PRIVATE INSURANCE. MEDICARE. IESS. (2 out of 3 is my advice)
I would like to preface this article by stating, I am not a lawyer, or an MD so do your own due diligence.
I would like to thank Daniela Cordero at Cuenca Expat Insurance for providing private insurance and support. I came to this country 3 years ago from the US and kept Medicare even though it only provides coverage in the US. Fast forward 2 years to the time I had to update my visa. I kept BMI but dropped Medicare for cost savings (about 200/month).
If you do not take Medicare when eligible you may have a fine of 10% each year and wait for the open enrollment period. I found an exception buried in an internal memo.
EXCEPTION. If you are working overseas and that government has a universal insurance plan (IESS).
- KEEP YOUR PRIVATE INSURANCE HERE.
- FILE YOUR TAXES CORRECTLY HERE AND THE USA. American citizens can be double taxed, so do your FBAR (IRS) and RIMPE (Ecuador tax) if needed.
- ENROLL IN IESS. I had Daniela do it. Personal note, Daniela and I visited an IESS facility. She would not use the bathroom.
- CANCEL MEDFICARE PART B AND LIST IESS AS YOUR PRIMARY INSURER. This was the most difficult thing. BE PERSISTENT. Personal note. I used an internet-based phone system that was linked to a poorly set up of a supposed security camera. That made things worse.
- DOCUMENT YOUR BUSINESS INCOME IN ECUADOR. I do not have a regular job with pay stubs but I report income from self-employment on my taxes. I met the physical presence test and avoided double taxation. To qualify as self-employed for Medicare you must have an employee.
- IF NEEDED, return to US for good in future, get Medicare and drop BMI and IESS. I think the worse that will happen is that Medicare will say no, you are paying the fine and waiting just like anyone else that refused Medicare when eligible.