Health Insurance in Ecuador: A Broker Explains the Real Options for Expats

Carlos Ramírez founded BlueBox Asesores in 2013 and now works with about 2,500 foreign clients, roughly 80 percent of them American. HiExpat spoke with him about how health insurance actually works for foreigners in Ecuador, and about a misunderstanding around preexisting conditions that can cost newcomers money and coverage if they don't plan for it. This interview was conducted in Spanish and translated into English for this article.

Who BlueBox serves

HiExpat: Tell us about BlueBox and the kind of foreign client you see most often.

Ramírez: BlueBox is an insurance agency founded in 2013. We work across the insurance sector broadly, offering 23 lines of insurance, including health, life, travel, vehicle and home insurance, and some lines tied to business, imports and exports. From the founding, our clear objective was to work with the foreign market, which represents 75 percent of our clients. Currently we work with around 2,500 foreign clients, of which probably 80 percent are American.

Three real paths to coverage

HiExpat: If a 65-year-old American retiree arrives in Ecuador, what real insurance options does that person have, and roughly what does each cost?

Ramírez: There are three real options. One is the free insurance that anyone can access, tied to the Ministry of Public Health. Two is the IESS — Ecuador's social security system, which foreigners often just call "the IESS" — which anyone can join voluntarily. Under voluntary affiliation, you pay 17 percent of the unified basic salary, which currently comes to around 78 dollars a month. It's worth knowing that the IESS is mandatory for every worker in Ecuador, so one of its drawbacks is simply the volume of people trying to use the service. The third option is private insurance. There are currently 21 health insurance companies in Ecuador, and they offer different levels of coverage — basic plans, major medical expense plans, and international plans.

So to answer the question directly: the free Ministry of Public Health insurance is one option, the IESS is another, and the private sector, represented by about 21 companies, is the third.

The preexisting condition problem

HiExpat: What is the first thing an expat tends to misunderstand about health insurance here?

Ramírez: I think the main problem has to do with understanding what counts as a preexisting condition. Foreigners sometimes assume that if something happened to them 20 years ago, it's no longer a preexisting condition. In Ecuador, any prior diagnosis, prior surgery, ongoing medication, or symptoms must be treated as a preexisting condition, no matter how long ago it occurred. If it happened before the contract's start date, it has to be declared, and it will carry waiting periods that depend on the plan chosen.

In the private sector, it's very common to have a two-year waiting period before preexisting conditions are covered, and on top of that, preexisting conditions carry a coverage limit. Another common confusion is that clients assume the coverage for preexisting conditions goes up to the plan's full maximum coverage amount. That's a mistake. Coverage for preexisting conditions is set at 20 unified basic salaries, which today is around 9,800 dollars — that is the total ceiling for preexisting-condition coverage, regardless of the plan's overall limit.

Diabetes, high blood pressure, cancer: what's actually covered

HiExpat: With all this in mind, what happens with something like diabetes, high blood pressure, or a cancer diagnosis that's already been treated?

Ramírez: These are covered after the waiting period. But diabetes, cancer, or any diagnosis — regardless of whether it's already resolved, as you mention with cancer — has to be declared, and the insurance company determines the waiting periods. Once that waiting period has passed, declared illnesses are covered.

Why this matters before you sign anything

HiExpat: For someone weighing whether to buy private insurance here versus relying on the IESS or the free public system, what's the practical takeaway from what you've described?

Ramírez: The practical point is that none of these three options is automatically the "easy" one. The free system is available to anyone, but people need to understand what it does and doesn't offer. The IESS is affordable, but it's used by every worker in the country, so wait times and capacity are a real factor. Private insurance gives more choice across 21 companies and different plan levels, but anyone with an existing health condition — even one from decades ago, even one that's fully resolved — needs to go in understanding how preexisting conditions are defined, what the waiting period will be, and what the coverage ceiling is for that condition specifically. Declaring everything accurately upfront is what protects you later.

What this means for you

If you're planning a move to Ecuador and have any prior diagnosis — diabetes, high blood pressure, a past cancer treatment, or anything requiring ongoing medication — assume it will be classified as a preexisting condition under Ecuadorian private insurance rules, according to Ramírez, no matter how long ago it happened or how well it's now managed.

Before choosing a plan, ask directly: what is the waiting period for preexisting conditions on this specific plan, and what is the coverage ceiling for those conditions. According to Ramírez, private plans commonly apply a two-year waiting period, and preexisting-condition coverage is capped separately from the plan's overall maximum — currently around 9,800 dollars, based on 20 unified basic salaries.

Compare all three paths Ramírez described — the free public system through the Ministry of Public Health, voluntary IESS affiliation at roughly 78 dollars a month, and private insurance across Ecuador's 21 companies — before deciding, since each carries different tradeoffs in cost, wait times, and how preexisting conditions are handled.

Whatever you choose, declare your full medical history accurately when you apply. According to Ramírez, undeclared prior diagnoses, surgeries or ongoing medications are the root of most coverage disputes he sees among the roughly 2,500 foreign clients BlueBox works with.

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.

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