How a Health Insurance Hike Pushed One Couple to Cuenca, Ecuador

A married couple who relocated from the United States explain how a single health insurance premium increase became the number that convinced them to move to Cuenca.

Keith Potter and his husband, Justin Lander, had talked for years about living abroad once their son finished school. Ecuador wasn't the plan at first. It was one stop on a 2017 vacation that also included Quito and the Amazon. The decision to actually move came later, and it came down to a number.

The number that changed everything

According to Keith, the couple's health insurance in the US kept climbing, and last year it jumped again. "We realized after they took another increase last year that we could pay for our cost of living in Ecuador for what our health insurance cost every month," Keith said. That comparison, not a lifestyle fantasy, was what moved the timeline up.

Before that, the couple had been building a loose list of countries to visit and vet, with no fixed date to leave the US. The premium increase gave them a deadline.

How Ecuador compares

Keith said the couple considered Costa Rica, Panama and Uruguay, and had long dreamed of Spain, where he had studied decades earlier. Spain was ruled out mainly for practical reasons: being far from family in the US on a different time zone, along with cost, made it less workable while they still had close relatives stateside. Uruguay came up briefly but was set aside. Costa Rica and Panama stayed on the list longer, but according to Keith, Ecuador "checked a lot of boxes" that the others didn't combine in one place.

Those boxes included the US dollar as Ecuador's currency, legal recognition of same-sex marriage, and a climate Keith described as consistent: "the weather's great, spring all year long." For a couple weighing practical constraints against a long-held dream of Europe, those factors tipped the decision toward South America.

What the dollar economy and legal recognition unlocked

For Keith, using the US dollar removed a layer of financial uncertainty that comes with currency risk in other countries. Equally important was that Ecuador recognizes same-sex marriage. Keith said this mattered beyond symbolism: it affects hospital visitation rights, estate planning and other practical matters that come with being legally married in the place you live.

On daily life, Keith said the couple has had no negative encounters related to being a same-sex couple, whether with their landlord, service providers, or in Spanish-language exchange groups with local Cuencanos. He also pointed to an active LGBTQ community in Cuenca that includes both expats and Ecuadorians, with a monthly brunch that regularly draws over 100 people, along with other social gatherings at bars and coffee shops.

Concrete extras the savings unlocked

The core financial comparison, according to Keith, wasn't about discretionary spending. It was that their full monthly cost of living in Ecuador, including rent, utilities, and health insurance, added up to roughly what their health insurance alone cost in the US.

That gap allowed the couple to add things Keith said they couldn't have justified in the US. He gets a 90-minute in-home massage once a week, which he said costs about $200 a month. His husband had extensive dental work done at what Keith estimated was 15 to 20 percent of the US cost. The two also had hair transplants done, which Keith mentioned with some humor during the interview.

Keith also pointed to smaller, less obvious savings. He said the biggest single financial shift was that the couple stopped ordering from Amazon, since things in Cuenca are found by asking around rather than searching online. According to Keith, this is a cultural habit in Ecuador: businesses often don't have functioning websites, and word of mouth through friends and neighbors fills that gap.

What this means for you

If you're comparing Ecuador to Costa Rica, Panama, or a longer-held dream destination like Spain, Keith’s experience suggests a few practical questions worth asking yourself before you commit:

• Pull your actual monthly health insurance bill in the US and compare it honestly to published cost-of-living estimates for the Ecuadorian city you're considering. Keith’s decision turned on this exact comparison.

• If legal recognition of your marriage matters for hospital access, estate planning, or residency applications, confirm the current legal status directly with Ecuadorian authorities rather than relying on general expat reports.

• Don't assume online research tells you everything about day-to-day logistics. Keith noted that many businesses in Cuenca don't have real websites, so expect to build a local network to find services, from dentists to home repair.

• Visit for an extended period before moving, not just a two-week vacation. Keith said the couple's longer trips, including one extended by a dental procedure, gave them a realistic feel for daily life rather than vacation mode.

• If elective medical or dental work is part of your financial case for moving, get specific quotes from providers in the city you're considering rather than relying on general percentage estimates.

Ecuador won't check every box for every reader weighing it against other countries on a shortlist. But for this couple, the combination of the dollar economy, marriage recognition, climate, and a lower cost of living added up to a decision driven less by dreaming and more by arithmetic.

This article is based on an interview conducted by HiExpat on 2026-10-27. Rules and prices change; confirm with the relevant authority before acting.

Photo: iam luisao / Pexels