Changes in Ecuador’s medical system make health insurance for expats more important than ever

Aug 7, 2023 | 0 comments

For foreign residents, deciding whether or not to buy health insurance in Ecuador is one of biggest challenges they will face.

Should they maintain their insurance coverage in their home country? Should they cancel that policy and purchase private insurance in Ecuador? Should they sign up for health care offered by Ecuador’s Social Security system, as many earlier arrivals have?

The staff of Cuenca Expat Insurance.

Or, given the low cost of health care compared to other countries, should they plan to “self-insure,” paying for services as needed, an option promoted by some “move-overseas” websites and publications.

According to Daniela Cordero, a partner at Cuenca Expat Insurance, the decision has become more important than ever.

“Many of the foreigners moving to Ecuador have heard that we have free medical care here,” she says. “It says in our constitution that no one can be denied care if they need it, even if they can’t pay. The problem is that the accessibility and quality of public health care and Social Security health care have suffered in the past few years.”

She adds: “This situation deteriorated during the Covid pandemic and has not really recovered since then.”

An example of the problems members of the Social Security system – also known by its acronym IESS — have faced are delays and cancellations of referrals to private health providers. “For many medical specialties, IESS refers members to private doctors and hospitals but because the system is late making its payments to these providers, getting appointments and transfers have been delayed and sometimes denied altogether.”

She adds: “IESS is under terrible economic stress and this affects the quality of most of their services.”

Under current circumstances, Daniela says Social Security is like a “roller coaster” ride. “Many people who have relied on it for years, including members of my own family, are now going to private doctors and hospitals because they know they will get more reliable service.”

For Daniela, the bottom line is that private insurance is critically important for expats and is often the only option for decent health care. “The quality of private care is very good and, because of medical advancements in training and technology, it is getting even better,” she says.

“It is also important for foreign residents to have a local agent they can call when they need help. If you need medical assistance, I won’t refer you to a phone number in another country. My partner, Ramiro Crespo and I, live in Cuenca and consider our clients to be friends. You will always get immediate, personal attention from us.”

Daniela and Ramiro opened their office in Cuenca in October 2018 and have gained the trust and respect of many of Cuenca’s expats. They are part of Millennial Brokers, a Cuenca-based company that provides insurance services throughout Ecuador.

Considering the many questions expats have about health insurance, we recently sat down with Daniela and Ramiro to talk.

CuencaHighLife: First, tell us why expats should consider buying private insurance and second, why they should use the services of Cuenca Expat Insurance.

Daniela: Insurance is intended for unexpected situations, including emergencies that no one plans for. It may be true that you are covered by insurance in your home country, including by Medicare in the U.S., but if you have a health emergency in Cuenca, you need immediate care.

As for choosing Cuenca Expat Insurance, of course I would always recommend my own company, but that is not necessarily the purpose of this interview. What I find most important is to encourage expats to research the broker and insurance company they are planning to go with. It is important that both the broker and insurance company have years in the market, that they are financially stable, and that the information be made public.  At Cuenca Expat Insurance, we will take the time to get to know you personally and to know your specific needs. Unlike an insurance company with headquarters out of the city, or out of the country, we are local. We stand ready to help you when you need us.

Ramiro: We work with several larger insurance companies. But with a small handful of them, we have worked extremely well, and our clients have received excellent results when it comes to claims, coverage, and time to reimbursement. We also prefer working with these companies because as Daniela stated, they are international, but have branches located here in Cuenca.

CHL:  You also mentioned that expats have some special needs that you feel the local companies don’t offer. Can you explain?

Daniela: Yes, this is important because recently we have seen a change in the services our clients are asking for. When we started our business six years ago, most expats were interested in catastrophic coverage, usually with a high deductible to keep down the expense of the policy. Today, more clients are asking for comprehensive coverage with a lower deductible.

There are several factors for the change. One is the difficulties with IESS, since many of our clients are also voluntary members of that system. Another is that many expats are making fewer trips back to their home country and need a reliable general coverage in Cuenca.

We still offer plans, of course, focused on catastrophic coverage and can tailor these to individual needs.

CHL: We understand that, by law, insurance companies must cover pre-existing health conditions but there are restrictions at the beginning.

Daniela: That’s right. We make this very clear to all of our clients — health insurance plans in Ecuador don’t usually cover pre-existing conditions for the first two years. But by law, they must cover them after that up to 20 Ecuadorian basic salaries (currently $9,000). So, for most newcomers, they need to keep what they had at home if they have pre-existing conditions for the first two years. This is a question that even after years of explaining and publishing, I still get the most. So, if you have an insurance plan with coverage up to $150,000, for your pre-existing conditions, the maximum coverage will be $9,000. For other conditions or accidents, you will have your $150,000 unless otherwise specified.

CHL: Do you recommend they keep their plans permanently in their home countries?

Ramiro: Well, that’s really all client specific. For example, some clients have such serious pre-existing conditions that they want to keep their specialists in the US or Canada. So sometimes they only get catastrophic here and keep those plans at home. Sometimes, they keep those home plans and get a full medical insurance plan here. And of course, after two years, some drop their home coverage and get a full plan here.

Again, a lot of factors go into that decision. But keep in mind, they are spending anywhere up to three to four times as much for their supplement plans in the US for example, as they would pay here for an equivalent plan.

CHL: But isn’t that because they are less confident in the healthcare here?

Daniela: That may be part of it. But what they need to consider is that for a lot of routine health issues, they aren’t going to travel back to their home country. On the other hand, if someone is having trouble breathing, they are going to the emergency room, not catching an international flight back home. Having a medical plan here — and a regular doctor — only makes sense.

CHL: But can’t they just “self-insure?” Because the cost of care here is so much less expensive than in the U.S., let’s say.

Ramiro: That’s true. But you have to think about their overall care for the year, or longer. Someone who intends to stay here for good — even if they plan to go back to the US one or two months a year to visit family — is likely going to need medical care here as they get older. So, at some point they are going to want to have medical insurance. And keep in mind, there is a two-year lead time on any pre-existing condition, so that has to factor into that.

And, of course, there will always be emergencies.

CHL: It sounds like you are both in agreement that expats should consider getting health insurance here, but let’s get back to that question about how good the care is here.

Ramiro: Look, there are a lot of therapies here that are as good as in North America, some that are not. Take cardiac care here for example. It’s good here and getting better every day. We have a lot of expat clients who have cardiac issues and are very happy with the doctors they have found here. And most expats know how good hip and knee replacements are here.

Some important information that we have found over the last six years is that about 80% of our claims have been due to falls which naturally, later require physical therapy. The insurance companies we work with do not limit the number of P.T. sessions as other companies do.

Daniela: Respiratory care is very good here as well. Really, for most conditions, you are going to be able to find a good doctor here. Will you find as many as in the US? Of course not. But another thing we like about the companies we work with is that they do not have a network. They cover service wherever you go within the country. Patients are not locked into one set of hospitals and clinics or doctors. They can find the best and go to whoever they want. This is another huge difference and benefit that the companies we work with offer.

CHL: A lot of expats are on IESS. So, why would someone be better off getting a private health insurance plan instead of just going to IESS?

Daniela: Beyond the issues I mentioned before with IESS, it’s important to know that the price expats pay for coverage is not much less than what they would pay for a private plan. Second, the IESS system is very difficult to traverse – even when it functions well. Many expats end up paying a medical facilitator to help them get what they need out of the system. On top of that, they also have to purchase their own supplies, medication, and other equipment that may need to be used for their procedure.

CHL: Two more questions that we know our readers are going to want to know answers to. First, tell us about the costs for the plans you offer. Second, and don’t be afraid to tell us you don’t know the answer to this, but are expats required by law to have health insurance in Ecuador?

Ramiro: Okay, let me take the first question because Daniela has been meeting with several lawyers for opinions on the second question.

The plan prices we can offer are very reasonable because the coverage is significant. Without getting into the nitty and gritty of each plan, let me say this. We think that the plans we can offer expats covers all of their needs, and a lot more than the other plans available in town at a reasonable and competitive price.

One thing that we think is invaluable is the ability to go see any doctor or visit any hospital you want. That can be the difference between good or great care, depending on your needs.

Second, our prescription coverage is very, very good. And that should be factored into any economic analysis of plans someone is looking at.

That said, what Daniela and I do for our clients is help them figure out exactly what they need and show them what options they have based on that. We are building long-term relationships with our clients so helping them feel satisfied is what is most important for us.

Daniela: This is true. Every client is different and has different needs. And our job is to help them be happy and to feel they can live healthy lives here in Cuenca.

Now, your second question, “Are expats required by law to have health insurance?” is a very confusing issue.

Actually, the law says that everyone —not just expats— is required to have health insurance. Though there is a separate section that deals with foreigners. The law states that in order to apply for your temporary visa, for the retiree and renters visa, you must have private health insurance. This was a change that was made in March of 2022. It is important to ask these questions directly to a lawyer as they are more up to date with any changes.

CHL: Ramiro and Daniela, thank you for helping to clear up some of the questions regarding expat health insurance here in Ecuador. We appreciate your time and your willingness to be so open with some of your answers. I’m sure you’ve given many of our readers some food for thought.


The Cuenca Expat Insurance office is located at: Av. Remigio Tamaríz and Av. Solano, Edifício Office, 5th floor, Office 5-6. For more information, contact Ramiro and Daniela at: or 099-520-6384 or visit:


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