New Ecuador health care system

Medicare coverage does not apply outside of US borders.

Anyone who leaves the US is not covered by Medicare.

Medicare dumps you.

But you'll still pay for it ... unless you opt-out.

Seoulguy-David is asking a legitimate question and responses 2 and 3 appear irrelevant to it. 
    Here in Quito, I dropped my Salud SA medical-dental coverage (age 63 with pre-conditions) recently, and have been saving $170 per month in premiums ($70 now vs. $240 with Salud).
    However, the 3-month waiting period before getting a doctor appointment has just concluded and so I have not availed myself of IESS (EC Social Security) medical services.
   There is wide consensus based on Internet postings and my discussions with Ecuadorians that it would be wise to use private health care in addition to any membership with IESS.  However, there are also reports that the government's efforts to increase the number of participating, qualified doctors have been successful.
   Re-capping David H's point so we stay on course here:  let us know if you have had direct experience with this Ecuadorian government medical program and how it has worked for you.

Those responses actually were relevant.  If David has Medicare, it only makes sense that he drop out of the Medicare system in the US.  There is no sense in paying over $100 a month for something that he cannot use in EC, but it's something he must request from Social Security, they will not do it automatically.

That being said, I appreciate your input about the IESS system.  I plan on enrolling in it when I receive my residency.

Thanks, cccmedia for reasserting my primary concerns. 

While I have complained about the cost of Medicare and my supplement, totaling $360/monthly, nothing substitues for quality medical care when you need it. With the exception of primary care, which has admitedly been substandard, the specialists and surgeons have excelled.

Many, many years ago, I was treated in Puerto Rico, but the physician/surgeon was also American.  However, in
Seoul, South Korea, the experience was completely different, having contracted the Chinese flu which never improved until I left the country.  In Mexico, I was foolish enough to allow a "cheap" dentist place a crown.  The tooth later abcsessed, and I lost it.  So, it pays to be careful.

So, cccmedia, if you have no preexisting conditions at 63, which would be rare, then I guess you would qualify for private insurance, but most 65+ have a myriad of medical problems, and they only grow with age.

David H

David, I have lived here for 3 years. I have had 2 Ecuador insurance companies. Both became totally disappointing and non paying and both did not cover pre existing. S---- and A---D-----. I have for 6 months now been enrolled in the voluntary plan for the IESS (social security) health plan for Ecuador. I am extremely pleased. No problem with preexisting, no co-pays all meds free with 90 day supply's. Very good doctors. My wife (Latino) has helped many of our other expat friends get signed up online. Spouses are added for $11.50 You pay only $70.04 a month for your self. That is less than $82 for both! There is a 3 month waiting period of paying premiums. However if you have an emergency or accident you are covered in the mean time. If at any time you have an accident requiring hospitalization, you will be taken to the closest hospital and transferred to IESS when you are stable. There also is no age limit we have helped sign up friends in there late 50's and friends in there late 70's also. All in all it is the best I have seen here. The only disadvantage for non Spanish speaking expats is that the doctors mostly do not speak English. A bilingual taxi driver or housekeeper can help.

We opted to use Confiamed in lieu of Medicare.  Much better.  We have a friend in IESS as well. Also off Medicare.  We are very happy with the care and the doctors here.

Good job of bringing the good news, Cuenca Boy, and with plenty of details.
   Let's hear more, Expat-Bloggers, as more people gain experience with the IESS and its recently expanded healthcare coverage.  Especially helpful would be your evaluation of the doctors' care.
   BTW, I also was disappointed with Salud coverage, as they refused to reimburse any of my eight medicinas under their pre-existing conditions policy.
   They did, however, steer me to a good doctor in Quito, Ney Dolberg, whom I continue to see after dropping Salud like a bad habit when I learned that IESS had expanded its coverage last winter.  Am now saving $170 per month in premiums for medical and dental coverage (IESS vs. Salud).

You pay for Part B ONLY -- YOu maintain Part A if you stay in Ecuador or another country , you hook up with Medicare as needed when you return to the U.S. and receive hospital and doctor coverage (unless, of course,  you decide to give up your citizenship and cash in your chits)

Have read that if you drop Medicare and need or want to return to the states for something very serious, surgery etc that you will pay a penalty for every year that you have not paid into Medicare. Does anyone know?

I have heard the same -- but there may be additional penalties as more people/ baby boomers leave the system (still a relatively small number) Check the Social Security/Medicare website.  Sue in QUito.

Right now if you request to opt-out, You still have part A but opt-out of part B only and you do have to request this and they will send you the form for you to sign takes about 2 months before it stops. Once you opt-out and you need to get Part -B back right now there is a penalty this could change in the future.  The penalty right now is 10% per year that you have opt-out for. So if you are out 2 full years you get a 20% penalty. Also you will have and additional plenty on the premium you pay it will also increase for the number of years you have opted-out. Now they do have which I have used away to opt-out without the penalty if you should have group insurance for example your spouse employers health plan. You can opt-out then when you want back in you need to have the employer sign a statement that you did have insurance and when it stopped because you only have so long to reapply before the penalty would applied. I have done a lot of checking on this and found out that you can appeal there decision if they should apply the penalty. I have choose to opt-out of Part B and if I should every need it back I am planning to appeal their decision because they will want the penalty and increase on my premium. I have talked to Soc Sec and Medicare both about this and they said that it would be possible to get a waiver from the penalty if I can prove I was out of the country and had other insurance and since they won't pay any claims that were made outside of the United States. But what they say today may change in the future it wouldn't be a guaranty that if you opt-out you would get the waiver, So it's a decision you would have to make and how much risk you want to take and it will take time to appeal their decision.

Cuenca Boy, Can you provide the web address to sign up online for the insurance. Thanks

The EC government healthcare system's website is www.iess.gob.ec
   Traiga su espanol.

THanks for all of the particulars .. having worked for large govt bureaucracies in the U.S., I find it  easier and simpler for me NOT to opt out of anything -- because penalties change and MEDICARE and SS may change fundamentally at some point -- no one knows ......I will do without the $ 100 plus dollars per month now and take that risk rather than pay lots more later (the penalty)   THat is the way I see and understand the issue, in perspective.  Welcome other points of view.

suefrankdahl wrote:

Have read that if you drop Medicare and need or want to return to the states for something very serious, surgery etc that you will pay a penalty for every year that you have not paid into Medicare. Does anyone know?

I'm not claiming to be an expert, but Medicare Part A (hospitalization) is automatic. Everybody gets it at 65.

Parts B&D are optional and cost more. B covers doctor visits, outpatient services, lab tests, etc. I pay ~$100/month for this. If I had not gotten it at 65 and tried to get it later, there would have been a penalty.

D covers prescription drugs. I don't have it, but I think it would cost me about $250/month if I wanted in now (at 67), plus a penalty.

Others may have more/better info.

gbfc;

Does EC IESS count as medical insurance? I doubt it.

To the other Sue: Have worked for the state and also another job that required Medicare reimbursement.Like you would not opt out of anything. Happy to pay Medicare the money. The sheer hassle of doing it and then trying to get it back if needed would be so aggravating and time consuming. Time is money, right. Can't put a price on the tranquility you went to EC for or the peace of mind that you can go back to the US  if you get really sick. This has happened to two of our members. .And when it changes it will be a nightmare. At this point I have Medicare thru SS Disability and try not to think that far ahead. It gives me a headache

I have been reading all these comments about Heath Insurance in Ecuador. Unfortunately, I gave it little thought, when I left Canada, it sort of slipped my mind. Now, after hearing good things about S...d, I find out, that they do not take on new members after 65. aaarrrggghhh.  It seems, that every time I turn around, there is another obstacle in the way. I shall overcome, however, and I am so glad, I lucked into this Ex-pat web site. I never even heard about IESS, although I have foreign and local acquaintances.  Thank you for all the info, I will try IESS and see what happens. The only thing I started 4 years ago, was Arthritis in the knee, and now it is in one hand. I pay no attention to it, and I do not have much pain. I love the mountain ranges of the Andes, and climb around in there with joy. At almost 70, I seem to have the constitution of a much, much younger person and since I now can stay here with my permanent visa for retirees, I also have a very positive outlook with one of those sunny dispositions.

Reading about new changes implemented at IESS , is hemidialysis civered ?? Any experience ? .roy

Sure. It is www.IESS.ec.gob

Does the new healthcare  rules apply to tourists who are in Ecuador?

Bruce

bruceberger wrote:

Does the new healthcare  rules apply to tourists who are in Ecuador?

Bruce

Bruce, sorry but the IESS healthcare is for citizens and residents only. It take 3 months of payments after registration to qualify for attention. All of the other government hospitals are free to anyone. If you have an emergency here you would be treated. That is in the 2008 Constitution. Tourists have many of the same rights as citizens.

""Does EC IESS count as medical insurance? I doubt it""


Your answer is:

The IESS is not insurance. It is an "association" of members or employees. (socio's) The law changed about a year ago to allow "voluntary" membership by paying a monthly fee. That according to the constitution includes residents. The IESS stands for Institution de Ecuador de Social Security

cuenca boy...thks.......i went thru the website for IESS but cause it's in spanish i couldn't get an answer.   how sure are you that IESS covers pre-existing conditions (dialysis).? .i can wait 90 days beyond getting my cidula and pay the costs of hemodialysis directly, but can't afford more than that. Pls adv.....rgds

roydophen wrote:

i went thru the website for IESS but cause it's in spanish i couldn't get an answer.   how sure are you that IESS covers pre-existing conditions (dialysis).? i can wait 90 days beyond getting my cidula and pay the costs of hemodialysis directly, but can't afford more than that.

Reading your letter literally, it appears you do not yet have a cédula though you can afford to pay directly for the cost of hemodialysis.  You need to seriously consider doing that (paying directly).

Go ahead and obtain the card, but if you need the procedure anytime soon, consider the delays and the related angst.

First, you need the cédula.  Then you need to set up a bank account.  Then, in Spanish or with help from an español speaker, you need to get on the IESS website to set up your account and connect the bank account to your new IESS account.

Then you need to set up your payments.  Only when the first payment has successfully been processed does the clock start running on your IESS waiting period.

Months later when the waiting period is finally over, a Spanish-speaking receptionist will be able to assist you in scheduling the procedure.  There is no guarantee against a further delay;  you can't expect to be scheduled for dialysis the next day or week.

I am not counseling you against moving ahead with IESS enrollment.

However, under the circumstances as I understand them, I would not be surprised if all of the above took five months or more.

So if you need the dialysis before, say, October 1st, consider contacting a private health provider (without insurance or IESS coverage involved) and do what it takes to preserve your health.

If you need an IESS-covered procedure in the next three months, well, barring divine intervention, it's not going to happen.

IESS does provide services without regard to pre-existing conditions, but that won't help you now.  Once you get enrolled and up-to-speed, it may help you down the road.

If my understanding of your situation is off, let us know, and perhaps different advice might be needed.

cccmedia in Quito

Cccmedia, I think roydophen is in New Jersey.

gardener1 wrote:

Cccmedia, I think roydophen is in New Jersey.

Which would explain why he doesn't yet have a cédula.

Wherever Roy is, he is a long way from making his first covered medical-appointment under IESS.

Virtually all medical procedures are cheaper in Ecuador than in the US, so it might be worth some 'medical tourism' in EC if his dialysis isn't covered by insurance in New Jersey.

However, that would be a temporary fix, since it's unclear whether Roy could qualify for an EC residency visa.

Absent such a visa...a cédula, an EC bank account and enrollment in IESS healthcare would be ruled out as possibilities.

cccmedia in Quito

Thanks,... ....i'm now in Dubai and doing hemodialysis here since 2012 covered by a local insurance co. I realize now that things won't be fast in ecuador (just thinking to apply to reside in ecuador) ,and your estimation of time for being covered under IESS once the cedula is ready seems logic, .it's a good idea to have a private insurance co in Ecuador or else it will cost me for one hemodialysis session arround 115 $ !! (i did search ),,i need 3 sessions every week ! ........can't miss a session .....just wanted to confirm the coverage of pre-existing condition, which is clear now........thks a lot.

roydophen wrote:

it's a good idea to have a private insurance co in Ecuador or else it will cost me for one hemodialysis session arround 115 $ !! (i did search ),,i need 3 sessions every week ! ........can't miss a session .....just wanted to confirm the coverage of pre-existing condition, which is clear now........thks a lot.

Although IESS disregards pre-existing conditions, the private insurance companies do not.  With your needs, you could not count on any coverage for the first year, if ever, from the insurance companies that currently operate in Ecuador. 

cccmedia in Quito

Yes, understood.........thks a lot for your valuable comments........b.wishes.

I have been paying into IESS since December 2014. There was a 3 mos. waiting period, before I could use it, unless there was an emergency.  Then I was told, the Hospital I went to in Guayaquil - Kennedy -  was Not accepting IESS and I would have to go to special hospitals, and doctors, who are willing to accept this insurance from the government. I have been paying a little over $70 a mos. and have not been able to use it, since I now live in a mountain town. I guess, I would have to travel to Ambato, about 4 hrs. away on a bus, to be able to finally use my IESS.  In the meantime, I heard - saw - on TV, that the government wants ALL hospitals to honour IESS, which would be nice, or at least let us know, WHERE this insurance is accepted.  HELP.  I need a full check up, I am 70, and my ears are hurting. I also ended up with Shingles in Guayaquil in February and they keep popping up every so often.  I really feel, that this insurance, although affordable, should be accepted by all doctors and hospitals, or it is really quite useless.

AmberFenton wrote:

I have not been able to use (IESS healthcare) since I now live in a mountain town. I guess I would have to travel to Ambato, about 4 hrs. away on a bus, to be able to finally use my IESS...I need a full check up, I am 70, and my ears are hurting. I also ended up with Shingles in Guayaquil in February and they keep popping up every so often.

Amber, I really don't know what you were doing in hot and humid GYE, but it was wise of you to get out of there.

What mountain town are you in now?  Please update your profile.

If you're finding that the altitude in the highlands is suitable, consider a move to Cuenca where Expats have been reporting good success with the IESS program. 

Also, there may be more support for you available from the Cuenca Expat community than in some pueblo four hours from Ambato.  That's simply not close enough to emergency care for someone in their early 70's who has a choice of where to live.

What is your rental situation?  Can you move?

The sooner you can move somewhere with favorable health care, the better.

An office visit with a doctor in your town, paying out of pocket, should cost you about $25-30.  Schedule at least a simple checkup for next week and get guidance and treatment for your current health problems.

Please keep communicating with us about this.

FYI, in case of emergency, any hospital in Ecuador is supposed to admit you and treat you at no cost (as an IESS participant) upon presentation of your cédula.  Once you are stabilized, you could then be transferred to an IESS hospital if necessary.

cccmedia in Quito

thank you for your kind reply.  I lived in Guayaquil for about a year and 4 mos., beautiful apartment near Samborondon. Unfortunately, no air condition, and since I was only renting, I decided against the extra expense. I am German/Canadian and the Canadian dollar was sinking low, so I lose $600 off of my pension a mo. A close friend suggested, we move to a rented house in the Province of Bolivar, which is not that far from Ambato, so I can afford to live in Ecuador. I am alright with the mountains, and actually prefer them. Cuenca is much too expensive for me. My day to day Spanish seems adequate enough to go shopping and chat with the hairdresser, and this white old lady seems to have been accepted by the local gentry.  The watchmaker is 100 and replaced a battery for me in my wrist-watch.  I am quite happy here. Even the house is 100 yrs. old, and we are fixing it up somewhat to suit our taste.  I do hope to eventually end up in Ambato, I really liked the city a lot. It is cleaner and nicer there.  We are going for a visit there soon, and I will get my check up then. Also need a dentist appointment.  I think, I got over those stupid Shingles for now. Other than that, I seem to be getting back into better shape, no longer huffing and puffing on the steep mountain streets. Thanks again for taking the time to reply.

AmberFenton wrote:

Canadian dollar was sinking low, so I lose $600 off of my pension a mo....The watchmaker is 100 and replaced a battery for me in my wrist-watch.  I am quite happy here....I got over those stupid Shingles for now. Other than that, I seem to be getting back into better shape, no longer huffing and puffing on the steep mountain streets.

Glad to hear your health is improving and you're getting medical attention, Amber.

That's quite a hit you're taking with the Canadian dollar, so it makes sense you would want to avoid the increasing COL in Cuenca, especially since you're obviously integrating well into your community.  What town is that?

Now about that hundred-year-old watchmaker.  An international team of researchers went to the so-called Valley of Longevity, the Vilcabamba valley, and found that the Ecuadorians there were exaggerating their age right and left.  People in their 90's saying they were almost 120.  So I take the claims of "centenarians" with a grain of salt.

cccmedia in Quito

In answer to cccmedia: I am in a small town in the mountains of the Province of Bolivar.  The watchmaker looks like he is about 78, but his grand-daughter claimed, that he was actually 100 years young. I could not believe it. He still fixes watches with that small magnifying glass in one eye. I will be tutoring some students in English, while trying to learn Spanish. Never a boring moment. People need to start appreciating what they have and try to make the best out of every situation. This is actually the second time I have immigrated to a foreign country. At 21, I left Germany to live in Canada for over 40 years. I also lived in Michigan for about 5 years, as an uninvited guest, if you know what I mean.  Life is a bowl of cherries, if you know how to spit out the pits.

I'm interpreting this feistiness and positivity as further signs that Amber is well 'on the mend.'

Cuenca boy,

I haven't visited this site for quite some time and was surprised to find the number of postings for this thread, in particular yours with the detail.  I wonder what your update  would be as you may have experienced the public system in the last few months.  What with renewing my passport and clearing up some business later on this summer, I've begun to put more time into scoping out the idea of overseas "retirement" or part time overseas "retirement".  I say "retirement" because I have had my own portable (i.e., web-based) business for the last 12 years and never foresee a time when this income will not be necessary.

Anyway, to the point, I'm surprised that some many Medicare users never mention the plain fact that you need Parts A, B, AND supplemental insurance for the co-pays.  It would also be foolish to go without Part D.  Some of your fellow expats may have forgotten that buying drugs in the USA is outrageously expensive, so for senior w/o Part D, no way!

This means that we're not only talking about the $104 base premium, but the premium for Part D and the premium for your supplemental.  I canged to the high deductible Plan F, which means I pay $96.00/month, but no coverage on co-pay until $2140.00 has been paid out first.  Believe it or not, this was cheaper than paying $280.00, going up to $300.00/month for full service.  So, the business about opting out is not just opting out of M/C, it's much more, and if you were to be hospitalized on Part A alone, your co-pays in one day (!) would be through the roof.  Expats need to get the facts.

D H