Health & Medical Information

Health and medical care is an important consideration when you move abroad. Thankfully, most countries outside the US have both affordable and high quality healthcare.

Colombia’s Healthcare System: An Expat’s Guide to Accessibility and Affordability

In this guest post, U.S. expat Daniel Arthur shares his knowledge of the Colombia healthcare system. Here is his story…

As an expat who moved from the U.S. to Colombia, I understand the anxiety about healthcare in a new country.

I was pleasantly surprised to find Colombia’s system not only accessible and affordable but also offering excellent care.

So, let’s dive into the details below. By the end of this article, I hope you’ll have a foundation for understanding the healthcare available in Colombia before you move!

Setting The Preliminaries

This article is designed for full-time expats living in Colombia on a migrant (M Visa) or resident (R Visa) visa and enrolled in Colombia’s EPS (public healthcare) scheme, which I will discuss below in greater detail.

The coverage and system discussed herein do not apply to tourists, visitors, and those on temporary visas. If you are “slow traveling” or vacationing here on a temporary visa issued solely by your passport, you are not eligible for any of these benefits.

Furthermore, as of October 22, 2022, those maintaining ANY Retirement Visas will no longer be eligible to enroll in the EPS system. Retirement Visa holders must maintain a separate Colombian prepegada (private) or a global international medical plan that covers them for the entirety of their visa term in Colombia.

It isn’t entirely clear whether those who received their Retirement Visa before the change in law will be “grandfathered” or continue their EPS coverage, so when your renewal comes up, always consult an immigration lawyer about current requirements. Laws, regulations, administrative procedures, and policies change regularly, sometimes with little or no transparent communication to the public.

I applied for my first M Spousal Visa from the Orlando Consulate in June 2022, moved here full-time in November 2022, and enrolled in SURA EPS as a beneficiary of my Colombian spouse. His SURA EPS premium payments are coordinated by his employer, who deducts our premiums through monthly payroll deductions and remits them to SURA on our behalf.

I just completed my M Spousal Visa renewal in May 2024 from Medellín, and with the renewal, I maintained my current SURA EPS with no lapse in coverage.

My situation is very different from most expats. Since I’m my spouse’s beneficiary, I’m not required to register with EPS as a contributor (and remit my premium payments directly to EPS). I’m not employed or have a regular income source, so I’m enrolled as a beneficiary.

Most expats and retirees must register directly with EPS and pay their monthly premiums to the EPS provider (unless they are employed by a Colombian company OR listed on their spouse’s plan as a beneficiary).

So what is EPS, prepegada, SURA?  I will expand on all of this below.

Understanding Colombia’s Two-Tiered System

Colombia’s approach to healthcare is a clever blend that ensures coverage for everyone in the country.

I’ll break down and explain the two main tiers below:

Régimen Contributivo (Contributory System): If you’re living and employed in Colombia, you’ll most likely fall under this system. Think of it like employer-provided insurance in the US in comparison. You and your employer make contributions, and this funds your healthcare needs.

Régimen Subsidiado (Subsidized System): The government steps in for those who are unemployed, low-income, or part of vulnerable populations. It’s Colombia’s equivalent to Medicaid or Medicare.

Regardless of your tier, the key players are the EPS providers –  your chosen health insurance provider.  Think back to the days of HMOs in the U.S.

They are your managed care plan – a medical clinic or group consisting of your primary care doctor who is an employee of the HMO (often owned by the HMO insurance provider, like Kaiser Permanente, for example).

Your EPS primary care physician coordinates, oversees, and manages your medical care, including referrals to specialists, outpatient referrals for procedures & labs, and writing prescriptions.

Well-known options include SURA, Nueva EPS, Mutual Ser, and Sanitas.  You can choose your EPS provider, although the choice is limited to the providers servicing your city.

Universal Coverage and What You Get

Near-universal coverage (around 95%!) is one of Colombia’s greatest healthcare triumphs. Both the contributory and subsidized systems offer the same comprehensive benefits:

  • Doctor’s visits (general practitioners and specialists)
  • Hospitalizations and procedures
  • Diagnostic testing (lab work, X-rays, etc.)
  • Medications
  • Preventative care (checkups, screenings)
  • Dental and vision care

Affordability: A Major Plus for Expats

Like the U.S. Medicare and Medicaid systems, the Colombian public EPS scheme provides essential, necessary, and critical care to those without insurance or who cannot afford a comprehensive medical policy and a system laced with bureaucracy. Contribution rates to your EPS are income-based, and the subsidized system is there for those who genuinely need it.

I can’t overstate the affordability of healthcare here. Compared to the US, it’s a breath of fresh air!

I paid cash (did not utilize EPS or insurance) to a top-notch dental facility with English-speaking doctors and staff to clean my teeth. The total cost to see the dentist for the exam and have the hygienist clean my teeth was $43.00!  Similarly, a visit to an English-speaking doctor trained in Texas for my annual physical was only $58.00!

Cash-pay patients can be advantageous in Colombia to avoid the EPS bureaucracy, just like in the U.S.

Since most people utilize some sort of insurance for their medical expenses here in Colombia, the insurance companies, in effect, dictate the level, quality, and type of care you receive. Their goal is motivated by profit and profit margin and reducing their overall expenses. Therefore, they approve the least costly treatment plan, not necessarily the doctor’s prescribed or preferred medical care for the patient.

Paying cash directly to a provider during service eliminates the “insurance red tape.” The provider can provide more efficient, quicker, and better-quality care without them or the patient fighting with insurance companies to get the care they need.  Sound familiar?  It is, for those of us from the U.S.

The costs are manageable and reasonable, even if you initially use private clinics or pay out-of-pocket before securing residency.

Quality of Care: It Surpassed My Expectations

Colombia invests significantly in hospitals and clinics, resulting in modern facilities nationwide. Doctors here are incredibly well-trained, often completing part of their education abroad, and are usually multilingual.

Finding fluent English speakers amongst your physicians, especially in larger cities, will be relatively easy.  Conversely, more rural towns tend to have only Spanish-speaking professionals across all sectors (not just healthcare). Consider your current language level when moving abroad.

Those not fortunate enough to live in a city with an English-speaking doctor can always bring a trusted friend or family member who speaks Spanish—especially advantageous if your friend or family member is a native Colombian!

Lastly, patients who do not “self-advocate” for themselves will inevitably receive lower-quality care and be subject to being taken advantage of, rather than those who do advocate for themselves, research all options, and are mindful of the expectations, policies, and nuances of the system, BEFORE they step into a clinic or hospital.

Challenges: What Expats Should Know

No system is perfect, and here’s where expats should be mindful:

Rural Disparities: Access to care can become trickier in remote regions. If you plan to move to a rural area, research local healthcare availability.

Wait Times: The public system sometimes has longer wait times for non-urgent procedures.

Bureaucracy: There is bureaucracy to navigate, but it gets easier once you understand how things work.  My SURA EPS is full of bureaucracy, especially when filling prescriptions for maintenance medications.

Private Insurance: A Supplement Worth Considering

While the EPS system is excellent, private health insurance can be an intelligent add-on, especially if you want to maintain your choice of doctors, enjoy faster service for non-urgent needs, and are relatively healthy.

The private system in Colombia, known as prepegado (prepaid or private), is similar to private insurance and employer-sponsored plans in the U.S.

The significant difference for prepegadas relative to U.S. employer-sponsored plans is that U.S. employer plans are required to offer a “guaranteed issuance without medical underwriting clause.” In contrast, Colombian individual prepegado and employer-sponsored prepegado plans require the insured to undergo medical underwriting.

What do we mean by this?  Colombia does not have laws guaranteeing policy issuance for those with pre-existing or chronic conditions.

If you have a complex medical history, be prepared for intense medical underwriting by the insurer, which likely results in denial of coverage.  Those offered a plan expect higher premiums to cover chronic or preexisting conditions.

Navigating the System as an Expat

As a non-resident, you may need to pay for some services out-of-pocket initially. Once you obtain your residency visa and cédula (national ID), you can join an EPS if it is still available.

Ask other expats in your area for recommendations, and remember that your EPS can help arrange doctor visits, prescriptions, and more.

Don’t be afraid to ask questions—most Colombians are friendly and willing to assist. If your Spanish is fluent, the actual EPS entities and your private insurer can also help!

Final Thoughts

Colombia’s healthcare system is a success story, especially considering its affordability. Consider Colombia as an expat destination, knowing that the system will manage and meet your healthcare needs at a surprisingly low cost with an excellent quality of care and where you will find professionals and people to help support you along your way!

AUTHOR’S DISCLOSURE: The topics discussed in this article contain accurate information at the time of publication, are for informational purposes only, and are based on my experience(s). The Colombian government regulates immigration, healthcare, and tax law. You should consult a licensed attorney and tax accountant before acting on the above article and its contents.



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How to Avoid & Treat Altitude Sickness in Ecuador

You might be drawn to the breathtaking landscapes and vibrant culture of Ecuador, especially in high-elevation cities like Cuenca (8,500 feet / 2,560 meters) and Quito (9,400 feet / 2,865 meters); however, you may experience a unique challenge: altitude sickness.

Similar conditions are found across various mountain cities in Ecuador and throughout the Andes, so if you’re planning a trip, you may be wondering how to prevent or treat it.

This guide provides you with insights into the symptoms of altitude sickness and offers practical remedies and preventive steps.

With this knowledge, you can ensure your visit or move to Ecuador remains both comfortable and enjoyable.

MEDICAL DISCLAIMER: This article is for educational and informational purposes only and does not constitute medical advice. Consult a doctor for medical advice, diagnosis and treatment if you experience any of these symptoms or others.

Symptoms of Altitude Sickness

It’s crucial to understand the symptoms so that you can distinguish between altitude sickness and other potential ailments.

View of Cuenca Ecuador from Turi.

Symptoms include:

  • Dizziness
  • Shortness of breath
  • Headache
  • Racing heart
  • Nausea or vomiting
  • Fatigue
  • Loss of appetite
  • Sleeping too much or too little

The tricky part is that it’s unpredictable; some people may feel the effects immediately upon arrival, while others may take a few days.

Preventing and Treating Altitude Sickness

Altitude sickness is no joke. The adjustment, often underestimated, can play a significant role in your acclimatization to life in this beautiful Andean nation.

Whether you’re contemplating a visit, a move or you already live in Ecuador, understanding the implications of altitude and how to combat its effects is vital.

Here are a few tips to best prepare and adapt to the heights of your new home:

  • Ascend Slowly: Ideally, take a few days to adjust to the altitude. If you’re driving in Ecuador, be prepared for rapid altitude changes. The pass through Cajas National Park reaches 13,000 feet / 4,000 meters before descending to Cuenca’s 8,500 feet / 2,560 meters.
  • Stay Hydrated: Drink plenty of water. The high altitudes and dry air can cause dehydration, worsening symptoms.
  • Diet Matters: Eat dark leafy greens to increase oxygenation of your blood. Avoid fatty foods, as they can decrease oxygen levels in your blood. Also, abstain from alcohol since it can lead to dehydration.
  • Rest and Adjust: Don’t overexert yourself when you first arrive. It’s not advisable to engage in strenuous activities like running, biking, or mountain climbing until you’ve acclimated.
  • Amelia and JP holding a packet of Mate de Coca TeaMate de Coca: This tea, made from the leaves of the coca plant, is a natural remedy known to help with altitude sickness. However, be cautious, as it can result in a positive drug test when you return home.
  • Breathe Properly: Deep breathing, in through your nose and out through your mouth, can be beneficial.
  • Consider Prescription Medication: Diamox is a drug that some travelers obtain before their trip as a precaution.
  • Relocate to Lower Elevation: In severe cases, the best remedy might be to move to a lower elevation. It’s a drastic measure, but for some, it’s the only way to find relief.

Our Experience with Altitude Sickness

One of the main reasons we left Cuenca back in 2020 was because of the elevation.

I’ve had episodes of altitude sickness both in Ecuador and previously in Colorado when we went to Summit County to go skiing. Sometimes, the symptoms were so severe that descending to a lower elevation was the only remedy.

However, after years of eating healthy and living the tranquilo Ecuadorian lifestyle, I no longer have issues with the elevation. In fact, we’re living at high elevation now and I haven’t had a single issue for over a year.

Most people adjust to the elevation in 3 to 5 days. That’s typically enough time for your body to increase the production of red blood cells, aiding in acclimatization.

If your body has difficulty adjusting, try one or more of the remedies listed above. Most importantly, drink lots of water and rest.

Watch Our Video About How to Treat Altitude Sickness



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The American Healthcare Crisis Is Worse Than You Thought!

It’s a devastating reality: many Americans are literally dying for healthcare – dying while they wait for it, or dying because they can’t afford it.

We often discuss the dire healthcare situation in the U.S. and compare it to other countries like Ecuador, where healthcare is both surprisingly better and cheaper.

For decades, Americans have been traveling abroad for medical care. The blossoming medical tourism industry is a direct reflection of the absurdities of the American healthcare system.

And we’re not only talking about elective or cosmetic procedures, but necessary medical and dental treatments as well.

Watch Our Video About Americans Dying for Healthcare

The Current State of U.S. Healthcare: Alarming Facts

Unfortunately, the U.S. healthcare system isn’t just expensive – it’s ineffective.

The United States is the unfortunate leader in healthcare costs globally, while simultaneously holding the worst outcomes among other high-income nations.

Recent studies conducted by The Commonwealth Fund reveal startling facts:

  • The U.S. has the lowest life expectancy at birth among high-income countries.
  • It has the highest death rates from avoidable or treatable conditions.
  • The country has the highest maternal and infant mortality rates.
  • It also has among the highest suicide rates; only South Korea is higher.
  • The U.S. has the highest rate of people with multiple chronic conditions.
  • The American obesity rate is nearly double the average of other high-income nations.

Disturbingly, a recent NPR report revealed that 38% of Americans are delaying medical treatments, doctor visits, and even routine dental and vision exams due to prohibitive costs. They also aren’t taking all their prescribed medications.

Insurance often falls short, with many people either uninsured or on high-deductible plans. Despite these plans costing $1,000 or more per month, they often don’t cover basic healthcare needs unless something catastrophic occurs.

Prescription drug prices in the U.S. are among the highest in the world. Some insurance plans don’t cover certain medications, making it extremely difficult for people to access necessary treatments.

Wait times for care are also unbearably long, with reports of six-month waits to see specialists – a delay that can prove disastrous.

The U.S. healthcare crisis is so severe that some people have left the U.S. permanently, seeking more affordable options abroad. That includes us!

See Also: The Real Reasons We Left the United States (and why we can’t move back)

The Solution: Medical Tourism

Medical tourism is becoming a popular option for many non-emergency treatments.

Countries like Mexico offer high-quality doctors and hospitals for a fraction of the cost.

For instance, our healthcare costs in Ecuador are substantially less. We have private health insurance that costs only $214 per month and covers both of us with a $100 deductible and a $15 copay.

It’s common for expats to pay out of pocket or self-insure because the costs in some countries are a fraction of those in the U.S.

You can also get global health insurance from a company like Insured Nomads, and most global plans often charge significantly less if you exclude the U.S. from your coverage.

Some countries even offer one-year medical visas, allowing you to stay for a year, save money, have an amazing experience, and take care of your health needs simultaneously. This makes it possible to combine your medical trip with a vacation, often for far less than the cost of treatment in the U.S.

However, it’s essential to note that not all aspects of medical tourism are rosy. Buying prescription drugs over the counter in countries like Mexico can pose potential risks. These drugs may not be regulated, could contain harmful substances like Fentanyl, or even be counterfeit.

While medical tourism is generally safe, it is crucial to research and take precautions.

See Also:

The Hard Reality and the Potential Way Forward

The reality is harsh: the U.S. healthcare system is broken, and nothing significant is being done to address this. The fact that people are dying while waiting for healthcare, or because they can’t afford it, is a damning indictment of the current system.

If you’re in need of high-quality, affordable healthcare, consider medical tourism as an option. Check out resources detailing countries with better, cheaper healthcare than the U.S.

Let us know in the comments if you have a U.S. healthcare nightmare story.



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Medical Tourism: Escape The USA Healthcare Scam!

Healthcare and Health Insurance in the United States is a huge headache that can rightfully cause you a lot of distress. We know people who work jobs they hate or even delay retirement simply because they need health insurance. It doesn’t have to be that way!

Before we moved to Ecuador, JP had two surgeries on his back that ended up costing almost $1,000,000. After that, our health insurance premiums skyrocketed. It’s a familiar story, but we found a happy ending, going outside the States for our healthcare needs. 

We’ve compiled a list of the top 10 countries that have better health care at a fraction of the cost. Now you can plan your next medical procedure along with the trip of a lifetime!

What is Medical Tourism? Best Countries for Healthcare

The concept of medical tourism may sound a little out there, but it’s becoming increasingly popular, and for good reason! In many of these locations, you can pay for a month long medical tourism trip and still spend less than you would to get the same procedure in the United States.

Medical tourism companies can help you get connected with doctors and ensure you have everything you need, including the proper visas. Another option is to apply for permanent residency, allowing you to stay there and pay a lot less for your healthcare. Global health insurance is also available, and if you exclude the United States from the list of places you get treatment, it can be extremely affordable. 

Let’s jump in and look at our favorite places to get medical care!

10. France

France is known for its high quality – but low cost – healthcare.  Every year, CEO world puts out a ranking of the top healthcare systems in the world, and this year France ranked number seven! 

There is even a specific healthcare system for foreigners called Protection Universelle Maladie (PUMA). It allows access to state healthcare after only three months of residence. If staying in France for three months isn’t quite what you’re looking for, you can also turn towards private or global health insurance to help cover the costs. 

If France sounds like the perfect place to get your medical problems dealt with, you’re not alone. Medical tourism is incredibly popular in the area. You can enjoy all the romance and beauty that is in France while getting the care you need. 

9. Spain 

9. Spain 

If you’ve ever dreamed of living where they filmed spaghetti westerns or where delicious Spanish wine is made, you might want to consider medical tourism in Spain. CEO World ranked Spain number 8 on its list of healthcare systems. 

This country features both a public and private healthcare system. If you’re looking to use the public system, you’ll need to contribute income tax and social security, but there are extremely affordable options for private insurance. In fact, some of the prices are as low as what we pay in Ecuador! 

Spain is incredibly popular for medical tourists because of its beauty and culture, as well as the long-term options for visas. 

8. Czech Republic

Ranked number 14 by CEO World, we love the Czech Republic because of its excellent health care, multiple options for visas, and low cost of living.  They are known far and wide for their excellent universal healthcare. 

If you’re looking to become a permanent resident in the Czech Republic, you are required to get private health insurance. There are lots of English-speaking practitioners, and medical tourism is popular, so they will be familiar with your situation and know how to deal with it. 

One of the unique offerings in the Czech Republic is its spa designed specifically for cancer survivors

7. Portugal 

With their state-of-the-art facilities and significantly less expensive procedures, Portugal is very popular among medical tourists. CEO World ranked its healthcare number 22, and treatment there can cost between 50-30% of what it costs in the US. 

Public health insurance is available for both citizens and residents, so if you go there as an expat, you’ll have no trouble using their system. It’s almost free, paid for with taxes and social security. 

6. South Korea

6. South Korea

South Korea was ranked number 1 by CEO World! It’s known for being safe and affordable, as well as having lots of things to do and see while visiting. That, combined with their available one-year medical visa, makes South Korea a very popular destination for medical tourism

We have heard from lots of friends that it’s a joy to live in South Korea as a foreigner, so this is one destination you won’t want to write off. 

5. Thailand

An excellent option for medical tourism, Thailand is ranked number 13 by CEO World. Thai hospitals are some of the best in the world, and the procedures cost a mere 10-20% of what you would pay in the US! 

Thailand is a popular destination for expats because of its exciting culture and low cost of living, so you may want to consider a longer-term visa. You never know if you might fall in love with the country! 

4. Malaysia

Even though CEO World ranked Malaysia number 34, the only ranking lower than the United States, we’ve done our research and believe that it’s a strong choice for your procedures. While the pandemic hit this healthcare system hard, they are back on track to returning as one of the top healthcare systems in the world. 

They’ve been putting a lot of effort into their medical tourism, which isn’t a surprise because their hospitals are top-notch and provide care for as little as 20% of the cost in the United States. Malaysia does have public healthcare that expats can access, but you’ll end up paying higher rates, so private health insurance is a great option – and not too expensive. 

You aren’t required to have health insurance in Malaysia at all, so if you want, you can pay out of pocket for procedures. 

3. Argentina 

3. Argentina 

Argentina is one of the best countries for healthcare in South America. CEO World rated it number 27 out of all the healthcare systems in the world. They have private health insurance that’s extremely affordable and just recently started to include medical marijuana. 

The healthcare costs are 60-70% cheaper than those in the States. There’s so much to experience in Argentina over your stay, and with a one-year medical visa available, you’ll have more than enough time to enjoy this country fully.  

2. Mexico 

A long-time favorite of medical tourists from America, Mexico is easy to get into and offers high-quality procedures at a fraction of the cost. Ranked number 29 by CEO World, Mexico’s healthcare system is 3–4 times less expensive than the US.

There are even hospitals all along the border that cater specifically to medical tourists! Many doctors got their training in the US, so they speak fluent English. There are both private and public insurance options, so no matter what, you’ll be able to find an option that works for you. 

1. Ecuador

Cuenca EcuadorIt should come as no surprise that our favorite place to get healthcare outside the US is Ecuador! Ranked number 25 by CEO World, it came in five better than the States.  

Our costs here are so low we’re always shocked when we go to the doctor to get anything done. We have health insurance that covers both of us for only $192 a month (with JP’s pre-existing condition).

We haven’t had any major procedures done since coming to Ecuador, but we know people who have had cancer treatments, shoulder injuries, and heart surgeries that they were very happy with. In general, healthcare will cost a mere 25% of the cost in the States, and many doctors speak English. 

You will deal directly with the doctor right away; you won’t have to spend weeks or months just interacting with nurses or admin staff. So many people come here for dental tourism as well, and it is significantly cheaper even with travel. 

Bottom Line

Healthcare can be such a complicated and stressful thing to deal with. We hope that by making you aware of the options, we’ve opened your eyes to the whole world of possibilities available to you with medical tourism.

Watch Our Video About Medical Tourism

Here are links to the references mentioned in the video:
CEO World Healthcare Rankings (2021)
Allianz Care Global Health Insurance
Cigna Global Health Insurance
GeoBlue Global Health Insurance
Bupa Global Health Insurance
The French Social Security System – PUMA
France Medical Tourism
Spain Medical Tourism
Czech Republic Medical Tourism
Czech Republic Medical Spa
Czech Republic Health Insurance
South Korea Medical Tourism
Thailand Medical Tourism
Malaysia Medical Tourism
Argentina Medical Tourism
Mexico Medical Tourism
Ecuador Health Insurance & Healthcare
Ecuador Dental Tourism (Cuenca)
Medical Tourism Country Index



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Our Ecuador Healthcare Experience

Before our recent hospital visit, we did not have in-depth personal experience with the Ecuador healthcare system. We know Ecuador has one of the best healthcare services globally, so we expected something nice. Pleasantly, our expectations were exceeded. The quality was so great that their affordable cost was almost shocking.

I met the doctor for a series of medical checkups and blood tests. Actually, I met four doctors and had three medical procedures and several lab tests.

I have a family history of colon and prostate cancer, so I need to check in with a doctor regularly. The tests are scheduled every 5 years, but I was already 2 years overdue for this one due to the COVID pandemic. I finally got tested and while the news is not exactly great, we are optimistic.

There are many good things to take away from our experience with Ecuador’s healthcare, and we will walk you through them in this article.

Ecuador Health Insurance Brokers

Ecuador’s health insurance system differs from the United States so we had many questions, which were answered by our private insurance broker, Maurice Miranda.

As we found out from Maurice, there is a remarkable difference between insurance brokers in Ecuador and those in the United States. He was very interested in getting us the right doctor and was heavily involved in scheduling appointments.

First Appointment

Our first appointment was at a private health institution. The facilities were impressive and looked much better than the few public hospitals we had formerly visited.

We didn’t know we were supposed to make payments at a machine before we could meet the doctor. Different systems clearly. Thankfully, our kind Doctor didn’t have any problem with our manners (Pun intended) and accepted direct payment from us.

Our doctor was amazing. She spoke and understood fluent English, missing only a few words, which was not a big deal as we understood the small Spanish inputs she used as substitutes.

She ran some vital checks and discovered my blood pressure was quite off the roof, which we all agreed was due to me being nervous. I was over two years past my checkup schedule, so I was a little anxious.

After the blood pressure check, I was expecting to fill out my family health history and information in a 14-page book, just like in the US, but that wasn’t the case. It was easier. Ecuador doctors use computers to collect all necessary info about your medical and family history. They ask the questions and you answer. I prefer this pattern as I really communicated and connected with my doctor. I expressed how I felt about my genetic vulnerability to prostate cancer and the toll of dealing with an over 50-year-old prostate which made urinating difficult.

Our doctor was great, empathetic, and very caring. She listened to my concerns and gave me a prescription to help in the bathroom. She ordered some bloodwork, a Colonoscopy and a Sonogram to ensure I didn’t have any other more obvious problem with my prostate.

She spent about 45 minutes to an hour with us. The total fee for the appointment was $15. We have private insurance with Confiamed this fee was our copay.
Our doctor directed us to get the bloodwork out of the way as soon as possible.

Bloodwork Test

Bloodwork Test

The doctors in charge of the bloodwork asked all the necessary questions regarding our diet. My wife and I generally maintain a whole-foods plant-based diet to keep my cholesterol at a safe level, so our diet was good.

They ran lots of tests, including checks on cholesterol levels, triglycerides, blood sugar, nutrient levels, PSA, parasites, and many other conditions.

The bloodwork was very comprehensive, as the specialists didn’t want to miss anything. About 5 to 6 blood vials were extracted, and I bet I looked a lighter shade of white when we left the hospital.

The entire cost was $188 for about 2 pages worth of tests, which was very affordable for a privately funded hospital. Our insurance covered 90% of the cost, so we paid $18.

The bloodwork results were out in no time, and the major concern was my high PSA and a low Free PSA, both bad. The good news was that the parasite test came out negative. The Sonogram test was next on the list.


It took us three days to get an appointment for the Sonogram. The doctor ran some tests and checked my prostate, bladder, kidneys, gallbladder, pancreas, and liver to see if anything was out of place. This check was as comprehensive as my bloodwork, and I think the doctor wanted to get a holistic view of my system because I complained of abdominal pain.

The Sonogram result was not very comforting. My prostate was 2.5 times larger than normal, which was worrying. The cost for the Sonogram was $80, with insurance responsible for 90% of that.

Now, it would be nice to mention something special about Ecuador’s healthcare. Every patient gets a unique medical record. So once I complete a test, the result is uploaded to my medical record.

A new doctor handling my case can just check my record and know the step forward. It is so easy and seamless.


The Colonoscopy test was the next on our list. When we went to make the appointment, they had openings the next day, but I wanted more time to prepare, physically and mentally.

On the day of the exam, my appointment was at 11:30AM and we were on our way home at 12:45PM. The result was excellent—no evidence of swollen tissues and no sign of cancer or polyps.

The only thing I didn’t appreciate was that the anesthetic made me sick. They used Propofol, which I’ve had several times without issues. But this time it caused a reaction.

Amelia got really scared when I passed out in the taxi on the way home. When I woke up, we were on our way back to the hospital, but I told her I just wanted to go home and go to bed.

The entire cost for the colonoscopy was $305 and insurance covers 90%.

Return to Our First Doctor for Result Review

We returned to our doctor after completing the three tests she recommended. She reviewed the results and was very comforting all through our one-hour session. Her major concern was about the situation with my prostate. She referred us to a urologist for better insight so we knew what we were dealing with. The fee was a $15 Copay.

The Urologist

The urologist didn’t speak English so it was more difficult to communicate with him. He was concerned about my family history of prostate cancer and made it clear that my PSA numbers and larger-than-normal prostate hinted that I might have a problem.

He called the imaging center right then to get the name of the doctor who runs the MRI. After the call, he recommended I schedule the MRI ASAP. We spent about 10 minutes with the him for a $15 Copay.

Contrast MRI

MRI Scan

After leaving the Urologist’s office, we messaged Maurice about the new development, and he scheduled an appointment the next day for a Contrast MRI. That’s right: the very next day!

A Doctor conducted the MRI, and she did the IV for the contrast. All necessary protocols were followed, highlighting how advanced the Ecuador health system is. I wore the noise-canceling headphones which the doctor spoke through when I was in the MRI.

The MRI was not the most comfortable place, and it felt like it wasn’t designed for an adult. My shoulders got cramped, and my arms were asleep for most of the time. Apart from that, everything was good.

The MRI results were out in 3 days. Another surprise. In the US, getting an MRI result could take weeks and even months.

The total cost for the MRI was $320 before insurance, which is quite affordable. The insurance handles 80% of the charge.

The Result and Meeting the Oncologist

The MRI result was a one-page report written in Spanish. I translated the words into English and could make sense of them to understand there were two spots on my prostate. That was clearly not good. It seemed like one of the two spots was likely cancer.

I messaged Maurice again and asked him to find me an English-speaking Oncologist, and he quickly set an appointment for the next day. Good luck finding such quick service in the US.

We met with the Oncologist for over an hour, and he explained the results and concerns. There were two spots in my prostate. One looked normal, while the other was likely cancer, but it was still very small to confirm.

The Oncologist explained that if it was cancer, it could be treated since it was spotted early. He ordered another PSA test with strict preparation specifications for the best reading. He also requested I get another Contrast MRI in 3 months for a better evaluation of the spots in my prostate.

The entire cost was $50 before insurance. We couldn’t get a Copay benefit since he is out-of-network. The insurance company will reimburse 80%.

The Revelation

It is never great to hear you probably have cancer, but we’re optimistic and happy we spotted it early. If it is cancer, it’s still small and treatable, and stats show that the survival rate at this stage is very high.

We’re still hopeful that the two spots are NOT cancer. We’ll know more after the next PSA test and MRI, but for now, we will definitely continue to live our best lives.

Total Costs

  • 3 Dr visit copays: $45
  • Oncologist out of network: $50
  • Bloodwork: $188
  • Sonogram: $80
  • Colonoscopy: $305
  • Contrast MRI: $320

Total cost before insurance: $988

Insurance Cost: $192/month for both – $15 copay, $100 annual deductible, 90% covered in-network, 80% covered out-of-network.

Insurance Reimbursements

  • $573 in-network – 90% back or $515
  • $370 out-of-network – 80% back or $296
  • $811 – $100 deductible = $711 back

Total out-of-pocket cost: $277

So insurance saved us from spending an outright $988, and instead, we only payed $277.

Clearly, in the US, we would have spent thousands of dollars even if we had insurance. Ecuador is significantly cheaper despite also having state of the art facilities.

Insurance Reimbursement Process

If you live in Ecuador, you will need private insurance to apply for your visa. However, the process may be a bit confusing, so a huge thanks to our insurance broker, Maurice, for helping us! We couldn’t have done it without him!

Documents You Need

  • Insurance Claim Form – Signed and stamped by the Doctor
  • Pedidos – Orders for the procedures
  • Facturas – Receipts with the RUC (hospital tax ID)
  • Resultados – All of the results and images from the procedures

You also need a bank account with the account holder’s name on it for your insurance claim reimbursement. I Had to open a new bank account in my name to get the reimbursement.

Our Take On Ecuador Health Care System

CEO World currently ranks the country’s health system at number 25, and we personally agree with this number due to the quality of service we received.

The country’s use of medical technology is impressive. We noticed that every institution we visited made a deliberate effort to make every medical session efficient and effective. For example, I did not have to write out my family history. I instead spoke about them while the attending doctor typed them. This option was more effective from a patient perspective, because I could easily relate with the doctor who clearly seemed to understand me.

The availability of a digital medical record was also very impressive. The results of every test I took gets updated on my medical record, and the new doctor only needs to check the record to know my health status. It was seamless and fast and saved me the pain of having to keep repeating the same information every time.

Another important part of our experience was the affordability of the tests. Everything was very affordable, and we are talking about the prices even before insurance. The entire cost before insurance was below the $1000 mark. In the United States, we would have doled out a few thousand dollars to get the same treatment.

Our verdict on the Ecuador healthcare system based on personal experience is that it is superb. We are even happier we moved to Ecuador following this experience!

Watch Our Live About Our Ecuador Healthcare Experience



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Ecuador Health Insurance: Private vs. Public IESS – Explained

Health insurance in Ecuador can be complicated and confusing, but it actually works very well once you learn a few tricks.

Ecuador has a public healthcare system, which is their version of universal care. There is also a private healthcare system that allows you to choose your own doctors and hospitals.

In this article, we’ll explain both systems, the pros & cons of each and help you decide which is best for you.

Health Insurance in Ecuador Explained

Ecuador Health Insurance

Universal participation has provided Ecuador with an excellent healthcare system. Medical procedures are a fraction of the cost in the US, and the quality of care is high.

Health Insurance in Ecuador is a bit different than the United States. You have the option of getting Private Health Insurance with one of Ecuador’s many health insurance companies.

Or, you can sign up for the Public IESS Health Insurance, which is Ecuador’s version of Universal Healthcare (Medicare/Medicaid). You’ll need your Temporary Residency Visa AND your cédula before you can apply for this plan.

Or, you can get both Private AND Public Health Insurance to make sure ALL your bases are covered. Since the cost of healthcare and health insurance in Ecuador is so much more affordable than in the United States, this is a viable option for many people.

The decision then comes down to a few significant distinctions: price, flexibility, and treatment of pre-existing conditions. Here’s what you can expect regarding each of those considerations for private insurance and the IESS. Hopefully, this information will help you choose which option or combination might work best for you.

Private Health Insurance in Ecuador

In Ecuador, there are 28 private health insurance companies to choose from. They provide health insurance that allows you to visit any private doctor and receive any treatment in Ecuador at private hospitals. Some plans even cover treatments outside of Ecuador.

Monthly premiums are generally affordable but can vary according to your current health factors (age, smoking, pre-existing conditions, etc.), coverage maximums, and the deductible that you choose. There are no network limitations like you’ll encounter using the public IESS plan.

For private insurance, in addition to the monthly premium, you can expect to pay a deductible on an annual or per-incident basis. You’ll also be responsible for a small co-pay for each doctor’s visit or prescription.

Ninety percent of in-network healthcare costs are covered, and 80% of costs out-of-network are covered by private insurance companies. Submit a claim, and the insurance company will reimburse you.

The government mandates coverage of pre-existing conditions, but there is a two-year waiting period before those treatments must be covered by private insurance. You’ll also have to secure private insurance before you go through the residency requirements of obtaining your cédula (Ecuadorian National Resident ID card).

Ecuador Public IESS Health Insurance

General Hospital in Manta

Once you have received your cédula, you can sign up for the public IESS health insurance plan. The IESS is the national social security healthcare system that all Ecuadorians must pay into unless they obtain private coverage.

Under the IESS coverage, expect no co-pays or deductible and all medical costs are covered at 100%. However, you will be restricted to the doctors, hospitals, and pharmacies within the IESS network unless you are referred elsewhere after seeking treatment from an IESS facility.

All pre-existing conditions are fully covered after a 3-month waiting period, which is often why expats choose to have both IESS and private coverage at the same time.

Health Insurance Deductibles in Ecuador

Private health insurance providers in Ecuador offer both low and high deductible plans. A plan with a low $100 annual deductible will cost more than a plan with a high $5,000 annual deductible.

You’ll have to pay up to this amount before your private insurance coverage kicks in, but you can also purchase additional gap insurance for as little as $40/month to cover the deductible.

Your premium will depend on the maximum major medical coverage level you choose and how high you’d like your deductible to be. The higher your deductible, the lower your premium will be. There are plenty of coverage levels to fit most budgets, as you can see in the examples below.

Health Insurance Prices in Ecuador

Overall, both health insurance and healthcare are very affordable in Ecuador, especially compared to the United States.

Ecuador Private Health Insurance Cost

Here are some examples of current private insurance rates for an average 65-year-old.

Total Coverage Annual Deductible Monthly Premium
$100,000 per incident $180 $220-$230
$500,000 annual $5,000 $70
Up to $6,000 (Vida Buena) $39.20

For some, combining private plans makes the most sense. Combining the Vida Buena plan for about $40 per month with a plan that covers up to $500,000 per year with a high deductible will cost about $110.

Effectively, by paying for both, you’ll avoid paying the high deductible and have substantial coverage in place for major medical emergencies.

Ecuador Public IESS Health Insurance Cost

Ecuadorian nationals pay a percentage of their claimed income into the IESS system as their monthly premium.

Expats who choose IESS insurance will owe a premium based on the minimum wage, which is about $83 per month.

Again, there are no deductibles or copays and all medical care is covered at 100%. You just have to pay the monthly premium to access services in the IESS network.

Health Insurance Claims Reimbursement in Ecuador

With the IESS, you won’t need to do anything other than pay your premium to access national healthcare services.

Filing Claims with Private Health Insurance

Ecuador Health Insurance Claims Reimbursement

Private insurance companies require that you to pay for healthcare services out-of-pocket before you can submit claims for each visit, procedure, or prescription that you’d like to have reimbursed.

You have three months (90 days) to submit each bill using a reimbursement claims form. Don’t wait too long to submit the paperwork in case additional documentation is required. Try to submit medical bills with the accompanying claims forms as soon as possible. Your insurance broker can assist you with preparing these claims forms and submitting them correctly.

If your insurance provider initially denies your claim for any reason, you can appeal the decision to the Superintendencia de Companias, who will review the request and make a final decision. If your paperwork is in order for a valid claim, the insurance company will likely be ordered to reimburse you. Otherwise, your claim can be denied.

This appeal process can take 3-5 months for a final decision, but it is free for you to apply. You have the option to file with the Superintendencia on your own, with the help of an insurance agent who’s familiar with the process, or through the free services of a public defender in Ecuador.

What if I can’t afford to pay for expensive medical services out-of-pocket?

Ecuador Health Insurance Filing Claims

Even though healthcare in Ecuador is far less expensive than it is in the United States, complicated treatments can still cost $20,000 or even more.

With private health insurance in Ecuador, you are normally required to pay for the services out-of-pocket and then file a claim to be reimbursed. However, what happens if you need expensive services like heart surgery or cancer treatment and you can’t afford to pay the entire hospital bill while you wait to be reimbursed?

If your treatment is NOT an emergency, you can get pre-approval from your insurance company and then you would only be responsible for paying the regular copays and deductibles.

If your treatment is the result of an emergency, such as an expensive surgery following a car accident, then you will only be required to cover the copay and deductible as long as you go to an in-network hospital. If you go to an out-of-network hospital, you will need to pay for all the services rendered before leaving the hospital.

However, if your emergency treatment is at an out-of-network hospital and you cannot afford to pay the entire bill, it is possible to submit a letter of commitment to pay to the hospital, which will mean you are legally required to pay the hospital even if the insurance company denies your claim.

This is another reason why it’s a good idea to work with an insurance broker like Carlos at Blue Box Insurance to help you negotiate this process.

If you do not have health insurance, you will be required to pay the entire amount before leaving the hospital.


The insurance framework in Ecuador makes it easy for residents to secure affordable coverage. Your best bet is to go through the options available and choose what will best meet your needs. An insurance agent can help you find what you’re looking for and secure that coverage.

There are plenty of significant differences between private and public health insurance and benefits to carrying one type or the other, or even both at the same time. Regardless of your decision, there are plenty of coverage variations for you to find quality, affordable health insurance solutions in Ecuador for your needs.

If you have more questions about health insurance or healthcare in Ecuador, we recommend contacting a health insurance agent/broker directly for more detailed or specific answers. To get in touch with Carlos and his team at Blue Box Insurance, please visit their website at and be sure to tell them you saw this video on Live Abroad Now.

You might also be interested in our article about the Cost of Living in Ecuador: A Guide for Expat Budgeting.



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Shocking Experience w/ Eye Exam & Glasses in Cuenca Ecuador at SOi Opticas

Our first eye exam and glasses purchase in Cuenca Ecuador was efficient, affordable and enjoyable. (This was NOT a sponsored video; we paid out of pocket and they didn’t know who we were.)

We went to SOi Opticas off Solano near the stadium to make an appointment and they took me right then. The doctor spoke English and had all the modern equipment. In fact, it was even more modern than the equipment I’ve seen in the States. The exam cost $25.

Since my eyes had gotten so much worse, I needed new lenses for my old frames. My eyes have 4 different prescriptions, 2 for distance and 2 for reading, so I got progressive lenses with the anti-reflective coating. The cost was $149 and they were ready in 2 days.

My new glasses cost $123 for the frames + $126 for the lenses without the anti-reflective coating and were ready in 1 business day.

Please tell them you saw our video on YouTube so maybe we’ll get a discount next time. We highly recommend them and will certainly be going there from now on.

Hopefully you enjoyed our video, and if you did, please LIKE, COMMENT and SHARE it, and SUBSCRIBE to our YouTube channel. ¡Muchas Gracias y Hasta Luego!

Watch Our Video About Getting an Eye Exam in Cuenca Ecuador



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Dental Tourism in Cuenca Ecuador + the Surprisingly Low Cost of a Crown

After quite an ordeal with a chipped tooth, I’m sporting a brand new crown and the cost will surprise you! That’s why we wanted to share this video about dental tourism in Ecuador. We know people who visit Cuenca and other foreign cities for dental work, and they more than cover the cost of the trip with the savings on procedures.

For all our dental costs, visit our original “Best Dentist In Cuenca” blog post.

You can find Dr. Grace’s contact info on her website:

Watch Our Video About Dental Tourism in Cuenca Ecuador



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Elder Care in Ecuador

Elder care in Ecuador is available, but not nearly as prevalent and somewhat different than in the U.S.

Ecuador is a familial culture, so it’s very common for multiple generations to live under the same roof. That means there is less need for dedicated nursing homes or assisted living facilities in Ecuador.

You will find some “tercera edad” (third age) facilities in the major cities like Cuenca, Manta, Quito and Guayaquil, but most expats who need elder care typically opt for in-home services provided by a nurse.

In-home nurses are available for around $5/hour. That means you can hire a full-time nurse to come to your home for around $40/day or $1,200/month. You can get 24-hour, in-home care for about $3,600/month, which is far more affordable than similar services or nursing homes in the U.S.

VIP Home Healthcare Services of Cuenca Ecuador

We get a lot of questions about home healthcare and elder care options here in Cuenca Ecuador, so we interviewed the founders of VIP Home Healthcare of Cuenca to get some answers.

VIP Home Healthcare provides a whole range of services, from nursing and homecare, all the way through to end of life.

Here are some of the services they provide:

  • Implement doctor’s instructions
  • Medication
  • IVs
  • Prescription Pickup
  • Physical Therapy
  • Occupational Therapy
  • Escort to Appointments
  • Post-Op Recovery
  • Short and Long-term Care
  • Dementia Care
  • End-of-Life Services – Legal Docs, Power of Attorney, Cremation
  • Language Translation
  • Errands
  • Housekeeping
  • Cooking
  • And more…

VIP Home Healthcare Costs

The cost of services varies depending on the type of care needed, days per week and hours per day. However, you can expect to pay roughly 1/3 the price in Cuenca compared to a similar level of service back in the States or Canada.

Insurance is currently not accepted, but they are investigating options.

Watch Our Video Interview with VIP Home Healthcare in Cuenca Ecuador



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The Best Dentist in Cuenca Ecuador – Dr. Grace Ordoñez

We’ve had several questions from our loyal subscribers about the health and beauty services here in Cuenca Ecuador so we thought we’d share our trip to the best dentist in Cuenca Ecuador for 2019 (according to

Dr Grace Ordonez Office

I went to Dr. Grace for a cleaning back in July, and was really impressed with her office and staff, and her knowledge and skill as a dentist. She was recommended to us by some gringo friends of ours.

Since then, she also won the Best Dentist in Cuenca Award for 2019 from This award is given based on the number of votes from mostly gringos who frequent (which is most of us). As a side note, Café Libre won the Best New Restaurant Award for 2018.

See More: Valentine’s Day in Cuenca 2019 + Aphrodisiac Dinner at Café Libre (Episode 68)

Amelia went to Dr. Grace for a cleaning in December, which is when she found out about the poor state of her old fillings. Several had mercury, which is horrible for human health in ANY amount. And others had been worn down due to Amelia’s night clenching. She also decided to get a nightguard to help protect her teeth from more damage.

We have been thoroughly impressed with Dr. Grace! She takes time to explain what she’s doing and she speaks great English so we can easily understand her. And now she’s helping us with our Spanish, too!

We were also very happy that she had the proper equipment to safely remove the mercury from Amelia’s mouth.

Dr Grace ExplainingDr Grace Mercury Equipment

Dental tourism and medical tourism are growing here in Ecuador due to affordable healthcare. Rather than give thousands of dollars to a dentist in the states, you could have an amazing vacation to Ecuador PLUS get your dental work done for the same price.

Here are the links to Dr. Grace so you can contact her if you need an appointment. Please tell her JP and Amelia from Amelia And JP sent you.

We didn’t get paid for this video or for referring people to her. UPDATE: Dr. Grace was so appreciative of this video that she gave us each a free cleaning! Yay!

Amelia’s Dental Costs

  • Cleaning: $20
  • Minor Filling Repair: $20
  • X-Rays: $8
  • Nightguard Specialist: $20
  • 1st Filling: $70
  • 2nd Filling: $90
  • 4 Other Fillings: $180 ($45/filling)
  • Nightguard: $200
  • Total: $608

JP’s Crown

I chipped a molar last April in Amsterdam on our trip to India for Chinnu’s wedding. When we got back to Ecuador, Dr. Grace put a filling in it, but due to the location and extent of the chip, the filling didn’t hold. The next step was a crown.

During the crown prep, Dr. Grace noticed that the chip and some decay extended below the gumline so she put on a temporary crown and had me schedule an appointment with a periodontist. He came into Dr. Grace’s office and removed a small amount of the gum so the permanent crown would fit properly. You can watch the video here: Cuenca Ecuador Periodontist – JP’s Gum Surgery.

After allowing the gum to heal for a few weeks, I returned for the finishing crown prep and the permanent crown mold. Unfortunately, my tooth would not deaden. After 3 vials of novocaine, my mouth was dead, but my tooth was not.

This happened during the initial crown prep appointment, but I was able to take the pain long enough for her to get the job done. The final prep required a lot more work, though, and the pain was too much to bear. Dr. Grace put another temporary crown on and had me schedule another appointment when she would have an oral surgeon on hand to deaden my mouth in a spot that should also deaden the tooth.

The oral surgeon used 3 vials of novocaine and put it in a spot that they use for oral surgery. Most of my face was dead, but I could still feel the tooth! On a scale of 1 to 10, it was only a 2 so she was able to finish the crown prep and take the mold for the permanent crown.

The next week, I returned to get the permanent crown, but the fit of the 3D printed crown wasn’t absolutely perfect, so she sent it back for an adjustment. The next day, I got my permanent crown and it’s awesome! I wish all my teeth were so shiny and new!

JP’s Dental Costs

  • Teeth Whitening: $150 (3 visits)
  • Initial Filling: $80
  • Periodontist: $80
  • 3D Printed Crown: $350

If you decide to go see Dr. Grace, the best dentist in Cuenca Ecuador, please tell here you saw Amelia And JP’s video!

Watch Our Video About the Best Dentist in Cuenca Ecuador



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