Tag Archives: Health Insurance

Plan Ahead

Today was the U.S. Embassy Outreach in David. I spent a large part of the day on a task for the Embassy and only attended about 15 minutes at the first of the meeting. I did leave cards with the ACS Chief for anyone needing to contact me, if a problem arises in David or Chiriquí in general.

I finally finished with my task around 5PM and returned to the Hotel for a followup. I understand that there were a few complaints that came up today about requiring a Bank Check for any payment to Embassy.

It was posted in BOLD in the Chiriquí Chatter post, so it should not have been a surprise. It might not hurt to point out why the process was put in place. It was determined by the security staff of the Embassy that it was not safe for them to leave the meeting with $5,000 in cash as they have in the past.

Credit cards are accepted at the Embassy, if you would prefer not using cash.

It also might be worth pointing out that it is not safe for anyone to be walking around in Panama carrying a large amount of cash. This always comes up when we near the holidays because thieves tend to stakeout the banks watching unsuspecting people make large withdrawals and then following them to relieve them of their money.

Another subject that came up during our evening discussion was related to healthcare or emergency care in Panama. I was told that the Embassy has had several calls from people asking for help, because the private hospitals, in Panama City, were not accepting them for treatment unless they deposited $10,000.

The fact is that the private hospitals have no responsibility to accept anyone, except possibly to stabilize a patient. After that, they will be shipped to Hospital Santo Tomás in Panama City, if sufficient funds aren’t available. Santo Tomás is the public hospital in Panama City similar to the Regional Hospital in David. If you are coming to Panama, plan on coming with Insurance.

Even if it is just for a vacation, get insurance before you come. Trust me, you don’t want to go to a public hospital, if you can avoid it. If you don’t speak Spanish, what are you going to do in a hospital where 95+% of the hospital staff only speak Spanish.

If your family in the US call to check on you, they won’t be able to communicate with the admission’s staff. If you call the Embassy, they will check on a possible patient, but they will not be able to discuss the patient’s condition unless they had previously registered on STEP and listed their contacts.

I have never found a person in the David Regional Hospital’s admission’s office that spoke English. I have spoken to some doctors in the Regional hospital that spoke English, but rarely find nurses speaking English.

If you are planning on moving to Panama and using the cheaper insurance offered by some of the hospitals, read the fine print well and it would also not hurt to go interview payment offices in the hospitals and ask some tough questions to understand how your coverage will work. Know which hospitals will honor that insurance and which ones won’t.

Panama can be a great place if you come with the right exceptions and plan ahead. If you don’t you may not enjoy it much.

Pardon my Rant

While I was waiting for Marion to finish a laboratory test last week, I started thinking about some of the recent discussions on some of the local forums.

Entirely too many people are moving to Panamá with no plan for their healthcare. This really concerns me.

They my be ignorant about Medicare not covering them in Panama. They may think their health is good and they don’t need insurance. They may not have money for insurance and think healthcare in Panama is cheap. They may think the country healthcare system won’t turn them away.

Let’s consider these thoughts.

First people need to understand that Medicare is not valid outside of the USA. If that is their plan, then they are not covered. They will not be admitted to any private hospital in case of emergency without providing proof of payment, often $4,000 dollars or more for admittance.

One should never think that good health is a reason not to have insurance coverage. Look are the increase in home invasions sending people to the hospital. Home invasions, automobile accidents, being in the wrong place at wrong time. Many things can send you to a hospital.

Since I moved here the private hospitals are becoming more insistent on proof of payment prior to admission. The minimum I have heard was $4,000 and normally it is $5,000 or more and depending on what the hospital expects the total care to be, it may request a payment plan. Continue reading Pardon my Rant

Healthcare Reality in Panama and The Cost of Living

No talk about the cost of living should exclude the topic of healthcare and planning for it. I have no problem with publications saying that healthcare is cheaper in Panama than the US, however, comparisons in quality are seldom mentioned.

If you live in Chiriquí, where I live, there are two reasonably large private hospitals. There are other private clinics and there are public clinics and hospitals. The availability of having places to go is not the problem. It is what is going to happen once you get there.

I volunteer as a Warden for the U.S. Embassy representing the David, Chiriqui area. This puts me in touch with many cases, usually at the public Regional Hospital (The Social Security Hospital).

That is because most accidents or other serious emergency cases are either taken there immediately or sent there when they are refused admittance at a private hospital. Continue reading Healthcare Reality in Panama and The Cost of Living

Rude Awakening

I received the following email this morning. Maybe it is time to put out another advisory, that retirement in Panama is not for everyone.

Hi Don Ray,
I visited with Peter yesterday. He said he had found John on the floor at the Occidental apartment. Peter said it was a hard fall but nothing was broken. It looked like someone had taken a bat to John. Peter had him transported to Regional. When they checked in at ER no one asked who would be responsible for the bill.

Regional kept him for 4 nights. Peter purchased a wheelchair. He went out there to pick him up. They unhooked the tubes, put John in the chair and off they go. The hospital did not present Peter with a bill. or ask for payment.

Peter is trying to get John checked into El Hogar de los Ancianos. John is #4 on the waiting list. Peter said they were going to charge $700/month. Peter said there is a place in Dolega but that is too far for him to go.

Peter was very impressed that you had made the trip to the Occidental and that a lady from the embassy called.

I just thought I’d update you. Some Americans are in for a rude awakening when they learn they can’t find a care home.


Last month I visited another U.S. Citizen in Algorrobos that is also on the waiting list. He had recently had a stroke and his neighbor’s are taking care of him until a vacancy is open. Continue reading Rude Awakening

Worthwhile Read

Another prominent blogger, in Chiriquí, is Richard Dietrich, His current blog is probably a worthwhile read. I usually don’t direct people to his blog because I view it an a “for Profit” blog as evidenced by the $1,144,000 property he is selling, other ads and promotion of his books.

The fact that he spends more time on cruise ships lecturing than living in Panama makes his Panama experiences different than the majority of people moving from the U.S., thinking they are moving here for a slower paced and cheaper way of life.

Depending on one’s age, it may be neither of those.

In his current post, he touches on items such as the “Pensionado Discounts”, “Gringo Bingo”, “Healthcare” and a new chapter to his latest book called “Exit Strategy”.

It is the Exit Strategy, I would like to spend a little more time on. No book, magazine article, or blog should be sufficient for making the decision of a permanent move to Panama, or any other foreign country for that matter.

At best, they may provide a reason for a closer look. The closer look needs to be intensive. You have to live like a resident for a minimum of 6-10 months in both the rainy and dry seasons. The longer the better.

You need to experience waiting in lines to pay bills, waiting in lines to get over charges removed from bills, language and cultural differences, water outages from hours to weeks, electricity outages from hours to days, continuous electricity fluctuation (which may damage connected devices), non English TV, gringo pricing, Internet outages (assuming you can get Internet), healthcare, healthcare insurance, and on and on.

With those 6-10 months, you may not need an exit strategy. You will either realize that Panama is a mistake for you or you will know a few of the things you have to cope with. I have lived here going on 13 years and continue to have new experiences.

And yes, I do believe you shouldn’t move here without an Exit Strategy. I know people who are here, who want to move back and can’t do it.

It may be because they put all their life savings into moving and can’t pull together enough money to make the move back. It may be because they came here and a health problem hit and they had no option to return because their health wouldn’t permit it. Many have had health bills in Panama that totally depleted all their savings. Of course, that happens in the U.S. too, except no one ever told you that the U.S. had cheap healthcare.

As a disclaimer, when I moved here, my long term plan was to live here for a maximum of 20 years, sell my property for a $1,000,000 and return to the U.S. I moved with an exit strategy in mind. In that regard, I was no different than my fellow blogger Richard.

However, an error in judgement in a second marriage removed that as a possibility. No I didn’t marry after moving to Panama, but was married in the U.S. exactly 10 years prior to my move to Chiriquí. The good news is that I would never have met Lilliam and her family if I hadn’t moved to Panama.

This reminds me, don’t move here, because you think the move will be good for your marriage. If your marriage is on shaky ground before the move, this move will end the marriage.

Bottom line, buy all the books you can and take advantage of all the media on the Internet to better understand living in Panama. The cost and time will be insignificant compared to a permanent move.

Just remember this old saying my dad used to tell me “ I know you think you understand what you thought I said, but I am not sure you realize that what you heard is not what I meant.”

No article, book or blog will compare with your individual Panama experience. HERE is Richard’s book, if you want to assist him with part of his exit strategy.

S.O.L. In Paradise – Beating A Dead Horse

As I mentioned in the previous S.O.L. post, it will be worth following the thread in Boquete Ning.

Today, Bonnie Williams wrote a comment that I don’t want to get lost in the midst all the other comments on the ongoing thread. While she limited it to ExPats in Boquete, I would expand it to all of Chiriquí.

Here is her comment.

I think we’ve beaten this subject to death. To summarize, I see expats in Boquete having essentially four options for healthcare:

1) Have no insurance in Panama. Go to Hospital Regional for medical emergencies, but be aware that it may be difficult to receive timely attention. And you will be billed upon departure. Non-emergency surgery will be delayed, perhaps forever. Plan to return to the U.S. for any needed medical non-emergency services.

2) Enroll in the Hospital Chiriqui co-pay plan. This will pay for many routine, preventive procedures, but it will pay only part of the cost of hospitalization and/or surgery, and there is a relatively low cap on how much it will pay annually. It pays for no bodily appliances such as stents and pacemakers. This can result in the patient owing a significant amount of money.

3) Buy comprehensive national or international insurance. It is expensive. But it has a high payout limit and, after the chosen deductible, pays most or all medical expenses. There generally is no required deductible for emergency or pre-approved hospitalization or procedures.

4) Self insure and hope that you have enough put aside to cover a catastrophic medical event such as heart surgery, serious automobile accident, etc.
As routine medical care in Panama is relatively inexpensive, most expats can meet those expenses without incurring significant financial difficulty. When considering health insurance needs, it is my opinion that particular attention should be given to catastrophic medical events which, without good insurance, could subject one to no care, poor care, and/or financial ruin.

S.O.L. In Paradise Discussion – Continued

The original S.O.L. In Paradise post I wrote provoked Lee Zeltzer to start a discussion on Boquete Ning called “Putting A Healthcare Rumor To Rest”.

I think healthcare is a necessary item to be discussed by foreigners living in Panama and those thinking about or in the process of retiring here. The discussion going on in Boquete Ning is very lively and I think it is worth your following the thread.

I do take issue with the way Lee framed his discussion.

What I take issue with is his saying,

“Don wrote about it, perhaps prematurely and then contacted the US Embassy to obtain verification.”

(“it” referring to Regional Hospital healthcare). That implies, that as an afterthought, I wrote the Embassy, which is not true. I wrote the Embassy prior to writing the post.

I felt that the information I had been given was of significant importance to be presented. I qualified that it might only be related to the fact that heart surgery would not be available in Hospital Regional after July 1.

Lee said that I should have talked to a second doctor before making the post. I have been in Panama since 2002 and know that you can get any number of answers from doctors. I would not trust the answer to this question being told by one, two or more doctors. The only way to get the real answer would be to ask the legal council of the hospital, and the Embassy is the best source to ask the question. Continue reading S.O.L. In Paradise Discussion – Continued

Let’s Talk Health Insurance

I am at the point that I need to investigate other insurance alternatives. I moved to Panama in 2003 and my age prevented me from looking at Blue Cross in Panama. I wound up going with MAPFRE, which, at that time, appeared to provide the best general coverage.

I have their basic plan. On reviewing my most recent VISA bill, I see that my monthly rate has grown to $845/month. I will be 73 in October and I realize that with age, coverage costs go up. However, I see no evidence that MAPFRE will ever reach a maximum limit and I am ready to start looking at alternatives.

I have only had one claim in 12 years and that was for a couple hundred dollars. Luckily my health has been good, but one never knows what is around the bend.

I consider healthcare one of the biggest risks in moving to Panama, if you don’t have a plan for paying medical expenses. I have seen too many cases of gringos being shipped from Hospital Chiriquí to the Regional Hospital, when expenses got too high, and most never walked out of the Regional Hospital.

So here is what I would like to find out from others living here. What has your research found to be the best cost effective solution? If you think you have a great plan that might work for me, I would appreciate knowing about it.

If you want to have your agent send me a plan to consider, that is great. If I can beat what I have for a better rate, then I will consider it.

I would like a international plan that provides coverage if I am on a trip. MAPFRE would pay if I were outside of Panama, but at Panama rates.

The discussions and comments that come from this post may also open the eyes of some considering Panama as their retirement home.