#548 – The Expat Files: Health, Caregiving, and Life in Latin America

Automatically transcribed from the original recording; names and wording may contain errors.

[00:00] South of the border down Mexico way That's where I fell in love when the stars above came up to play and now I wonder Hello there all you expat wannabes. I'm Johnny Mueller and you're listening to the expat files living in Latin America The show that tells you just what it's like to live work play and or retire down here in Latin America It's a mix of the good the bad the ugly and the great and it's all right here. So let's get started A lot of Canadians writing in lately, and I don't blame them for wanting to vote with their feet either They got two strikes against them that terribly oppressive Big Brother socialist state and that Miserable cold weather for more than half the year now we've all heard of that so-called model Canadian national health care system

[00:51] Some Canadians love it and some hate it. No one's without a strong opinion. That's for sure So today we're going to talk about some sad situations and catch-22s that Canadians are in we're talking about Canadians with health problems that seem to be at the mercy of their health care system So there are Canadians with health care problems that absolutely love living in Latin America But soon find out they can't live in Latin America full-time Because you see as it turns out if they live too many months outside of Canada They get cut off from the national health in other words They have to remain Canadians for tax purposes in order to take advantage of the system the one they've paid into dearly all these years Now you've heard the pros and cons of the Canadian national health system But I'm sure you'd never heard stories like this. So here goes

[01:38] I'll paraphrase this as usual to keep the train rolling Well, let me add just one more thing before I get going here All you ex-pet wannabes and gonna bees up in the States and in Canada who are taking a lot of horribly expensive Medications that may or may not be paid by insurance or the national health or Medicare or whatever Just remember when you get down here to Latin America Almost all those drugs are available to at quite a discount if they're generic, but if they're proprietary drugs, you know You have to have something by let's say Glaxo Abbot or Burroughs welcome Then you're gonna pay as much or more for those drugs down here Then you'd pay up in Canada or the States that is if you were paying out of your own pocket However, that said nearly every gringo and expat I know that came down to Latin America with their little satchel full of prescription medications that they'd been taking

[02:26] Year over year when up in the first world It turns out in time every last one of them has reduced his or her dependency on those prescription drugs And the reason of course is there's much less stress The weather is terrific the food that you buy in the markets anyway Although it may not be labeled organic or certified non-gmo You're getting it from the local truck farmers And it's as good and fresh as you're gonna get at Usually a quarter to a fifth of what you pay up in the States for the same thing So that said all you expat gonna bees and wannabes up there who are totally dependent on prescription medications for whatever chronic problem You have please don't use that as an excuse to talk yourself out of becoming an expat in Latin America That would be a shame but as strange as it sounds it seems like that's the case for many people up north

[03:12] People think they won't be able to afford or buy the meds They have down here that they're using up north which leads us directly to this email this one from Dave a Canadian snowbird Not by choice. He wants to live in Latin America But as you'll see he can't do it full-time because he's caught between the usual bureaucratic rock in a hard place Starts dear Johnny. I have written this summary of my situation with the hope you could advise guide and help me in some way I don't know what to do nor what to ask or expect from you, but here goes I subscribe to your podcast and it hit me why not see if Johnny can offer any hope for me I'm currently living here in Guadalajara as a temporary resident Then he puts in parentheses a non-working temporary resident And by the way to clarify things here when you get temporary residency in any Latin country

[03:59] They don't let you work not work for the man anyway of course you can have your own business and make all kinds of money if you Want but you just can't work for someone else not legally anyway, but you know this is Latin America And there are a million ways around anything, but you'll see that when you get down here So you're not supposed to be able to legally work for the man that is as an employee unless you have permanent residency But you knew that already right and by the way I'd say a good 95% of all gringles and expats who do work are their own bosses. They just don't work for the man That's one of the reasons they came down here in the first place, but that's another story anyway back to the email believe it or not Johnny I've been coming back and forth to Guadalajara Mexico from Canada for the last 15 years on the old FM 3 visa

[04:45] Until a new system started up so far. I have always gone back home to Toronto every year now What your listeners probably don't know is that if you're a Canadian citizen in order for you to maintain your Canadian national health care You must return to Canada for the mandatory five months a year to avoid losing it my greatest concern However is I really want to stay in Mexico full-time now Johnny My background story is not good nor happy and maybe it's time to admit defeat go back to Canada with my tail between my legs And check into a long-term care facility, but believe me Johnny I'm not going without a fight. So here goes I had a tumor removed from my brain stem and spinal cord in 1980 and was left partially paralyzed and in terrible pain

[05:31] I was 22 years old and it was just two months after graduating the university when it hit me Eventually, I got back to working. But after nine years at Bell Canada, I began deteriorating and had to leave on long-term disability I now live on about three thousand dollars Canadian a month plus I get my Canadian health care coverage My pills and medicines for example now along the way I met a nurse slash caregiver originally from Guadalajara, Mexico, and we've been together over 25 years now We decided to begin the back-and-forth to Mexico because I'm extremely Hypersensitive to the cold temperatures of Canada and the cost of staying in the US was way out of the question financially She has both Canadian and Mexican citizenship her two daughters ages 14 and 15 have also got both Canadian and Mexican citizenship

[06:20] But my caregivers husband is solely Mexican So anyway things do change and now I find myself Unable to physically tolerate the commute between the two countries even twice a year The last two years flights back and forth have been nothing short of hell for me Remember, I have to go back to Canada at least five months a year to maintain my national health care insurance It's also no longer feasible for my caregiver to drop everything and go to Canada with me especially not for five months She has started a cafeteria slash catering business and is working now in Guadalajara The saddest part is that my condition leaves me deteriorating and I spend much of my time now in bed in other circumstances I'd insist on someone being with me 24 7 note only because my caregiver knows me

[07:07] So well, is it possible for me to be left alone at times though? Never at night. It should be noted that she would be impossible to replace that is not hyperbole She is a trained health care worker driver cook secretary medication dispenser and so on now in Canada It would require hiring several staff unless I'm sorely mistaken I understand they all have their particular jobs and if you don't designate them that way and follow the rules It's against the law. By the way, I have paid into the IMS s that's the national Mexican health care system for three years Okay, I've got to say something. It's me again, Johnny the Mexican National health care system as well as the Honduran Guatemala Costa Rican you name it Whatever Latin American national health care system is pure garbage

[07:54] Their hospitals and clinics are medieval unsanitary stinky occasionally without power without water But you know what they say you get what you pay for So anyway forget about the national health care system in Latin America So don't come down from the first world thinking you're gonna get that free medical health care that everyone else has You'll be sorry The only way I'd ever recommend a gringo using that system is if you got in a terrible car accident Right in front of a national health care emergency room under any other circumstances Make the ambulance driver or whoever take you to the nearest private hospital or clinic, but you knew that already, right? Anyway, Dave goes on to say I found out in Canada There are so many rules about who can and cannot do what in a health care procedures I found out in my case that I have to literally become a business pay salaries

[08:43] vacation over time Taxes hire one person for housework one who is only allowed to touch my medications One to prepare my meals and baths now That's not to say I couldn't find one person to manage all that like my Mexican caregiver does now But in Canada that would be completely illegal great, but illegal now again I only receive about three thousand dollars Canadian a month plus to that my mother adds another two thousand So I make about five thousand a month right now My mother says that twenty four thousand dollars a year is a lot to pay a caregiver Whereas my caregiver says over a hundred thousand dollars a year wouldn't cover the cost for caregivers doing all of that up in Toronto So it's all a mess and I'm trying to find an honest-to-goodness cost that would be

[09:30] Reasonable that everyone involved could trust and maybe calm this debate So that's my situation and dilemma my seven months away from Canada is up the first of May and the many medications I take will run out then too when in Canada. I live with my 85 year old mother and I'm a resident I don't know or understand what to do concerning my legal status. I don't know where even to start I think my benefits, but not my pension require me to have provincial health care I would have to purchase my pills in Mexico with no reimbursement from Canada if I became a permanent resident there because again I'd be cut off the Canadian national health care system And here's another piece of random information my pension consists of the Canadian pension Then Canadian Bell makes up the difference. That would be my 3,000 a month

[10:18] I've heard if you're a non-resident of Canada, they take a 25% withholding tax and no deductions accepted So there it is Johnny. I'm looking for some answers and maybe some help Okay, Dave. I'm gonna tell you some things you're not gonna like to hear at all And I'm gonna tell you some very good things, too. Let's start with the good Dave. You're bringing in around $5,000 a month. What's that? 4500 us in Latin America. You are a rich man You know what that means down here in Latin America, and I'm talking about the Latin America That's off the gringo tourist trail not Mexico Dave on that kind of money. You're living like a king It's just that I guess you don't know how the fact is they've been Mexico where there's over a million and a half

[11:04] Gringos living there on temporary or permanent residencies right now. You pretty much lost your gringo advantage now from the gist of your email I understand it sounds like your mother is saying you're paying about $24,000 a year to your caregiver to pretty much take care of you And manage your life, correct? Well, you know what Dave if you were in any other big city in Latin America Let's put you in the Alti Plano where it's really comfortable. Let's say you're in Chella, Guatemala or Guatemala City or Antigua Guatemala or Copán Honduras or the Ruta del Flores in El Salvador or a hundred other such places in South America But let's not talk about South America now because well that means to travel there many more uncomfortable hours in the airplane and much more Money for the flight. In fact, you'll generally pay twice as much to go to South America as you will to Central America

[11:54] So anyway, let's get back to that business about paying a caregiver $24,000 a year, which is what I assume you're paying her right now Well, David might be true that paying 24,000 bucks a year to a caregiver up in Canada is Ridiculously cheap and wishful thinking unless that person is an illegal However in other parts of the world specifically Latin America any day of the week You could look into the big Latin newspaper one ads and find registered nurses are being paid around four to five hundred dollars a month To work in first world style big private hospitals in Latin America Now I'm talking off the gringo tourist trail, of course Which if I were your would be where I'd immediately want to relocate now you say your caregiver is irreplaceable and it's not hyperbole I beg to differ you say she's a trained health care worker driver cook secretary

[12:43] medication dispenser on and on well guess what that's the job description of every Latin American nurse whether she's a nurse's aide or an RN or even in operating room surgical nurse So bottom line if you're in Mexico and paying your caregiver 24,000 a year I don't care if she spends half the year up in Canada. You're overpaying her by four or five times However up in Canada is the completely different story and she's right You probably would have to pay around a hundred grand a year or more to get that kind of service because you'd have to Have two or three nurses on shifts. However down here in Latin America. You just have live-in nurses So the house or apartment you rent would have to have a couple extra bedrooms And what would that cost you well off the gringo tourist trail in a really nice section of town? Maybe three four hundred bucks a month and that's in a guarded gated subdivision, too

[13:29] And if I was you how I'd do it is I'd situate myself a couple of blocks from one of the big first world hospitals Have one maybe two live-in nurses, which would cost you maybe $10,000 a year and remember they'll be your full-time nurse bathe you give you your meds, etc Also cook and drive and clean and do your shopping for you and another suggestion forget about the Canadian national health care system You can get all your generic meds down here and most proprietary ones, too And what you can't get you can order direct from those cut rate internet pharmacies located in England Canada and elsewhere Where the meds are really really cheap But what about those oddball one-of-a-kind meds that are very costly aha Did you know that down here in Latin America? You could get any number of Cadillac insurance plans that cover practically everything including medications

[14:17] And I'm guessing you pay no more than a hundred to a hundred and twenty dollars a month for absolute full coverage But wait a minute you say they won't take me on with all my pre-existing conditions Wrong insurance plans down here are in their infancy in fact less than two percent of the Latin American population pays into a private insurance plan and Because these plans are just starting to come on board They'll take anyone and after six months or a year almost all plans will drop the pre-existing Conditions clause how about that? So you get a house or apartment a couple of blocks from a big first world hospital and that'll set you back three or four Hundred a month you get on that insurance plan that'll cost you a hundred to maybe at the most 150 bucks a month and believe it or not most plans will let you get on up to 64 years old and some through age 70 again have one live-in nurse or two on rotation

[15:09] Figure on the high end of 500 bucks a month for one in a thousand bucks a month for two and remember down here Anyway, if you have a live-in nurse or live-in housekeeper You're giving that person room and board too So you can pay them less in fact they expect that they understand it in fact I know a gringo who's in a wheelchair old guy around 81 years old now He's got a full-time live-in RN and he pays were a whopping 350 bucks a month plus room and board and of course He told me on the side she expects to get in his will but what the hell when you're dead you're dead That's what he says anyway, by the way, he says she gets Sunday off and another lady comes in that day again What about those special meds? Well, if you're one of those Cadillac insurance plans They'll cover most of that sometimes all of it, but only after the pre-existing condition clause kicks in

[15:55] So that means for the first year You'll probably have to milk the Canadian National Health System for what it's worth But after that you just pack your bags give them the finger and leave that is vote with your feet After you've been on the insurance plan at least a year, but then what if you can't walk? What if you're in a wheelchair or non ambulatory? How do you find these places off the gringo tourist trail? How do you find these houses and these hospitals and these medical plans? Well, I can tell you forget about finding them on the internet and forget about these medical tourism outfits that are sprouting up all over the internet too They know they've got you as a kind of a captive audience and they know gringos who haven't had boots on the ground want to be reassured They know rule number one That's gringos want to have another gringo English speaker to deal with and they put all their faith and trust in these people and believe me

[16:41] There are good people but there are scammers out there, too And you don't always get those great deals you hear so much about not when you go through a gringo middleman who advertises on the internet Okay, then so how do you set this up? How do you do it? How do you get pointed in the right direction and find the right people? Well, here's a great first step if it's impossible for you to make it down yourself Send one of your trusted friends or family members to one of my expat insider seminars I've got one coming up in July note I have a full four hour long health care segment then I take you to first world hospitals show you first world insurance plans for expats Introduce you to doctors and specialists, etc. That's all part of the seminar because everyone's interested in health care So that's a good first step. So then what if you can't make it to the seminar?

[17:27] Well, lucky for you, I've developed a kind of a network here in Central America Mostly around Guatemala Honduras El Salvador, but extends beyond that. It's a kind of an expat concierge service It's a service that offers to help gringos and expats pretty much find whatever they're looking for including housing insurance medical services But not limited to any of that For example, the concierge service can help you buy a car get it registered hook you up with phone service and utility service when you rent Or buy a place etc, etc Actually, it's an idea that was developed by expert blogger John Galt So whether you're down here or not, we have the people to look into those things for you In fact, some of my expat insider seminar girls are college graduates with cars and they can and do all that kind of legwork for green Gringos and expats so Dave in your particular case

[18:15] The ladies in the concierge service will be able to locate a very nice place for you to live in a nice neighborhood Very close to a first world hospital. They'll find insurance plans get quotes for you They'll interview and or set up interviews for you with registered nurses They'll visit nursing schools put help wanted ads in the paper for you do all that legwork before you get down and as to how long It will take and how much it will cost Well, of course that depends completely on what you're looking for and the duties involved But the ladies themselves will probably only run you a hundred dollars or so a day and that'll include the car, too And of course if you're stuck up in the states there Canada You'll be doing a lot of skyping with the ladies, of course to work out the specific details of whatever your plan is I just want you to know that those services are available and the ladies and the service are approved by me and of course by my

[19:03] Good friend John Galt who was the brains behind this idea? So if and when you do come down to one of my expat insider seminars After you head back home to Montreal or Cleveland and you formulate your plan and come back down We've got those people ready and waiting to help you out in whatever you need Oh, and by the way, the ladies are 100% bilingual, too, but let's push on Here's a letter from another pretty unhealthy Canadian snowbird that also goes back and forth from Canada to Latin America It starts I'm from Manitoba, Canada And I still go back to Canada five months a year to keep my Canadian national health insurance I have a heart condition major allergies GI issues and of late do not handle stress So very well and have anxiety issues because of my arthritis the climate in Canada just does me in

[19:48] It's not so much to cold though That does a number on me But it's the changes in the weather that kill the fact is because of the weather changes in cold I lose my mobility very fast when I'm in Canada I have a hard time picking things up and can't squeeze toothpaste tubes can't walk for more than 10 or 15 minutes But I live here half the time in Z what nail Mexico by the way, it's me Johnny again I know that place rather well again. It's a small resort beach town, but it's on the tourist trail Anyway, he says when I'm there I take no pain meds and do all the above and even swim two K's a day In other words, I'm in remission when I'm in Mexico and in good weather However, I always thought when I couldn't travel back and forth from Canada to Mexico. I could just stay in Z what nail wrong Yes, we'd still get our Canadian pensions and our teachers pensions from Canada would continue to come

[20:37] But we will not be able to get our meds from Canada anymore So far I see a lot of the meds I take are available here in Mexico, but some not available at all However to try to clarify residency things we have met with a taxation lawyer and two tax accountants What we learned shocked us and blew our plans out of the water. We own a condo here in Z. What nail It's never generated any income because we live here when we're down here However, if we were still residents up in Canada and sold it we'd have to pay capital gains to Canada if we become a non-residents That is get permanent residency in Mexico The Canadian government would not be able to collect that capital gains tax However, I understand if we did become Canadian non-residents The Canadian government would try to take the capital gains on whatever it was worth at the time

[21:25] Well, that just sucks and the clincher is for us that in Canada. There's a 25% withholding tax every year Now as Canadian residents at least we can take deductions and pay a 25% based on our net income However, if we're non-residents, we have no deductions at all such as medicine, etc And we'd pay this 25% based on our gross income So basically as it turns out I have to trade my health and mobility in order to have sufficient income to live on in Canada, I'm not impressed too bad for me too bad for Manitoba, Canada Also because it will cost them much more in health care by staying in Canada for those five months than if I were to stay here in Z. What nail full-time. That's for sure Okay, let me jump in here and say these guys too are missing the point. They're not getting good advice

[22:14] Like I said before you could get Cadillac insurance coverage for around a hundred to a hundred twenty five bucks a month that includes your meds and everything else and some Of these insurance companies have worldwide coverage. So what's wrong with this picture? Who's not telling these guys that? Why do you think that is that's because they're living in gringo eyes communities And I'll bet none of them speak Spanish worth a damn either. That's what you get when you end up living in gringo communities So there you have it Both these guys are basing their whole lives on the fact that they need the Canadian national health system to get him their meds Period that's a totally s backwards way of looking at things and by the way in this last guy's letter He says he owns a condo in Z. What nail and he's worried about paying capital gains tax to Canada when he sells it

[23:00] Well there again this guy got some really crap advice because obviously he doesn't have his condo in an SA corporation Using an SA corporation, you know, there are legal ways around all that stuff Well again a lot of misinformation and bad advice He goes on and says the accountants told us that several people just end up staying in Mexico But keep a physical address in Canada and hope they don't get caught that way They get their national health care insurance very tempting But I'm sure I would not do well physically in a jail cell. He says now here's the part that blows my mind He says regarding the Mexico national health care system, perhaps it's fine in other parts of Mexico He says but here in Z. What nail you wouldn't want to bring your neighbor's canary there Everything about the whole system is about 60 years behind Canada. They haven't got a CT scanner or an MRI

[23:50] But the medicines are free often inferior but free now when we came here We thought that the national health care system in Mexico would be okay But when my husband ended up with cancer had surgery in Canada came back down here and had blood clots in his lung Then we had to make a run back to Canada and we were almost not allowed on the plane because of his condition Which we had to lie about and then we were allowed to fly what a horrendous experience I wouldn't wish on anyone hence a high level of stress and anxiety. Okay again So these people were very misinformed that had some crappy advice I mean what planet is that guy living on when he didn't know the national health care systems in Latin America completely suck In fact, he said just now he went down thinking the national health care system was okay The fact is ever since I started this show. What's it now six years ago from day one?

[24:42] I told the world how absolutely useless crappy and medieval Latin American national health systems are yet this guy says we thought the medical care would be okay Well, it is it's more than okay. It's first world But you got to go to a first world style hospital or clinic and it'll still be a quarter to a fifth as much as you Pay for it up in the states Why let the Canadian health care system or any government make your important life's decisions for you if you're so worried about losing that Canadian Residency and thus your so-called free medical health Why don't you just get one of those very cheap Cadillac insurance plans down here in Latin America and settle permanently? Get your permanent residency. So bottom line for those of you who are not in the best of health and may even be quite handicapped

[25:27] You have to start looking off the gringo tourist trail That's the only way to live a first world life on a small pension or Social Security That said I mentioned my next expat insider seminar is coming up in July 2016 That's three months away and I promised I'd announce an early bird discount sign-up rate And here's the deal if you sign up anytime before May 1st You'll get the early bird rate, which is five hundred dollars off the single sign-up rate and a thousand dollars off the two-person Double occupancy rate so you've got about a month to get in on the early bird discounts so check out the seminar information and sign-up page by going to Www the new expat calm and on top of the page. You'll see Johnny's 2016 July seminar click on that link and it'll take you right there or send me an email the expat files at gmail.com

[26:20] And I'll send you a direct link that'll take you to the information and sign-up page And by the way during my last seminar in January the famous John Galt from the new expat comm website Took a group of our seminar attendees on two spectacular side trip guided tours a four-day Pre-seminar trip and a four-day post seminar trip now these occurred immediately before and immediately after my main seminar And his two events received such amazing reviews that John Galt again has promised to do a repeat performance this time But only for a small group of our seminar attendees that said I urge all you Perspective seminar attendees to add a few extra days on to your trip and really try to make one if not both of John Galt's side trip events So again the pre-seminar side trip is four days before the seminar starts and immediately after that trip you go to the seminar

[27:10] Then there's the post seminar trip which starts immediately after the seminar for four days running So check out the details on John Galt side trips Just go to www then who expect comm and you'll see the link on the main page That said don't forget to check out my youtube channel to see the photos that go along with the audio do subscribe. It's free You've been listening to the expat files living in Latin America coming to you twice a week from somewhere south of the border Email me the expat files at gmail.com And if you want me to help you sort out your own Latin American plans schedule a one-on-one consult with me Just send an email and let me know at the expat files at gmail.com. No spamos