California Health Insurance Offers Services In Mexico

Since 2000, private California health insurance companies, and at least one employer group, have developed binational health insurance plans. Cross-border health insurance plans first came onto the scene after the Knox-Keene Health Care Service Plan Act of 1975 was amended to legalize and regulate binational HMOs.

Both immigrants from Mexico and U.S. citizens take advantage of the lower prices of medical services across the border. Nearly one million Hispanic and non-Hispanic white Californians seek medical care in Mexico every year, according to UCLA researchers and colleagues. Their study is published in the journal Medical Care, and it is the first large-scale population-based research on U.S. residents obtaining healthcare in Mexico to be published.

Who Seeks Healthcare outside the U.S. and Why Medical Tourism Is Growing

To study this issue, researcher used the nation’s largest state health survey. That’s an analysis of 2001 data from the California Health Interview Survey. The investigators estimated that 952,000 California adults seek dental, medical, or prescription services in Mexico each year. Only about 488,000 of these 952,000 were Mexican immigrants.

Prescription drugs were the most common medical service that non-Latino whites from California went to Mexico to obtain. As expected, cost was the primary factor.

Not surprisingly, studies show that the heaviest users of Mexican-based healthcare services are people who live closest to the border. Another factor that may weigh-in is the growing shortage of primary care physicians in the U.S.

As healthcare reform allows more people the freedom to seek medical care, the primary care physician shortage is expected to become more of a problem. This shortage affects both California and the nation. The shortage is especially evident among U.S.-based Hispanic care providers. That’s another contributing factor to the growth of cross-border California health insurance plans.

Cross-border California Health Insurance Coverage

An estimated 150,000 Californians are covered by one of several private insurance companies that provide cross-border health coverage. These plans typically offer access to emergency care in California, along with routine and hospitalization services in Mexican border towns, such as Tijuana, Mexicali, Tecate and Rosarito.

Such cross-border healthcare plans are growing in popularity because healthcare costs in Mexico are estimated to be from 70 percent to 90 percent less than the same services in the U.S.

Healthcare reform may grow this cross-border market as citizens feel pressure to have California health insurance, and employers feel pressure to provide it.

How Binational Health Insurance Works

The Mexican-based Sistemas Medicos Nacionales plan was the first HMO licensed by the California Department of Managed Health Care to contract with California employers, and cover medical services in Mexico. This is the only Mexican-based HMO that covers health services provided in the U.S.

SIMNSA Medicos Nacionales contracts its network of more than 200 physicians and two clinics along the U.S.-Mexico border to Aetna and Health Net. Both insurers offer a cross-border insurance product.

In addition, Blue Shield of California’s Access Baja plan was licensed in 2000 to cover emergency services in California, and routine services in Mexico. Blue Shield of California uses its own Mexican-based provider network with members primarily located in Tijuana.

CIGNA is also reported to have filed for approval of a cross-border health insurance plan.

At present, coverage is mainly restricted to Mexican towns that are located within 50 miles of the U.S. border. People in Los Angeles or San Francisco, however, might prefer to fly to Guadalajara and Mexico City where many more health care options are available.

Growth Predicted for California Health Insurance Cross-border Plans

Dramatic expansion is expected, and a study in 2008 that was published in Health Affairs found that 62 percent of those surveyed expressed interest in a reasonably-priced cross-border health insurance policy.

Health Net’s cross-border health insurance plan, Salud HMO y Mas, has been performing well because it is more affordable than traditional plans. That gives it a particular advantage in the economic downturn.

Small employers may find that cross-border health insurance plans can be 30 percent to 40 percent less expensive than U.S. plans. For members of Health Net’s Salud HMO y Mas, co-payments for a doctor’s office visit in Mexico may be as much as 75 percent lower than co-payments in the U.S.

Medical Tourism Extends Beyond Mexico

Mexico is not the only destination of Americans traveling out of the country to receive medical treatment. High-quality treatment from U.S. board-certified surgeons can often be had for a fraction of what it would cost in the U.S. Substantial savings are available on cosmetic surgery, dental work, and even bypass surgery, and knee replacement surgery.

Americans have begun to explore, customize, and take advantage of healthcare options around the world. The need for these services is great enough that someone has stepped up to assist with medical tourism. The national leader is PlanetHospital, which has staff doctors to consult with Americans who are interested in traveling to other countries for healthcare. PlanetHospital doctors recommend appropriate surgeons and facilities, and arrange for all medical treatment.