Mario Miranda is a health insurance agent located in Cuenca Ecuador. He stopped by to answer some of our questions about Ecuador Health Insurance, specifically the pros and cons of IESS vs. Private Health Insurance.
There are two types of health insurance in Ecuador: Public and Private.
Ecuador Public Health Insurance – IESS
Ecuador’s public health insurance program is called IESS. It’s the single payer option and the most affordable option for healthcare. However, it comes with a few drawbacks. Here are the pros and cons of Ecuador’s IESS:
Ecuador IESS Pros
The main benefit of the IESS plan is affordability. The monthly premiums cost less than any of the private plans, plus there’s no deductible, no copay and no limit on coverage.
Ecuador IESS Cons
While it is the most affordable, Ecuador’s IESS healthcare isn’t the most convenient. First, you have to go to the IESS hospitals for all of your doctors and treatments.
Second, due to the high volume of patients (and lack of funding), you might need to wait 2 or 3 months for an appointment.
Third, if you need a specialist, you may need to see a non-IESS doctor or hospital, which may not be covered.
Fourth, you can’t get on the IESS plan until you have your cedula (that’s your government issued ID card) and you can’t get that until you have your temporary resident visa. You’ll need health insurance to apply for your temporary resident visa so that means you’ll need to get private health insurance when you first move here regardless.
Finally, we’ve heard from our fellow gringos that the IESS facilities are not as updated or modernized as the private hospitals in Ecuador. This could potentially cause record keeping problems or lack of proper treatment.
Ecuador Private Health Insurance Options
While the Ecuador IESS healthcare is affordable, it has some serious drawbacks. That’s why most gringos opt for a more expensive private health insurance plan.
Ecuador Private Health Insurance Pros
Depending on which private health insurance company you choose, you’ll be able to visit one or more of the private hospitals and clinics throughout Ecuador.
We have Confiamed, which is one of the best health insurance companies in Ecuador, and we’re able to go to nearly every private hospital in Cuenca. The exception is Monte Sinai, but we have two other high quality in-network hospitals that are just as close to our house.
The wait times to see doctors or get treatments is also much lower than the IESS plan. We can usually see our doctors, even specialists, the same day or the next day. Additionally, we have the mobile phone numbers for all of our doctors and they told us to WhatsApp or call them directly if we have any urgent needs.
The hospitals in Ecuador aren’t as nice as the medical Taj Mahal’s they build in the States, but they’re very clean and have modern equipment. Most of our doctors were educated in the States or in Europe, and we’ve been very impressed with how current their knowledge is.
Our plan also comes with $30,000 in travel insurance.
Ecuador Private Health Insurance Cons
Cost is the main downside of private health insurance in Ecuador. Not only are the premiums higher, but there is a copay and a deductible, which varies by company and plan.
The plan we have with Confiamed costs $157/month for both of us. We have a $100 deductible per person and a $6 copay. It covers 90% of costs for in-network and 80% of costs for out-of-network doctors and hospitals.
Private health insurance plans also have a limit on coverage, again depending on your plan. Our “maximum limit for disability per person” is $30,000 per year.
That may not seem like a lot, but the cost of healthcare in Ecuador is so dramatically low compared to the States that $30K would cover most healthcare needs.
For example, a doctor’s office visit costs $35, total. That goes for my neurosurgeon, as well. My last neurosurgeon appointment back in Denver cost $250 and I saw the physician’s assistant. I didn’t get to see the neurosurgeon.
To give you a better idea of healthcare costs in Ecuador, a friend of ours ate some street food and got an amoeba, which can be deadly (don’t eat street food). She went to the emergency room and was admitted for one night in the hospital. She was sent home with medication the next morning. That afternoon, the emergency room doctor made a housecall to see if she was ok.
The entire cost for the ER visit, one night at the hospital, medication and the doctor’s house call was $373. In the States, that would have easily been $15,000 (without the house call since no doctor in the States does that anymore).
Another friend of ours had an elective plastic surgery procedure that was NOT covered by insurance. She said the total cost was $1,200, but in the States, it would have easily cost between $15,000 and $20,000. And the work she had done looks incredible!
As you can see, healthcare is very affordable here in Ecuador, but if you want a higher maximum coverage limit, Confiamed has a plan with a $100,000 limit. Our $157 plan would cost $175/month if we increased the limit from $30K to $100K.
Ecuador Pre-Existing Conditions
With both the public and private health insurance options here in Ecuador, pre-existing conditions are only covered after you’ve had the insurance for 2 years. This is a relatively new change to the IESS plan, which covered pre-existing conditions on the first day until recently.
While the public IESS plan doesn’t have a limit on coverage, our private health insurance plan will only cover up to $7,500 in expenses per year related to a pre-existing condition.
That’s a concern for my continuing spinal issues because another surgery would likely cost far more than $7,500, even here. My two spinal surgeries back in Denver cost nearly $1 Million so I would expect them to cost in the neighborhood of $50K to $100K here.
However, with our current health insurance plan provided by Amelia’s company back in Denver, we have a $12,000 deductible and the insurance only covers 60% of medical costs.
So if I were to repeat my two surgeries with our current US-based health insurance, it would cost us over $400,000 out of pocket. We could figure out how to cover $50-100K, but $400K would bankrupt us. Even with health insurance in the States, it would still cost us FAR more than just paying cash without health insurance here in Ecuador.
Ecuador Health Insurance Is Required
Health insurance is required in Ecuador, even if you’re here on a tourist visa. We purchased travel insurance through Allianz Global Assistance for our exploratory trip. We also used that insurance for our move to Cuenca until we were able to get private health insurance through a company that is now out of business.
You may be able to sign up for private health insurance before you move here since everything is done electronically now. Our health insurance is billed to our credit card and all the docs can be signed digitally.
If you would like us to put you in touch with Mario Miranda, we’ll be happy to send an email introduction if you drop us a note through our Contact Us page.
Or you can use our Scrollodex containing all our English-speaking service providers in Cuenca, including doctors, visa agents, drivers, tour guides and more. Learn how to gain access here…
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