Ecuador Health Insurance Update

                         Ecuador Health Insurance

While completeing the six question GringoTree insurance survey, it occured to me that readers may appreciate an update on health insuarnce. As a retired health insurance broker and former CPA, I reviewed policies available after moving to Cuenca in 2011. We expect to remain in Cuenca long term and do not plan to use US Medicare unless absolutely necessary. Since we are self employed with US income, our premiums are deductible on our 1040 tax return (medical expenses are not deductibe).

Salud: $10,000 ded. Comprehensive major medical for $104/month/couple, includes $4.50 office visit (healthy couple 63/57).

Salud: unlimited lifetime cancer $38/mo couple to age 120+

Santa Inez: network 90%, Rx, office and hospital, $80 deductible, $6000 max per illness (offsets $10,000 deductible on Salud plan above)) $40/mo/couple premium, life ins, ambulance, accident,etc.

Coopera: $2 office and dental, 80% max of $400/yr for $5/month/couple. Great for blood tests, prescriptions, routine needs.

Quality may vary with providers. Some speak good English.

We bought coverage while healthy because we expect Medicare to become very restricted under ObamaCare. Ecuador is our lifetime plan even though we will be forced to pay massive Medicare premiums under ObamaCare. The cost of Medicare premiums will nearly double starting in 2014.  ObamaCare must be purchased in 2014 if you are in the US over 35 days per year and under 65!
 Or you may pay a large penalty every year.

For further details  review our other postings under our "Health Insurance" headings.

Wait a minute. What is the exact language of the IRS regulation?

“The annual national average bronze plan premium for a family of 5 (2 adults, 3 children) is $20,000,” the regulation states.

 

“Bronze will be the lowest tier health-insurance plan available under Obamacare — after Silver, Gold, and Platinum,” CNS explains. “Under the law, the penalty for not buying health insurance is supposed to be capped at either the annual average Bronze premium, 2.5 percent of taxable income, or $2,085.00 per family in 2016.”

    Source:  http://www.theblaze.com/stories/2013/02/01/surprise-irs-calculates-cheapest-obamacare-plan-will-average-20000-per-family/

Health Insurance Part II

         Medical Insurance in Ecuador – Part Two

                         

                     Policy We Purchased & Why

We may be typical of healthy North American Expadorians nearing retirement, so here is our thinking. I am 62 and Sue has fewer laps around the sun (late 50's). We take no serious medications nor have pre-existing conditions. Economy, some US coverage, quality of carrier (and agent), and continuation past 70 are priorities.

Policies with several agents were considered. Now for the boring, but important details by insurer.

Pan American offered a high end international policy with full US coverage at US medical cost reimbursement within their US network. Unlimited maximum coverage. However, cost was over $600+/month. Since our annual time in NC will be well under the 90 days allowed by our Cedula, we will skip the nuances.

Best Doctors offered a similar plan.

Humana offered a tempting variety of plans which changed by the time of our purchase decision. Policies and prices change here like in the fast moving US marketplace. However, you had to buy the expensive underlying "first dollar" coverage to be eligible for the catastropic coverage.

Salud won us over with a combination of features and policies. Their separate cancer plan has no deductible, continues in force throughout our lifetime, with unlimited maximum coverage. Cost $17.50 monthly apiece. So we can live to 100 and get inflation proof coverage (unless they change the policy).  You know, nothing is guaranteed forever!   A six month waiting period applies before coverage kicks in.

We skipped the first dollar, small co-pay plan that would cover the first $11,000 of claims due to the cost and our risk tolerance.

Our final choice was a $10,000 deductible with $128,500 in coverage with $55,000 accidental death insurance. Total premium for us both is $98/month. Coverage is reduced to 30% at age 70. Who knows what Medicare or private care will look like in even a few years?

Yes, a waiting period of 3 months for hospitalization; immediate coverage for accident or emergencies. And you may use any hospital. US coverage is paid at Ecuadoran medical costs (20% to 40%  US costs) - a common provision in Ecuador.

We may later add a small first dollar plan to assist in the first $10,000 in claims exposure. Meanwhile, office visits average $25 in Cuenca.

Future postings:

* A new plan offered by Banco Pichincha and Santa Ines Hospital

* Coopera's new small claim, first dollar coverage for $2.62 in monthly premium

* Homeowners coverage; earthquake, theft, etc.
           Salud,    Gary

Health Insurance

            Medical Insurance in Ecuador – Part One

                          Basics and Background

My twenty years in North Carolina medical insurance sales passed very quickly amid constant government interference, regulations, and politics. I remember the basic considerations well: Deductible, co-insurance, co-pays, networks, exclusions, pre-existing conditions, underwriting at issue or at claim processing, preferred rates, maximum coverage per year/lifetime, company ratings, age pricing, history of premium increases, and most importantly agent integrity. And then there is taxation/deductibility, health savings accounts. Group coverage has several additional considerations.

Ecuador has interesting twists on many of these issues. They use waiting periods and broadly defined pre-existing conditions due to the difficulty of obtaining physician records of medical history. The US Medical Information Bureau (MIB) for sharing claims history does not exist here, so underwriting (medical history review) may occur after the claim is submitted. Surprise!

Baby boomers are uncertain of Medicare’s cost cutting in the future. A quick return to the US may be impractical for many medical conditions. Quality is excellent here, but some procedures and drugs may not be available.  Policies often end at age 70 or become dramatically reduced. And what about “long term care”?   Then there is medical inflation.  Oh well, we cannot eliminate all risks!

Policy design is quite different in Ecuador, due to different considerations of family economy, culture, social security, and entitlements. Medical records have lesser importance in a low litigation society. And a cash-based society expedites care and eliminates much bookkeeping. Care delivery looks like the “good old days” in North America. Rarely do we encounter long waits with clip boards/laptops, medical transcriptionist, holdup or billing/medical records staff.

Bi-lingual multi-line agents with understanding of US customs and expectations are rare in Ecuador. Maybe this blog will help!

                        How to Shop Health Insurance

Since my experience is limited to the Andes city of four rivers, I’ll start here. Pleeease, folks, give me your feedback on any errors or omissions. As usual, check more than one source!

Shop a variety of agents, policies and companies. Get referrals. Tell your prospective agent exactly what you are looking for and your premium range. Ask several times and be patient. Will the agent help with claims? Do they maintain office hours? Expect clear and definitive answers – do not be rushed by the language barrier.

Questions to ask your prospective agent:

            How long in health insurance business?  Companies represented?
            Will agent help with claims process?  Office staff and hours?

            What is Company size, rating, etc?  How long in health insurance in Ecuador?
            Waiting period for office visits; hospital admission?

Hospital network required. Out of network % covered.

             Underwriting (medical review) requirements?

Guaranteed renewable? (can policy be cancelled

Does policy end or reduce at age 70 or 75?

Residency required?
             Is a separate cancer needed (lifetime coverage, unlimited claims)?

Coverage in US, other countries. At Ecuadorian costs or US

Definition of "reasonable and customary" costs for reimbursement?
Definition of  pre-existing?

Additional International Policy questions:

Maximum limits for major illnesses vs costs in EC and US

Policy issued in US or EC (under EC or US law)

How long is business- in what countries?

Next week:   What coverage did we purchase and why?
                          Salud,     Gary