here.
BCBS GENERAL CONDITIONS

2. The cost of all the plans
TARIFAS 2015

Pros of Blue Cross/Blue Shield Costa Rica
1. You can apply with a passport. Legal residency in Central America is not required, however you must use a Central American address to apply for coverage.

2. All of the Blue Cross/Blue Shield plans are worldwide coverage. The coverage includes 180 countries, except for Vietnam.

3. No physical is needed if you are under 65 years old. If you apply when you are 65+ you will need to send an extensive list of exams performed within 2 months of the application.

4. All of the plans include travel insurance that cover $10,000 per person with a $75 deductible per event. It will not cover more than 60 days of travel.

5. Blue Cross/Blue Shield of Costa Rica insures all people living in any Latin American country.

6. Blue Cross/ Blue Shield is accepted at Vivian Pellas hospital and the new Militar hospital in Managua.

Cons of Blue Cross/Blue Shield Costa Rica

1. The Maximum Lifetime Policy coverage is low.
Humanus Plan – $100,000
Sanitas Plan    –  $300,000
Regius Plan    –  $ 1,000,000

As you may know $100,000 is nothing in the U.S. or Europe to cover medical costs.  Most expats take the Sanitas or Regius Plan for more coverage.

2. There is no option to exclude the United States from a Blue Cross/Blue Shield Plan. If you have other options for coverage in the United States, Europe, or Canada, Blue Cross/Blue Shield may not be the best company for you.

3. Outside Latin America the deductible is 20% of the first $5,000. Then BC/BS will cover 100% up to the insured amount. Please focus on the Hospital Room and Intensive Care Unit outside of Latin America. These products were designed for the Latin American market, but give some coverage in the U.S. and the rest of the world for only 180 days a year.

4. As with all insurance, pre-existing conditions must be reported when applying for health insurance. Depending on the severity of pre-existing conditions, BC/BS of Costa Rica has the right to deny you health coverage.

5. Each year, the Blue Cross/Blue Shield policy will cost 9% more.

6. Since Blue Cross/Blue Shield automatically offers limited coverage in the U.S. it may open the door for higher rates down the road. Mixing the U.S. with non U.S. Expat global coverage opens the door for quickly rising rates.

7. Blue Cross/Blue Shield has companies based in Panama, and now Costa Rica. When the U.S. health insurance companies get a foothold in a Latin American country, expect very expensive renewal rates.

8. For Internal or Outpatient hospital services in Costa Rica, the United States or outside the United States: The Insured must use a hospital or facility or similar institution that is a member of our network of affiliated providers, in order to receive any benefit payable for such services.

Website for Blue Cross Blue Shield of Costa Rica  Note that this website does not give you the option of paying online or filling out an online application and submitting it electronically.

B. WEA Signature Plan

I contacted     Robert Tillotson, the insurance agent from Belize
Offshore Health Benefits, LTD
robert@tilloglobe.com
t. 504.264.3250
t. 512.296.4976
www.offshorehealthbenefits.com

Here is his initial letter:

Welcome to Offshore Health Benefits, and the WEA Signature Series, our represented CEMG group medical insurance plan (a Lloyd’s of London backed product).

The WEA plan is one of our top performing represented global medical insurance plans now. The rates are some of the lowest in the business and they do a good job at paying claims. Let’s talk over Skype when you are free, I have a few questions.   Through our group, you will receive 5% off the total premium, once approved and processed.

Please review the attached information from the PA group, our partner. The WEA Signature plan allows for more time in the States than many global medical plans.  They give you the option of not including coverage in the States and saving premium dollars. Plus, through our group, we will have the annual fee waived for each member.. Keep in mind that the Medical Underwriting process is more rigid than other carriers, and a medical questionnaire is required for those 65 years of age and older.
 
WEA boasts decades of service to expats communities all around the world and it focuses its efforts on providing quality international medical plans with comprehensive coverage solutions for global citizens. It forms part of the PA Group, an international benefit organization that designs, distributes, and delivers solutions to protect the assets, health and well-being of global citizens. WEA works with trusted global Medical Network Providers and reliable Assistance Services to ensure complete client care and support.The best thing about WEA is that you can customize your health care solution according to your needs and lifestyle, and not the other way around, so that being a citizen of the world will not affect you or your beloved ones.

The flag product of WEA for expats is the Signature plan that works for individuals, couples and families and offers a comprehensive health care solution worldwide. You can choose among three different options within the Signature plan, Care, Select and Elite, with a maximum coverage of $5,000,000 USD.

There are impressive standard benefits included with all three plans such as worldwide coverage with optional U.S. Coverage, hospitalization, emergency medical evacuation, repatriation, maternity benefits, and finally, dental and vision benefits.

The Signature plan covers both in-patient and out-patient benefits from standard routine procedures to complicated oncology treatment giving you a peace of mind when it comes to your health and wellness.”

Sounds wonderful! I like the options of excluding the U.S. for cheaper premiums.

1. WEA Brochure and Overview of the Signature Plans
WEA Brochure Jan 2015

2. A comparison of the medical benefits with the three Signature Plans.
WEA Signature Product Comparison 2014

3. WEA Signature rates
WEA Signature Rates Aug 2015

4. WEA Signature Application Form
WEA Signature Application 2014 (with member fee)

Pros of WEA Signature Health Insurance

1. The lifetime maximum coverage is much higher for all three plans. The Care Plan starts at $1,000,000.

2. You can opt out of U.S. coverage if you have other options for health care in the U.S. making the premiums much lower. Plus, you can go anywhere in the world, excluding the U.S. and Canada, and it offers direct billing and discounts.

3. The premiums are divided into male and female costs.

4. You can purchase WEA Signature Health Plan with a passport and a Central American mailing address.

5. Vivian Pellas Hospital and Hospital Bautista, both in Managua are covered by the AXA network insurance provider. But the best thing is that one may go anywhere of their liking and the PA Group can call any hospital direct and work out payment, they do this often.

6. It usually takes 2-4 days to process the application form for WEA health insurance if no other medical records are required.

7. Payments and claims can be made online and they have a 24 hour chat line so that they may serve you better.

Here is the WEA Signature Website

Cons of WEA Signature Plans

After a thorough comparison of these two insurance companies, I cannot find any cons for the WEA Signature plans. They are completely individualized to meet the needs of most expats.

So, which insurance will we choose? What options will we explore for coverage in the U.S. when we return to visit friends and family? Stay tuned for Part Two: Two Happy, Healthy Expats with International Health Insurance… or something like that.🙂

Update: I have had  many people give me other suggestions for International Health Insurance coverage. So, I am making a list here. Please add to my list if you have International Health Insurance.

1. BUPA website
A friend who lives on Ometepe Island is going through chemotherapy treatments at Vivian Pellas in Managua and this is her health insurance.

2. VUMI website
Friends in Panama have this health insurance

3. IMG website
Friends that are moving to Portugal presently have this health insurance.

 

 

31 thoughts on “Part One: Let’s Get Real about Health Insurance in Nicaragua

  1. Pingback: Our 2016 Costa Rica Healthcare Plan, by Rob Evans - Retire for Less in Costa Rica

  2. Pingback: Retire for Less in Costa Rica – October 6, 2016 - Retire for Less in Costa Rica

    • Natalie, in Part Two of Let’s Get Real About Health Insuranace for Expats, I wrote, “Our premium cost in the 60-64 year age group is $2365.48 annually with a $250 deductible for each policy holder. We chose the option to pay the full amount annually, however we could pay monthly $197.12. That is coverage for BOTH of us. Very affordable!!!

      If you read Part Two, I hope your questions will be answered.

  3. If we have to have a Latin American address to qualify for the insurance, how do we arrange for insurance before we arrive? We’re in the US now, but plan to move to Nicaragua in Feb and don’t yet have an address there? Thanks for your help.

    • Stephanie, I would recommend waiting until you arrive. Get a post office box when you arrive, and then start the process. Once we decided on the expat international insurance that met our needs, from filling out the application to approval took 3 days and our insurance took effect immediately.

  4. Fabulous! It would be super if you start compiling all the information you acquire and start putting together an informational blog– and charge for your services. We are in the USA and looking into where in the world to retire within the next 6-9 months. I am 54 and paying almost $800 month for private health insurance in the US (and I am healthy!) while my husband, very healthy also, is 68 and on Medicare.

    We have come to the conclusion that we have to go where I can buy affordable coverage, while he purchases travel insurance for evac back to the US, OR we can buy affordable coverage for both of us.

    Our research and travels have included Ecuador, Panama, Nicaragua, Guatemala, Mexico (we love Oaxaca and Guanajuato), SE Asia, and South Africa (absolute top notch, high quality care for both of us, including dental and vision, is $475 month).

    A third option your readers may consider is to look into citizenship in another country, and by that I mean acquiring citizenship through ancestry (a relative)–countries like Italy, Ireland, Spain, and the UK allow for this. As an example, my mother is native British, and I discovered that through her I am entitled to UK citizenship. It cost about $120 USD and a wait of 5 months, but now I am a British citizen. This morning I was getting quotes for travel, trip, or expat health insurance and learned that when I put UK instead of US citizenship the prices are are much, much cheaper. That $120 I spent was a very wise investment.

    Seriously, if you compile enough (worldwide) information you should put it together on a website for the hundreds of thousands of worldwide expats and charge a monthly sdubscription fee.You would make a nice profit from your site!

    • KD, thank you so much for your very informative and detailed comments. I never thought about citizenship from an ancestor. Great idea for some expats with dual citizenship.
      I am going to keep compiling information I receive from my readers. I’ve been thinking about creating an e-book with my Let’s Get Real About series and including the section for health care. Since we live in Nicaragua, it would be more specific to Nicaragua, but can include general information for people considering living abroad in Central America.
      Of course, I am retired and it sounds like a lot of work to me. lol I enjoy the research and I am good at researching different topics that apply to our lives in Nicaragua, so it’s more of a fun project for me than a money making proposition. But, then again, maybe if I compiled this info into an e-book and sold it, the proceeds could go to fund my elementary school library on Ometepe Island. More decisions.🙂 Thanks again for your comments.

  5. wow, we are very fortunate living in Ecuador. The health plan here, IESS, is easy to get on and the cost affordable. We pay $71 each a month and it covers pretty much everything. The catch, it can be very confusing going through the process of appointments, tests etc especially if you’re not fluent in Spanish. There are rules to be followed but not everyone ( docs) know them all. But so far so good. When we travel back to US we get the $26 travel insurance, $25,000 coverage , $50 deductible. Stay well amiga

    • You are extremely fortunate to be able to buy Ecuador health insurance. If only we had those options in Nicaragua. I know your insurance was extremely valuable when John was hit while riding his bicycle. Did it cover everything? Do you have to pay a deducible?

  6. I love your story of the National insurance agent who informed you that you were out of luck for health insurance but qualified for their burial plan – that seems to sum it up! And God help anyone with pre-existing conditions which most people have acquired when they reach 60 and beyond … We’ve gone with IMG for international coverage with a very high deductible for serious events but have paid out of pocket for the care we’ve needed in the last 3 years, One of our first priorities when we return to Portugal will be investigating what insurance is available in their country – I’m not holding my breath! Anita

  7. For an American citizen 65 or older, one option would be to enroll in Medicare; along with a part B and part D supplement, just as you would if living in the US, and in addition to buy a medical evacuation policy (e.g. from InternationalSOS, about $800 / year), and then to just pay out of pocket for minor problems, and plan to be airlifted to Houston for major problems. The evacuation policy covers up to $25K for emergency stabilization, if needed, prior to air-ambulance evacuation.

    • Thanks, David. We are exploring medicare options, but we still have a couple of years before we can apply. Most International Health Insurance companies offer a medical evacuation plan included in the policy. However, if we had something catastrophic happen to us while living abroad, I feel that the care is much better in Nicaragua, than we would receive in the U.S.
      We are looking at ACA for coverage since we still have a house in the states, but the deductibles are outrageous. Most companies have a $6-$12,000 deductible. Why pay that if we are only visiting the U.S. and have a car accident or something catastrophic? We are better off to go with cheap travel insurance that covers the U.S. That is what we usually do.

    • Yes, John and Susan, I read your blog and I commented on your wonderful post. I did check out VUMI, but it didn’t meet our needs in Nicaragua. Although they have a great website and you can make payments and submit claims online. Thanks for the link. It is one more option for everyone who is reading my blog to investigate.

  8. I’m curious about what time frame a semester is — Google suggests 16 weeks. Most colleges have three semesters in the US (counting summers) or four quarters (also counting summers). That would make the difference between a good deal and a so so deal. I didn’t see any time frame for the Belize company’s payments.

    • Rebecca, I have no idea what a semester is. lol When you apply online for the WEA health insurance, they give you the option of paying annually, semi-annually, quarterly, and monthly. We applied today for the WEA Signature Plan and because we paid the annual payment ( which won’t be submitted to our credit card company until we are accepted…48 hours from today), we got a 7% discount for paying annually.

  9. WOW,,,YOU ARE SUCH AN ANGEL WORKING ON THE EARTH PLANE!!!!!!

    THANK U SOOOOOO MUCH FOR ALL OF YOUR INFO ,,,IT JUST MAKES ,,,,EVERYONES ,,,,EXPAT LIVES SO MUCH EASIER!!!!!!

    CANT WAIT TO READ CHAPTER 2!!!!
    MUCH LIGHT ,
    Heidi Lane

    • Haha. You write with such enthusiasm, Heidi. Part Two will be coming next week. We submitted our application today and Ron’s job is to research our options for the U.S. whether it be travel insurance that covers the U.S. for catastrophic accidents, ACA, or just wait until we can get Medicare. Researching all this stuff has been a full-time job lately. YIKES. So many questions.

  10. I love Nicaragua, but on all 3 trips there (Granada) I got sick with GI problems that typically lasted a week. Tried to eat in clean places – but who knows.? One huge problem not talked about much is what Doctors call Soil Transmitted Helminths – Roundworms to you and I. Eggs very common in uncooked vegetables in Nicaragua. I imagine that if you live in Nicaragua, you will probably get worms at least once a year.

    A poor country with generally broken infrastructure. It’s biggest asset is its people. Nicas are be some of the nicest people in the world

    • Yes, Tommy, the people are what make this country great! Although we are healthier living in Nicaragua than we have ever been before because we raise a big garden, eat fresh fruits, swim and walk daily, and live a simple life with little stress, there are ALWAYS those nasty parasites we have to watch for. We deworm regularly. lol

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