Health Insurance in Panama: Barriers to Entry

Health Insurance in Panama

Finding Health Insurance in Panama

Health Insurance in Panama

New expats – that aren’t fluent in Spanish – look to a healthcare broker to provide a variety of quotes.

I received an email in the last couple of weeks from a woman in her 70s. The woman is moving to Panama this month, and suddenly realized: Oops! What about local health insurance?

I hated to be the bearer of bad news, but in reality, a month before you move to Panama is probably too late to get a new health insurance policy issued.

Why, you ask? A ha! Well, this is Panama, and getting new health insurance in Panama can be complicated.

Finding Health Insurance Providers in Panama

Unlike the new healthcare exchanges in the States that are administered by each state, there’s not one place to go and find all the health insurance companies listed in one place on the web. Not in English, anyway.

So, most new expats – that aren’t fluent in Spanish when they arrive – look to a healthcare broker to provide them with a variety of quotes. I’d recommend it, for those new to the Panama market. I won’t promote any certain one, but you’ll find English speaking reps at both Semusa and Ducruet in the city. And there’s a possibility there are others, but both of those have been around for some time.

Pre-Existing Conditions Still a Major Issue in Panama

A new health insurance policy in Panama requires a number of physical exams.

That’s right. A new health insurance application in Panama will require you to report:

Any visits to the doctor in the past five years,
Any surgeries in the past ten years, and
Any drugs you take or have taken in recent past.

Not only will you be mired in a number of pain-in-the-butt forms to fill out to get your application going, you’ll also be required to take a physical exam.

Unfortunately, we’re not just talking about a pee-in-the-cup type of exam. Nope. This is much more complicated than that.

Here’s a list of the exams a new health insurance policy in Panama requires you to take when you apply:

• A variety of blood tests
• An AIDS test (yes, you have to consent, but the application requires it!)
• A physical exam by a Panamanian physician (which you have to pay for)
• A PAP smear or prostate exam
• An EKG and/or stress test

Tick Tock, Tick Tock: The Waiting Game

The approval process in Panama can take up to two months.

If you’ve read my books, you’ve learned by now that efficiency rarely exists in Panama. And, that is very much the case when you are applying for health insurance.

When my husband and I applied for a new policy a year or so ago to replace one we’d had before, the approval process was five weeks. This year, a fellow expat couple applied for a policy through Pan American Life, and the approval process took almost TWO MONTHS. And, even then, the late 50’s husband was approved (with several exclusions lasting up to two years each), and the mid 40’s wife was denied with, “Oh, sorry, you don’t fit our ‘profile’ and therefore, we can’t be approve you.”

I’m not lyin’. The reality is that she’s in menopause and while healthy now, had a few complications in the last five years, and thus, they turned her down. Hmmm. Not surprising as Panama is a very machismo society. I would be surprised if there’s a woman even sitting on their application review panel! (Then, knowing that it’s Panama, such a  panel might not even exist….)

So, take note: pre-existing conditions are very much alive and well in the Panama health insurance market, and the local companies are still using them as reasons to decline applications, just like was done in the U.S. for years and years and years.

What’s it cost for a new health insurance policy in Panama?

Of course, the answer to that question depends on your age, and how healthy you are. But here are some examples below, based on a poll of some of our expat friends.

  • Couple – him late 50’s, her late 40’s – $2,300 per year with PanAmerican Life
    • $350 deductible per person per year, and max of $10,000 per year in coverage (local rates), no international coverage
  • Single fellow – late 50’s – $1,430 per year with PanAmerican Life
    • Same deductibles as above; only local, no international coverage
  • Couple – him mid 50’s, her mid 40’s – $6,600 per year with Worldwide Medical
    • This policy DOES include coverage in both Panama and the U.S.
    • Panama deductible: $350, US deductible: $1,000 after all Panama healthcare options have been exhausted.

My best advice once you have a healthcare policy in Panama: If you like it, keep it!

A quick Q & A on health insurance and health care in Panama, in general.

Q: Is overall health care in Panama cheaper than in the U.S.?
A: Undoubtedly, yes. A doctor visit can be from $25 and up, depending on where you go. I talk more about the overall health care system in Panama in my second book.

Q: Is health insurance cheaper in Panama than in the U.S.?
A: Undoubtedly, yes. Compare $2,300 per year for the top example above, versus a similar policy in the U.S. that costs $1,300 per month. The challenge – for those of us with advancing age – is that the lower cost is very much a good thing, IF you can get approved.

Q: Are most health insurance plans in Panama HMO’s or PPO’s?
A: Most of them are neither. You normally don’t choose a primary care physician, nor do you have to get a referral to go to a specialist with most local health insurance plans in Panama. But most insurance plans do have a list of doctors, and if you go to one of them, you pay an agreed-upon copay, and if you see someone not not on the list, you pay in cash, then have to get reimbursed, AFTER you satisfy your deductible then, then the old 80/20% split kicks in (again, think 1990′s). Be prepared, the reimbursement can take weeks, and sometimes months.

Q: Can I monitor my own health care plan in Panama online?
A: Sadly, no. Another detail still stuck in the 1990’s, unfortunately. The reality: paperwork, paperwork, paperwork. I think several companies are working on getting their own online systems up and going, but to my knowledge, nothing has been implemented.

For more on Panama, and life in Panama as an expat, follow the Panama Gringo Guide and Elizabeth Vance on Twitter and Google+.

And, for those of you starting down the path on the health insurance application process adventure in Panama, good luck!

 

Expats in Panama, er, Paradise

Casco Viejo Panama
Casco Viejo Panama

Colonial buildings in Casco Viejo

The BBC published a story yesterday in their Expat Guide online by reporter Alina Dizik. I’ve always admired the Brits, because much of the time their outlook is a bit more reasonable – perhaps more pragmatic – about the state of the world, and not so darn positive, which the U.S. tends to be. (Take today’s stock market for example…) At any rate, this is one of the very first articles about Panama by an outside media agency that rings absolutely true in my book, and I think it’s worth your time to take a look at it.

A number of Panama expats quoted

Read comments from Panama’s World Trade Center head, as well as a local expat who owns a hotel in Casco Viejo, Panama’s UNESCO World Heritage site. And, Kent Davis, the rising expat star in Panama’s real estate market was also interviewed. I’ve always liked Kent’s insight, where he’s quoted – he’s a very reasonable guy. No stardust here. And, lastly, Skyler Ralston of Young Expats in Panama (YEP!) is also quoted. I interviewed her on this very blog two years ago, and you can refer to that interview here, which is still very relevant about how young expats find there way in this country. Read the BCC article on Panama here. I think you’ll find it very useful if you’re looking to move to Panama, retire in Panama, or just want to visit Panama. Kudos to reporter Alina Dizik for excellent journalism.

Finding a Maid in Panama

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The Luxury of Having a Maid in Panama

When we first moved to Panama, I was aghast that the apartments we looked at still had an area as part of the floor plan with a tiny bath and what appeared to be a very small walk-in closet. “What is this supposed to be?” I asked the real estate agent. “Oh, that’s the living area for your live-in maid,” she replied. It was hardly big enough to put a twin bed in and I told her as such. “Don’t worry,” was the reply. “You’ll be able to buy her a special bed to fit the space.” Sure enough, I saw mattresses smaller than twin size advertised in the newspaper not long after, and they were specified for the “maid’s room”.

In 2007, having a live-in maid was still very much the norm in the country. The average salary at that point was around $12 for domestic help. Per day.

Of course, we angered all of our neighbors and friends by hiring our first maid back then for $15 per day. “Stop it!” some of them exclaimed. “You’re driving up the prices for all of us!”And, that was for a maid who came and went every day, not a live-in, as I couldn’t imagine having someone in our personal space 24/7.

We ignored them, and we still overpay to this day. I like to think of it as one of our contributions to the Panama employment market, and maybe even to the rise of the middle class in the country.

Rate in 2007/2008 for a full-time live-in maid with benefits (vacation, social security, etc): $200-220. Rate for a full-time live-in nanny with benefits at that time: $225-250. At that time, finding a maid in Panama was not that difficult.

Domestic wages increasing in Panama

We now occupy a home 1/5 the size of the apartment we originally rented when we moved to Panama in 2007/2008, and now – in 2015 – we pay $35 per day for our maid that still comes and goes. Yep, that’s right: that’s a 233% increase in salary for the gal that works for us over the past eight years. It’s still PENNIES compared to what we paid – back in 2008 – in the U.S. for three hours of cleaning: $60! And, that help (in the U.S.) didn’t do dishes or cut up fruit, when I needed it. Nor would I have asked.

Today’s average pay for domestic help in the city of Panama is around $20 per day, depending on where you live (and how easy it is for the woman to get to you) and how big your home is. In the beach areas on the Pacific side, it may be lower – around $15. Note that generally this rate does NOT include a woman who will also help you cook. This is just for cleaning. (And, I do refer to most maids as women here in the country because doing household work in this neck of Latin America is still very much thought of as ‘women’s work’. The feminist revolution is only just now beginning to be born here, in the younger generations.)

I can’t speak to the rates for maids in the Interior – in smaller towns like El Valle, Boquete, Las Tablas, Santiago, etc. – I imagine because some of those areas are more rural and removed from the city, the rates may be less, but that’s a question better posed to some of the other bloggers in Panama that cover those areas.

Meanwhile, the rates for a maid in 2015 – at least in the city of Panama – for a full-time, live-in nanny: $450 and up. More than double what it was seven years ago. That is, if you can find one at all. Their numbers are on the decline.

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Domestic help in Panama becoming harder to find

It’s at least once a month that I hear a complaint from a Panamanian colleague. “Nannies are getting expensive. Maids are hard to find.” My usual response is to turn to them in mock horror, “Let me guess: you’re paying around $250 a month still?” To which, they stammer, “Well, yes, but I can’t afford anything more….”To which my usual response is, “And you haven’t gotten a raise at all in the past 7-8 years?”

And, believe me, most of them are professionals and most of them have. So I ask you: shouldn’t the salaries of domestic help be increasing in that same time period too?

Panama is thriving. The national Minister of Finance just came out with his projections for Panama’s economic growth rate this year: 6.2%. That’s phenomenal in a world where most countries are just trying to stay afloat.

With more companies moving to Panama who bring more jobs to Panama, which means more people relocate to Panama – well, you get the picture. Demand of domestic help is higher, supply is lower, and thus, prices increase. It’s economics 101, people.

Plus, las empleadas as a whole are getting smarter, and more educated, generally about their options in the marketplace.

Domestic help in Panama choosing other positions

Now, let’s be honest. If someone lives in a market that has less than 4% unemployment (like Panama), and they can get a job with regular hours in an office or in a hotel, versus slaving away in a domestic situation that does not have central air conditioning (most homes don’t) and that may have irregular or extended hours, would you blame them?

Some of my fellow expats may be mad at me for saying this, but I don’t blame the young women a bit! This is part of Panama’s upward movement, of positive economic growth, of the rise of a strong middle class – all the things that makes New World type countries New World-esque. And, Panama – as I’m sure you’ve read if you’re reading this blog – is well on its way, at least somewhat.

So, you won’t find me joining my national and long-time expat friends in lamenting their difficulties about the lack of domestic help in Panama – whether it’s a maid or a nanny or a gardener – in 2015.

My philosophy is simple: times have changed in Panama, especially in the past eight years, since we’ve had the opportunity to call Panama our home. It’s for the better: we’ve got more choices. And with more choice, you’re going to pay through increased prices and more competition. And most of the Panamanian local job force have those same choices too. Change is good!

Looking to hire domestic help in Panama?

In my mind, it’s simple, really. Be fair. Be reasonable. And pay slightly more than the market does. Result? You’ll never have problem finding a person that would like to work for you.

Want more realistic insight on moving to Panama, relocating to Panama, or what the culture is like before you visit Panama? That’s what my Gringo Guides to Panama are all about: What to Know Before You Go and More to Know Before You Go.