If you are buying private cover here at 65, the price is not your main problem. The underwriting is. An Ecuadorian private policy is medically underwritten, priced by age band, and written with exclusions that are specific to you rather than generic — so the answer to “what does it cost” is genuinely unknowable until an insurer has read your history, and any page that gives you a figure is describing somebody else.
That is an unsatisfying sentence and it is the true one. What this post can do is tell you what moves the price, what the exclusions actually do, which questions get you a usable answer, and when the honest call is not to buy at all.
Checked 4 September 2026.
Why nobody can quote you without asking
Three variables set the number, and you control exactly one of them.
Age band. Premiums step up in bands, and the steps get steeper with each one. This is the single largest factor and it is the reason the same policy is a different product at 55, 65 and 72. It is also why when you buy matters: entering the market younger, and staying continuously insured, is worth more than shopping hard later.
Medical history. You will complete a health declaration, and it will be read. This is ordinary private insurance behaviour, not an Ecuadorian peculiarity, but it lands hard on this site’s median reader — somebody arriving at 60-plus with something already on the file.
The hospital tier. Policies are sold with a network, and the network is the product. A policy that gives you the private hospitals you would actually choose costs more than one that does not. Ask which hospitals, by name, before you compare two prices — two quotes with different networks are not comparable numbers. Which hospital does what in Cuenca is the post to read alongside a quote.
The one you control is when you buy and how long you stay covered. That is not nothing, but it is mostly a decision you make once.
What “exclusion” means here, in practice
An exclusion is not a discount. It means the policy does not pay for that thing, and if that thing is the reason you wanted the policy, the policy is decorative.
The exclusions that matter to somebody arriving in their sixties are the ones attached to conditions you already have. These are not usually blanket refusals; more often the insurer issues the policy with a named exclusion, or with a waiting period before that condition is covered, or with a loading on the premium. All three are normal. Which one you get is underwriting, and it is decided on your file rather than by a rule you can look up.
Get every one of them in writing, listed, before you pay. Not described on a phone call. Listed, in the policy document, with the wording. The failure I have watched most often is somebody who was told “that’s fine” verbally and discovered a named exclusion at the point of claiming, which is the worst possible moment to be reading your own policy for the first time.
The Spanish to ask for is: "¿Me puede enviar por escrito las exclusiones y los periodos de carencia que aplican a mi póliza, con mi declaración de salud?" — “Can you send me in writing the exclusions and waiting periods that apply to my policy, with my health declaration?”
If the answer is anything other than a document, you have your answer about that insurer.
Two other categories worth asking about directly rather than assuming: what happens on renewal — whether a condition that develops while you are insured can be excluded at the next renewal, and whether the premium can be re-rated individually — and the annual and lifetime caps, which are the difference between a policy that covers a catastrophe and one that covers part of a catastrophe.
The comparison that actually decides it
The choice is almost never “private policy or nothing”. Once you hold a cédula it is a choice between three positions, and the third one is the one people forget to price.
IESS alone. Costs nothing to join, applies a contribution calculated from a figure you declare, and — the point that matters here — does not underwrite you on the way in. The public system does not read your history and price you. For somebody with a significant pre-existing condition, that single property can outweigh everything a private policy offers. The affiliation itself is one online session, and the difference between the two systems on this exact point is its own post.
IESS plus private. The common answer for people who can afford it: the public system as the floor, the private policy for speed and for the hospitals you would choose.
IESS plus cash. Underrated, and a real strategy rather than a fallback. Routine private care here is priced in a way that makes paying out of pocket viable, so some residents carry IESS, pay cash for consultations and diagnostics, and hold no private policy at all — accepting that a catastrophic event would be met by IESS and by savings.
Which of the three is right is an arithmetic question about your own numbers, and it turns on one thing: how much of the private premium is buying speed you will use, versus catastrophe cover you already have through IESS. If you are healthy and patient, position three is defensible. If you have a condition needing regular specialist attention and you cannot tolerate a queue, position two is what you are paying for and it is worth it.
I am not going to tell you which. I will tell you that the people I know here who are happiest with their private policy are the ones who bought it for a specific, named reason, and the ones who resent it are the ones who bought it as a general precaution and then used IESS anyway.
Before you pay, get these seven answers in writing
- The premium, by age band, and what it becomes at the next band — not just this year’s figure.
- The exclusions on your file, named, after underwriting rather than before.
- The waiting periods, per condition and in general.
- The hospital network, by name, and whether it includes the hospital you would choose in an emergency.
- The annual and lifetime caps.
- Whether renewal is guaranteed, and whether the premium can be re-rated for you individually rather than for the whole band.
- What happens if you leave Ecuador for an extended trip — this catches people who go home for three months a year. The absence question has a residency side too.
Any broker who cannot produce those seven is not saving you work; they are deferring it to the day you claim.
When the answer is don’t
There is a version of this where the honest advice is to skip the private policy, and no insurer or facilitator will ever give it to you, so it goes here.
If the underwriting excludes the one condition you were insuring against, the policy is not solving your problem. Take the exclusion letter, price the cash cost of managing that condition here, and compare it against the premium. Sometimes the premium is simply worse.
If you are healthy, patient, and hold reserves, IESS plus cash is a coherent plan and not a compromise. A great many long-stayers here run it.
If the quote is only affordable at a network that excludes the hospital you would actually want, you are buying a document rather than access.
And the one that is not about money: if you are 68 and the decision is keeping you awake, buy the policy. Sleeping is worth a premium and the arithmetic does not have to win every argument.
What this does not cover
Nothing here is advice about your home country’s system, and one mechanical fact belongs in that sentence rather than in a comparison table: Medicare does not pay for care in Ecuador. What that means, mechanically and no further is a later post, and what to do about it is a question for your own adviser.
This is also not medical advice, and no part of the underwriting conversation should be had by guessing what your history means. Declare everything. A policy voided for non-disclosure is worse than no policy, and it is the one outcome on this page that is entirely avoidable.
Sources
- IESS, Seguro de Salud — the published description of coverage for the insured and their family, read 4 September 2026.
- gob.ec, IESS trámite Afiliación voluntaria de personas domiciliadas en el exterior y dentro del país — the cédula requirement and the contribution calculated from a declared monthly figure, read 4 September 2026.
No premium, age-band price or exclusion list is quoted above from any named insurer. Those are set on your own file by underwriting, they change annually, and a figure printed here would be a figure about a person who is not you.