When we first moved to Cuenca, Bo and I decided to be "self insured" for our medical needs. We figured if we kept the money we would have to pay for monthly health premiums in our own account, we would come out ahead - due to the low cost of medical care here. Most insurances we had inquired about wanted at least $100 a month per person (way less expensive than the high premiums in the USA) and the coverage wasn't that great - plus the paper work and hassle to get reimbursed was not a smooth process. We decided that $2,400 in the bank per year would cover more than enough of our yearly medical bills. But, what if we had an emergency? A BIG emergency???
Sometimes we sail through our life by faith. We have been back to the USA three times without any medical coverage. Yes, it's risky - but, we've been okay so far. As for medical coverage in Cuenca, that's different. To spend a day or several days in the hospital is low enough for us to pay out-of-pocket if we had to. Yes, it would be a big chunk of money, but we could do it. Then I heard about the IESS Government insurance. For a few months it was blocked from ex-pats being able to apply for it, and we missed that window of opportunity. Around March of this year it became available again for ex-pats, and I jumped on it and got Bo signed up with me as his dependent. However, the rules were changed. Now, there was a three month wait for coverage from the time we were entered into the computer. Bo's monthly payment would be $70.04 and mine would be $11.59, for a total monthly medical premium of $81.63.
For the first three months, the payments were for Bo's coverage only. My payments then began in August. We are now both covered 100% for all of our medical needs: Doctor appointments, lab work, x-rays, ultrasounds, prescriptions, eye, and dental (the DENTAL covers us when we turn 65). So how does it work?
1 - Once your 3-month waiting period is met - you call the IESS phone # (07-413-4555) and ask for your first GP doctor appointment. I told them I wanted a doctor in El Centro, so they scheduled Bo at the IESS Consultorio building near Parque Calderon (we love walking to everything - even our doctor appointments!!!). On Friday, we met with Dr. Marco at 7:15 am. He was kind, attentive, and thorough. Of course, going to a doctor appointment here is so painless. No waiting, no paperwork to fill out. The doc does all of that in front of you on his computer - and it's minimal and to the point, "How can I serve you, and why are you here today?" No privacy act rules, no secretary or nurses or other patients waiting in adjacent rooms! He does it ALL and you're it for the entire appointment. He asked Bo why he was there, we told him all Bo's concerns, he ordered labs, an ultrasound, and scheduled Bo for his specialist appointments and physical therapy. He checked Bo out for a couple of GP issues, gave us our future appointment instructions, shook our hand, and we were out the door. No papers to sign, no money to pay - just a friendly "Gracias."
2 - We were given a slip of paper with three different numbers. We went to the pharmacy line, gave them the paper, and they gave us Bo's prescription. Free! We then went to the lab area, gave them the paper with the other two numbers, and they entered two appointments into the computer for Bo's lab work and Ultrasound.
3 - Today we walked back over to the lab (same building as our doctor). We stood in line for about 5 minutes, Bo's turn came and they sat him down and drew his blood - free. His results will be back on Thursday, and he has a follow-up appointment on Monday with Dr. Marco to review his labs. He is also scheduled next week at the IESS Hospital for physical therapy and in September he will go see a specialist at the IESS hospital.
4 - The next appointments we will make will be for eye care and to have Bo's hearing checked. The procedure is the same. The General Practitioner doctor will schedule these appointments during Bo's Monday visit.
5 - The appointments are important to keep. If one has a medical emergency during the waiting period, you can go to any hospital and supposedly IESS will cover your medical care there. I have heard conflicting stories about this - so I need to verify this information. Sometimes the pharmacy does not have the prescription required, so one has to go to another pharmacy (plenty of those in Cuenca) and pay for the prescription. Because medication is so inexpensive here, no problem!!
6 - Are the doctors as good as the ones practicing outside of the IESS Government Insurance? Absolutely. Our family doctor in Cuenca, Dra. Rosita, told us that she would be an IESS doctor but because she doesn't have handicap ramp access to her office (you have to climb stairs - yes!) - she was not approved. I think some doctors like that monthly fixed income paid to them by the Government. We will still see Dra. Rosita if we need her medical expertise. She is brilliant, kind, and charges $10 per visit with free follow-ups. We love her! For now, we are establishing our medical care with IESS so we are in their computer system. Then if and when an emergency occurs, we will have that 100 percent coverage.
Yes, for less than $1,000 a year medical insurance premiums and 100% medical coverage, it's worth it for us to go through the system. Nothing fancy here when it comes to hospital care. You don't get a private room, you provide your own personal care items for your hospital stay, and you're not pampered and charged for every little thing like back in the USA. The important thing is the quality of care - and we have heard only wonderful things about the care and treatment others we know have received from the IESS doctors. Is it like the USA? Of course not! Don't come expecting a USA doctor-hospital experience. But, do expect to receive quality medical care from excellent physicians.
If you are a legal resident of Ecuador and have a Cedula, you are qualified to apply for IESS Insurance. Application for voluntary enrollment can be made at the Social Security office in Cuenca on Gran Columbia (Instituto Ecuatoriano de Seguridad, or IESS). You can also sign up on line at www.iess.gob.ec.