Ecuador stands out as one of the leading Latin American countries in terms of health care opportunities. Though there is occasionally a rift between regulations and reality, the country constantly seeks to improve its current policies; the constitution itself guarantees the right to health care! Several different options for coverage are available to expats relocating to Ecuador.

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Option 1: Go Public

For four decades, Ecuador’s public health care options received generally critical reviews from its constituents. However, in 2008, the government decided to give the system a makeover and between 2000 and 2014 the country jumped from 111th on the world’s list of “countries with most efficient health care” to 20th. Meanwhile, the US currently sits at the 46th spot on the list. Public insurance is handled through the Social Security Administration (IESS).

How Does It Work?

Those that participate in the public health care system will enjoy all medical procedures, screenings, and medications completely free of charge. Clinics require that affiliates schedule routine visits by phone, and emergency needs will be fulfilled by the nearest hospital. When a hospital is unable to perform the procedure required, the state will transfer the patient to a capable private hospital, and cover all charges.

IESS-Yes: Becoming a Member

No one is automatically enrolled in the program; they must physically visit the office and register to become a member. As long as payments are met, members will remain in good status until the end of their lives. Applicants that are older than 65 will not be considered for acceptance. The monthly cost is adjusted as needed so that it reflects 21.5% of the average wage, which right now sits at about $60/month.

The Downside

Though virtually unlimited free health care sounds great at first, a large number of residents have taken advantage of it, resulting in very long lines and scaled-back service. In addition, public facilities often do not receive enough funds and have to redirect patients requiring more expensive treatments. Finally, since health care professionals’ salaries are regulated by the government and not dependent upon their patient base, some have neglected to improve their practice or become specialists.

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Option 2: Private Insurance

While Ecuador has a multitude of private carriers that currently operate in it, such as Confiamed, Salud, and Años Dorados, they are less often used than the public system. Still, shoppers have a little more customizability with these options. For example, Salud offers tiers of plans: level 1 has the most basic form of coverage with a low monthly fee and higher deductibles.

The coverage options extend all the way up to level 7, which includes private hospital rooms, a life insurance policy, and a cancer rider. Cuenca News conducted a survey of Ecuadorians regarding their insurance coverage that contains a wealth of testimonials useful in distinguishing among plans.

How Much Will I Pay?

Of course, premiums will vary a great deal depending on what the plan covers. On the low end, a company called Coopera offers a monthly fee under $3.00, but all medical purchases will have some amount covered by the purchaser. Salud, Latin America’s largest insurance company that was mentioned earlier, gives us a more representative example. The average 60-year-old man may expect to pay between $70 and $100 for a middle-grade plan. A comparable plan in the United States would cost over 10 times that amount!

Is Coverage Guaranteed?

In Ecuador pre-existing conditions are considered just as they are in the United States, and private insurers reserve the right to deny coverage based on them. In addition, most require applicants to be under 70 years of age. However, there are still more companies that will cover expenses resulting from pre-existing conditions!

Option 3: Who Needs Insurance?

Many local Ecuadorians choose not to enroll in any insurance programs. They pay out-of-pocket for all required procedures and are content doing so. As is always the case, patients must demonstrate the ability to cover their charges before admission; for non-subscribers, this basically means handing them a credit card or cash instead of an insurance card.

Self-insurance might be a good idea, and can be done by allocating a bit of money each month to cover any health expenses. It is safe to say that most expats in Ecuador choose not to have either health insurance option simply because the costs are so much lower. In many larger cities, alternative health care options, such as homeopathic and naturopathic medicine, are also in place.

Present, But Not Prolific

Ecuador has quality health care, but remember that it does not exist everywhere. Smaller areas may have a limited scope of capabilities or minimal stock of fairly simple items like crutches. Still, they should be able to handle regular care and minor issues. Larger cities, on the other hand, will have exponentially more traffic traveling through their doors and may not be able to see you unless it is an emergency. The benefit of those areas is their more modern facilities and training. Potential expats should self-assess their current medical state to determine which region of the country, if any, is right for them.

Potential Regional Medical Issues

Immunizations play a major role in ensuring a family’s health as they travel to Ecuador. The most important are for tetanus, hepatitis A and B, typhus, yellow fever, diphtheria, rabies, and pertussis. Insects present the most danger to those that have not developed any resistances to their diseases.

But don’t worry too much; despite the fact that most regions have year-round malaria risks, there are only 686 cases per 100,000 residents. Dengue, also carried by mosquitos, is a concern as well. The main defense against these pests is a combination of well-covering, bright attire and copious amounts of repellant on exposed skin.

What Have We Learned?

Ecuador makes for a great place to retire, in large part thanks to its stellar health care system. All coverage options are equally viable for expats, and should be determined on a case-by-case basis for each person depending on his or her needs and budget. Tell us which one you would pick in the comments section below!