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One of the more frustrating questions expats are faced with when they move to Ecuador is, “What exactly do I need to do about health insurance?”
Whether they have chosen to maintain their health insurance in their home country, or have decided to cancel it and take out private insurance, or government-backed insurance here in Ecuador, there are a confusing maze of questions to wade through that often have only partial answers, or no answers at all.
Making the issue even more troubling is the Ecuadorian government’s stance over the last three years on expatriate insurance requirements.
In February of 2017, the Ecuadorian government first floated the idea of requiring health insurance for any foreigners visiting or moving to Ecuador. That idea then became a “mandatory” insurance requirement for tourists entering the country in May of 2018. But it did not last. And by August of 2018, this requirement was no longer going to be enforced.
This issue continues to be a concern for most expats, but it is only one of many of the questions regarding healthcare in Ecuador (and Cuenca specifically) that many of new-comers ask about.
With these questions in mind, the Cuenca Dispatch (TCD) sat down with Daniela Cordero and Ramiro Crespo, of Cuenca Expat Health Insurance, to try to get answers to some of the questions expats are asking.
Daniela and Ramiro opened their office here in October of 2018 and have quickly been gaining the trust and respect of many of Cuenca’s expats. They are part of a larger company called Megabrokers out of Quito and have recently become the exclusive providers of BMI medical insurance plans for the expat market here in Cuenca.
TCD: First, thank for you sitting down with us and congratulations on getting the exclusive arrangement with BMI for expat clients here in Cuenca. Why don’t you tell us about that?
Ramiro: Well, we are really excited about this, because BMI is one of the largest medical insurers in Ecuador and has been in the country for over 25 years. They are an international company, based out of Miami, but they only recently opened a branch here in Cuenca.
Daniela: Yes, what matters the most about BMI is that they understand international clients, so we have been able to work with them to offer expats a plan that really fits their needs. As part of Megabrokers, we offer other international providers, but the BMI plan we now have is almost uniquely tailored to work for expats.
Ramiro: Daniela brings up a good point: we only work with international companies that can offer plans that help our clients here and out of the country. We don’t work with companies that are only operating in Ecuador. We find that those plans don’t fit the needs of many of our expat clients.
TCD: Okay, thanks for bringing that up. You also mentioned that expats have some special needs that you feel the local companies don’t offer. What do you mean by that?
Ramiro: Well, for one thing, most of our clients are first only seeking a catastrophic. They ask for this for two reasons, first, they generally keep their Medicare coverage (called the same in the US and Canada), and in a lot of cases their supplement insurance as well. But they know they need emergency care here. They don’t care about going back to the US to get their routine care, at least when they first move here.
Daniela: That’s right. But also remember—and 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 have to cover them after that up to 20 Ecuadorian basic salaries. So, for most newcomers, they need to keep what they had at home if they have pre-existing conditions.
TCD: 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, that 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 3 to 4 times as much for their supplement plans in the US for example, as they would pay here for an equivalent plan here.
TCD: But isn’t that because they are less confident in the healthcare here?
Daniela: Sure, that’s part of it. But what they need to consider is that for a lot of routine health issues, they aren’t going to want to travel back to their home country. If someone is having trouble breathing here, they are going to go to the Emergency Room to get checked out. Having a medical plan here—and a regular doctor—only makes sense.
TCD: But can’t they just “self-insure?” Because the cost of care here is so much less expensive than in the US 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 conditions, so that has to factor into that.
TCD: It sounds like you’re 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 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.
Daniela: And 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 BMI plan is that it does not cover services through a network. It covers service wherever you go. Patients are not locked into one set of hospitals and clinics or doctors. They can find the best and go to whoever they want.
TCD: Do the other local plans offer that?
Ramiro: No, and again, this is why we are so happy to be representing BMI to the expats.
TCD: 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: Well, first of all, the price of IESS for expats is not much less than what they would pay for a private plan. Second, the IESS system is very difficult to traverse. Many expats end up paying a medical facilitator to help them get what they need out of the system. Don’t get me wrong, for many Ecuadorians this is all they can get for health care coverage and they are happy for it. But there are much better options.
TCD: Okay, two more questions that we know our readers are going to want to know answers to. First, tell us about the costs of the BMI plans. 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 BMI plan we can offer expats covers all of their needs, and a lot more than the other plans available in town.
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: What Ramiro says is so 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. However, after having raised this very question with multiple lawyers over the last month, there is no firm 100% correct answer.
What it comes down to is this, even though the law says foreigners need to have insurance, the law does not specify the enforcement for not having it. So, no one really knows what to do about a foreigner not having it. Can that present a problem for an expat travelling back here from a visit to the US? Maybe. Maybe not.
The law does specify a penalty of 17% of the person’s wage. So, if a foreigner quoted a certain monthly income to get their Visa, then maybe they can be charged 17% of that amount. Again, no one knows for sure.
But my —our— position on this is simple. If you plan on living here, even for a short time, you should have some type of catastrophic health insurance. Because even though health care is much less expensive here, a heart attack and long-term stay in a hospital can still add up to large numbers. And, if you plan on staying here permanently, why wouldn’t you want to have your healthcare taken care of here?
TCD: Well, 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 Health Insurance office is located at: Av. RemigioTamaríz and Av. Solano, Edifício Office, 5th floor, Office 5-5. For more information, contact Ramiro and Daniela at:firstname.lastname@example.org or 099-520-6384 or visit: cuencaexpathealthinsurance.com.