Healthcare in Ecuador for Retirees — IESS, Private Insurance, and What to Expect

Healthcare in Ecuador: Better Than You Expect, Cheaper Than You Imagine

Healthcare is the number one concern for American retirees considering Ecuador — and understandably so. After decades of navigating the U.S. healthcare system, where a single hospital visit can generate a five-figure bill, the idea of relying on a developing country's medical system feels risky.

Here's the reality: Ecuador's healthcare system, while imperfect, provides excellent care at a fraction of U.S. costs. Modern hospitals, well-trained doctors (many educated in the U.S. or Europe), and a public insurance system that costs under $100/month have made healthcare one of Ecuador's strongest selling points for retirees.

Let's break down everything you need to know.

The Big Picture: Medicare Does NOT Work Abroad

First, the critical fact that changes everything: Medicare does not cover you outside the United States. There are extremely limited exceptions (certain Canadian and Mexican border situations), but for all practical purposes, if you retire to Ecuador, your Medicare coverage is worthless.

This means you need an alternative — and Ecuador provides two strong ones: the public IESS system and private healthcare.

If you return to the U.S., you can re-enroll in Medicare during Open Enrollment. But while living in Ecuador, you need a different plan.

IESS: Ecuador's Public Healthcare System

What Is IESS?

The Instituto Ecuatoriano de Seguridad Social (IESS) is Ecuador's national social security system, which includes comprehensive healthcare coverage. Think of it as Ecuador's combination of Social Security and Medicare.

Mandatory Enrollment

As of current regulations, all visa holders in Ecuador are required to enroll in IESS. This isn't optional — it's a condition of your residency visa. The good news: the coverage is genuinely comprehensive.

Cost

For retirees (jubilados), IESS affiliation costs approximately $88 per month based on the 2026 SBU of $482. This is calculated as a percentage of the SBU and covers the enrollee. Dependent spouses may incur additional charges.

To be clear: $88/month for comprehensive health coverage that includes doctor visits, specialist care, surgery, hospitalization, emergency care, and many prescriptions. Compare that to the average U.S. Medicare Supplement plan at $150–$300/month — which still leaves you with copays and deductibles.

What IESS Covers

• Primary care — General doctor visits at IESS clinics
• Specialist care — Cardiology, orthopedics, neurology, oncology, etc.
• Emergency care — Emergency room visits and ambulance service
• Hospitalization — Inpatient care, including surgery
• Laboratory and imaging — Blood tests, X-rays, MRIs, CT scans
• Prescription medications — Many common medications covered at no additional cost
• Dental care — Basic dental services (extractions, fillings)
• Physical therapy and rehabilitation
• Mental health services

The Reality of Using IESS

Honest assessment of the IESS experience:

Pros:

• Comprehensive coverage at an unbeatable price
• Major surgeries (knee replacement, cardiac surgery) covered at no additional cost beyond monthly premiums
• Good network of hospitals and clinics in major cities
• Prescriptions are often free or very low-cost
• Emergency care is generally responsive

Cons:

• Wait times for specialists can be long — 2–8 weeks for non-emergency appointments
• Elective procedures may have wait lists of months
• Bureaucracy is real — appointments, referrals, and paperwork take patience
• Facility quality varies — Cuenca's IESS hospital is modern and well-equipped; smaller city facilities may be more basic
• Language barrier — Most IESS doctors speak limited English
• Appointment scheduling can be frustrating (online system, phone lines)

IESS Hospitals

Major IESS hospitals that retirees commonly use:

• Hospital Jose Carrasco Arteaga (Cuenca) — Modern, well-equipped, the primary IESS hospital for Cuenca's expat community
• Hospital Carlos Andrade Marin (Quito) — Large, comprehensive facility
• Hospital Teodoro Maldonado Carbo (Guayaquil) — Major IESS facility on the coast

Private Healthcare

Many American retirees in Ecuador maintain IESS (it's mandatory) but supplement it with private healthcare — either through private insurance or by paying out of pocket.

Private Insurance Options

Several insurance companies offer health coverage in Ecuador:

Important notes on private insurance:

• Pre-existing conditions: Many private insurers in Ecuador either exclude pre-existing conditions or impose waiting periods (6–24 months). Be honest on applications — insurers do investigate claims.
• Age limits: Some policies won't accept new applicants over 65 or 70. Start coverage before you hit the cutoff.
• Deductibles: Plans with lower premiums typically have higher deductibles ($500–$2,500).
• International plans: If you plan to travel frequently or visit the U.S. for care, an international plan (Cigna, GeoBlue) provides broader coverage but at a higher cost.

Private Hospitals and Clinics

Ecuador's private hospitals are where most retirees go for non-emergency specialist care, elective procedures, and anything where they want shorter wait times and English-speaking staff.

Top private hospitals by city:

Cuenca:

• Hospital Santa Ines — Modern, popular with expats, many English-speaking doctors
• Hospital Monte Sinai — Excellent specialty care
• Clinica Santa Ana — Good general care

Quito:

• Hospital Metropolitano — Ecuador's most prestigious private hospital
• Hospital de los Valles (Cumbaya) — Convenient for valley-dwelling expats
• Clinica Pasteur — Strong cardiology department

Guayaquil:

• Clinica Kennedy — Multiple locations, comprehensive care
• Hospital Clinica Alcívar — Well-regarded private facility

Out-of-Pocket Costs

Many retirees, especially those with good health, simply pay out of pocket for private care. The costs are so low by American standards that this is a viable strategy:

Even major surgery in Ecuador costs less than many Americans' annual insurance deductible.

Prescription Medications

Pharmacy costs in Ecuador are dramatically lower than in the U.S., and many common medications are available without a prescription (though you should always consult a doctor).

Common medication costs (monthly supply):

Key pharmacy facts:

• Fybeca and Pharmacys are the major pharmacy chains, similar to CVS/Walgreens
• Many medications that require prescriptions in the U.S. are available over-the-counter in Ecuador (though regulations are tightening)
• Antibiotics technically require a prescription but are sometimes dispensed without one
• Controlled substances (opioids, benzodiazepines) do require prescriptions
• Bring your current prescription list with generic names — your Ecuador doctor can prescribe local equivalents
• Specialty medications (biologics, certain cancer drugs) may be harder to find or more expensive — research availability before moving

Dental and Vision Care

Dental and vision care are areas where Ecuador truly excels for retirees.

Dental Care

Ecuador has become a dental tourism destination for good reason. Quality is high, and prices are 60–80% lower than in the U.S.

• Cleaning: $25–$40
• Filling: $30–$60
• Root canal: $150–$300
• Crown (porcelain): $200–$400
• Implant (single tooth): $800–$1,500
• Full set of veneers: $2,000–$5,000

Many Cuenca dentists speak English and use modern equipment (digital X-rays, CEREC same-day crowns). Ask the expat community for recommendations — word of mouth is the best referral system.

Vision Care

• Eye exam: $25–$40
• Prescription glasses (frames + lenses): $40–$150
• Contact lenses (monthly supply): $20–$40
• LASIK surgery: $800–$1,500 per eye
• Cataract surgery: $1,500–$3,000 per eye

Practical Healthcare Tips for Retirees

Before You Move

1. Get a complete physical in the U.S. before departing
2. Stock up on prescriptions — bring a 3-month supply of all medications and a list of generic names
3. Get your medical records — digital copies of major test results, surgical history, allergies, and medication lists
4. Complete any pending procedures — especially if they're complex or require follow-up
5. Dental work: Consider getting any major dental work done in the U.S. if you have good insurance, or plan to do it in Ecuador at huge savings

After You Arrive

1. Enroll in IESS immediately after receiving your cedula
2. Find a primary care doctor — ask the expat community for English-speaking recommendations
3. Locate your nearest hospital and emergency room
4. Register at a pharmacy — Fybeca has a loyalty program that provides discounts
5. Learn basic medical Spanish — "emergency" vocabulary could be critically important
6. Establish care with a dentist and eye doctor

Emergency Preparedness

• Emergency number: 911 (yes, same as the U.S.)
• IESS emergency line: Available through your local IESS hospital
• Medical evacuation insurance: Consider a plan like MedjetAssist ($250–$350/year) for emergency evacuation to the U.S. if needed
• Blood type: Know it and carry the information in your wallet
• Emergency contacts: Have local contacts who speak Spanish in case of emergencies

Healthcare for Specific Conditions

Heart Disease

Ecuador's major hospitals have full cardiology departments. Interventional cardiology (stents, angioplasty) is available in Cuenca, Quito, and Guayaquil. Regular medications are affordable and available. Many cardiologists trained in the U.S. or Europe.

Diabetes

Management is straightforward. Metformin and insulin are affordable and widely available. A1C testing costs $8–$15. Continuous glucose monitors (CGM) are becoming available but may be more expensive than in the U.S.

Cancer

Major hospitals in Quito and Guayaquil have oncology departments with chemotherapy and radiation therapy. For rare cancers or complex protocols, some retirees return to the U.S. for treatment. Having an international insurance plan or medical evacuation coverage is wise for this scenario.

Mental Health

Psychiatry and psychology services are available in major cities. Therapy sessions run $30–$60 per hour. English-speaking therapists exist but are limited — online therapy with U.S.-based providers is a popular supplement.

Orthopedics

Joint replacements, spine surgery, and orthopedic care are well-established in Ecuador. Recovery and physical therapy are affordable ($15–$30 per session).

A Smart Healthcare Strategy

The most cost-effective approach for most retirees combines multiple elements:

1. IESS (mandatory, ~$88/month) — Your safety net for major medical events, hospitalization, and chronic disease management
2. Out-of-pocket private care — For routine visits, specialists when you want shorter wait times, and dental/vision
3. Medical evacuation insurance (~$250–$350/year) — For the rare catastrophic scenario where you need emergency transport to the U.S.
4. Optional: International private insurance ($200–$400/month) — If you travel frequently or want coverage back in the U.S.

Total healthcare cost for most retirees: $100–$200/month for excellent, comprehensive coverage. Add $200–$400/month if you want premium international insurance.

Next Steps

1. Research IESS enrollment — Understand the process and timeline (typically done after receiving your cedula)
2. Get pre-existing conditions documented — Bring complete medical records from the U.S.
3. Stock up on medications — 3-month supply plus generic name list
4. Ask the expat community — Join Facebook groups for Cuenca or your target city and ask for doctor recommendations
5. Budget for healthcare — Plan $100–$200/month for the IESS + out-of-pocket approach, or $300–$500/month if you want comprehensive private insurance on top

Healthcare in Ecuador isn't just "good enough" — for many retirees, it's genuinely better than what they had in the U.S. The combination of low cost, personal attention (doctors who spend 30+ minutes with you), and comprehensive coverage through IESS creates a healthcare experience that relieves the financial anxiety so many American retirees carry.

Your health is too important to let fear of the unknown stop you from exploring Ecuador. The system works, the doctors are skilled, and the prices will make you wonder what you were paying for back home.