Ecuador Health Insurance: The Three Real Options for Retirees

A broker who has spent more than a decade insuring foreigners in Ecuador explains the three paths to health coverage available to a newly arrived American retiree — and the fine print on pre-existing conditions that catches many people off guard. This interview was conducted in Spanish and translated into English.

If you're comparing Ecuador against Panama, Costa Rica, Mexico or other retirement destinations, health coverage is usually one of the first practical questions you need answered. According to Carlos Ramírez, an insurance broker and founder of BlueBox Asesores, a retiree moving to Ecuador has exactly three real options, and the differences between them matter for both cost and what actually gets covered.

Who Carlos Ramírez is

Ramírez founded BlueBox in 2013 and now handles 23 different insurance lines, from health and life to travel, vehicle, home and business coverage. According to Ramírez, foreigners make up 75% of BlueBox's client base — around 2,500 people — and roughly 80% of those foreign clients are American. That gives him a direct view into how U.S. retirees actually navigate the Ecuadorian insurance system once they arrive, not just how the rules read on paper.

The three options

Asked what a 65-year-old American retiree can realistically choose from, Ramírez was direct: "Hay tres opciones reales de seguro: uno, el seguro gratuito vinculado al Ministerio de Salud Pública; dos, el IESS, en el cual se paga el 17% del salario básico unificado, un equivalente a unos 78 dólares al mes; y por último el seguro privado, donde existen 21 aseguradoras de salud en la actualidad." ("There are three real insurance options: one, the free coverage tied to the Ministry of Public Health; two, IESS, where you pay 17% of the unified basic salary, equivalent to about 78 dollars a month; and finally private insurance, where there are currently 21 health insurers.")

The first option, according to Ramírez, is public coverage through Ecuador's Ministerio de Salud Pública, which anyone can access at no cost. The second is IESS, the country's social security health system, which foreigners can join voluntarily for an amount tied to Ecuador's unified basic salary — currently about $78 a month, according to Ramírez. He noted that IESS is also mandatory for Ecuadorian workers, which creates a practical downside: "Uno de los inconvenientes probablemente del IES es el número de personas que tratan de usar el servicio" ("One of the probable drawbacks of IESS is the number of people trying to use the service"), meaning wait times and demand on the system can be significant since retirees are sharing it with the entire formally employed workforce.

The third path is private insurance. Ramírez said 21 companies currently sell health coverage in Ecuador, offering a range of products from basic plans to major-medical plans to international plans, giving retirees more control over network, coverage limits and speed of access — at a higher monthly cost than IESS.

The pre-existing condition trap

Ramírez said the single biggest misunderstanding among foreign clients involves pre-existing conditions. Many assume that something diagnosed or treated years earlier no longer counts. It does. According to Ramírez, Ecuadorian insurers treat any prior diagnosis, prior surgery, ongoing medication or even symptoms as a pre-existing condition, "sin importar hace cuánto tiempo se dio o cuándo se dio" — regardless of how long ago it occurred. If it happened before the policy's start date, it must be declared.

That declaration triggers a waiting period. Ramírez said it is common in the private sector for pre-existing conditions to carry a two-year waiting period before coverage kicks in, and even after that, coverage for pre-existing conditions is capped. He said a common misconception is that pre-existing condition coverage goes up to a plan's full maximum benefit. In fact, according to Ramírez, that coverage is limited to the equivalent of 20 unified basic salaries — currently around $9,800 total.

Asked directly whether diabetes, high blood pressure or a cancer diagnosis that has since been resolved would be covered, Ramírez was clear: all of it must be declared, regardless of whether the condition has been overcome. After the waiting period specific to the policy, declared conditions are covered — but not before, and not without limit.

What this means for you

If you're weighing Ecuador against other countries on your shortlist, health coverage is worth pricing out before you commit to a move, not after.

• Compare the three tracks on your own numbers. Free public coverage, IESS at roughly $78 a month, and private insurance from 21 companies each carry different trade-offs in cost, wait times and flexibility, according to Ramírez.

• Assume everything in your medical history counts. Ramírez said Ecuadorian insurers consider any past diagnosis, surgery, ongoing medication or symptom a pre-existing condition, no matter how old it is.

• Ask about waiting periods and caps before you buy. Private plans commonly carry a two-year waiting period for pre-existing conditions, according to Ramírez, and total coverage for those conditions is generally capped around $9,800.

• Get specifics in writing. Since coverage limits and waiting periods vary by plan, ask any broker or insurer to spell out exactly how your own medical history would be treated before you sign.

• Confirm current figures independently. The $78 IESS estimate and the $9,800 pre-existing condition cap are tied to Ecuador's unified basic salary, which can change; verify current amounts before budgeting.

This article is based on an interview conducted by HiExpat on 2026-09-03. Rules and prices change; confirm with the relevant authority before acting.

Photo: Los Muertos Crew / Pexels