Small Wins

One of the reasons Mikey and I chose to move to Uruguay was its promise of healthcare for all. At least, that’s what people said—and what the country’s website confidently suggested. As we got further into the process, we learned we’d need to pay into the system for a year since we hadn’t yet contributed taxes. Fair enough.

Then Mikey broke his foot last January, and we discovered there’s a bit more nuance to “healthcare for all.”

To start, Uruguay does, in fact, provide healthcare to citizens, residents, and even guests. You can receive care at no cost. However, it’s largely emergency-based and may require some patience—think a six-hour wait in the ER. But hey, you will be seen and treated… eventually.

On the opposite end of the spectrum is private insurance—think Blue Cross Blue Shield-level coverage. These are the “if you have to ask, you probably can’t afford it” plans. Hospitalized? Expect a private room that rivals a four- or five-star hotel. Care limits? Practically nonexistent.

And then there’s the middle ground: the mutualistas. Not public care, not quite luxury—but definitely a step up. Several companies offer these plans across Uruguay. You can apply by walking into one of their hospitals, at which point they’ll review your application and decide whether you’re worthy. (Nothing like a little suspense with your healthcare.)

The alternative route? Start a small business—yes, really. It can be just you (and optionally one employee), and it doesn’t even need to generate revenue. You pay a monthly tax (called FONASA), which goes into a larger pool that helps cover medical costs when insurance falls short. The upside? If you go this route, a mutualista cannot deny you coverage. Suddenly, entrepreneurship feels very… medicinal.

Mikey and I initially tried applying on our own. That quickly turned into a bureaucratic escape room—one that required a cereal box decoder ring we did not possess (I am sure it is in a landfill in Bristol Connecticut). Thankfully, our friend Blue connected us with Dr. Eli Abad, who helps expats navigate this maze. We had a video call, shared our medical histories, and she gave us the verdict: Mikey—no problem. Me—with bipolar disorder—high likelihood of denial. And even if approved, mental health coverage would likely be excluded for 1 to 2 years.

WTF, indeed.

So, small business it was.

We headed to our local Abitab to start the process. Since I’m the one teaching English as a second language, we registered it under my name. Easy enough. Then we were told to wait a few hours for an email to set up a password.

We waited.
And waited.
And waited.

After a few days, Anna (Dr. Abad’s accountant, who was helping us through this part) followed up. She couldn’t access anything either. We sent texts. Emails. Sky writing (okay, not really). No response.

Three weeks later, Dr. Abad suggested Mikey try registering instead. He went to Abitab, completed the paperwork, turned to leave—and before he even hit the door, got a text from BPS.

Once again… WTF.

Now it was Mikey, Dr. Abad, and Anna finishing the process. One final question remained: would I be listed as a domestic employee or a husband? To declare marriage, we’d need an apostilled certificate from New Mexico—which could take weeks. (Sally, if you’re reading this… we may be calling in a favor.)

On Tuesday, we met Dr. Abad—who is, in fact, awesome—at CASMU, the mutualista we chose. She explained that Mikey could register, but I could not at that time due to our “relationship classification.” Strike.

As Mikey completed his paperwork, I sat off to the side, growing more frustrated by the minute. I was about ready to throw my hands up and walk away. Just one more thing not going our way.

When he finished, Dr. Abad came and sat beside me. She asked how I was doing—and I told her, honestly. She didn’t rush it. She asked thoughtful questions: Why did I leave the U.S.? Was I excited before the move? What had changed? She acknowledged that this transition is hard—and that for someone managing a severe mental health condition, it can be even harder.

She didn’t just hear me. She got it.

That alone was rare.

Later that day, we were notified that I had been listed as a domestic employee. By Wednesday, we were able to register me. As of May 1, we’ll officially have healthcare.

A win—finally.

Now, one genuinely impressive aspect of Uruguay’s system: emergency care. In a major emergency, you call, and they send an ambulance. Sounds standard, right?

But wait—there’s more.

For a relatively low monthly fee, you can enroll in a program where they’ll send an ambulance to your house for less urgent issues. Flu? Sprained ankle? Feeling off? Call them. The ambulance arrives with a driver, a nurse, and a doctor. The doctor evaluates you on the spot. If you need hospital care, they take you. If not, they treat you at home.

Need follow-up care? A nurse comes back. The doctor checks in again.

It’s like Uber Eats—but for healthcare, and significantly more useful.

Now for a slightly darker perk: you can also opt into funeral services. Pay a monthly fee, and it helps cover your funeral costs—burial or cremation. At first, it felt a bit… macabre. But the more I thought about it, the more it made sense. After all, who deals with death regularly? The medical field.

We decided to skip that option—for now. An ambulance staffed with a Latin men showing up at our door felt like the better investment.

Good ROI?
I suppose I’ll have to get back to you on that… eventually.

Thanks for sticking with me to the end. As always—be kind to yourself, and be kind to one another.