The Medicare Question: Does Your US or Canadian Coverage Work in Ecuador?
This is, without a doubt, the most frequently asked—and most critical—healthcare question from prospective North American retirees. The answer is simple, non-negotiable, and understanding it can save you from a catastrophic financial mistake.
Does your US Medicare or Canadian provincial health plan cover you if you move to Ecuador?
The answer is a definitive NO.
Your government-sponsored healthcare is geographically bound. It does not follow you when you move abroad.
For US Citizens: The Medicare Rules The official Medicare policy is explicit: in “most situations,” Medicare “won’t pay for health care or supplies you get outside the U.S.”. Ecuador is considered “outside the U.S.” and is not one of the territories (like Puerto Rico or the U.S. Virgin Islands) where coverage applies.
But what about the “loopholes” and supplemental plans? Let’s be very clear, as this is where the confusion happens. These exceptions do not apply to permanent residents.
- The “3 Rare Exceptions”: The Medicare handbook lists three rare cases for foreign hospital care. A rational review shows none apply to an expat living in Cuenca. They involve: 1) A medical emergency in the U.S. where a foreign hospital is closer; 2) A medical emergency in Canada while driving directly to or from Alaska; 3) Living in the U.S. near a foreign hospital that is closer than a US one. None of these cover a retiree living full-time in Ecuador.
- Medigap Plans: Some supplemental Medigap plans (like C, G, N) cover “foreign travel emergencies”. The key word is travel. This coverage is only for the first 60 days of a trip and has a lifetime limit (often $50,000). It is not a health plan for permanent residents.
- Medicare Advantage (Part C): These plans are strictly geographically based. You must live in the plan’s US service area. If you move to Ecuador permanently, you are technically required to be disenrolled.
- Prescription Drugs (Part D): This is the most rigid. You cannot be enrolled in a Part D plan while living abroad. You must contact your plan to coordinate disenrollment when you move.
The Big Dilemma: Should I Keep Paying for Part B? This is the tough, personal question. If you move to Ecuador, you will be paying monthly Part B premiums for coverage you cannot use in Ecuador. However, if you drop Part B and later decide (or are forced by illness) to move back to the US, you will face a permanent, lifetime late-enrollment penalty and may have to wait for an enrollment period to get coverage. Most financial advisors recommend that expats keep paying for Part B as a “catastrophic” insurance policy for a potential return to the US.
The bottom line is clear: your government healthcare does not follow you. You must secure a local Ecuadorian plan (IESS or private) for your life in Ecuador.
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