Colombia Information

Colombia is one of the most popular countries in Latin America for expats and digital nomads. It has a modern infrastructure with a low cost of living.

Colombia’s Healthcare System: An Expat’s Guide to Accessibility and Affordability

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In this guest post, U.S. expat Daniel Arthur shares his knowledge of the Colombia healthcare system. Here is his story…

As an expat who moved from the U.S. to Colombia, I understand the anxiety about healthcare in a new country.

I was pleasantly surprised to find Colombia’s system not only accessible and affordable but also offering excellent care.

So, let’s dive into the details below. By the end of this article, I hope you’ll have a foundation for understanding the healthcare available in Colombia before you move!

Setting The Preliminaries

This article is designed for full-time expats living in Colombia on a migrant (M Visa) or resident (R Visa) visa and enrolled in Colombia’s EPS (public healthcare) scheme, which I will discuss below in greater detail.

The coverage and system discussed herein do not apply to tourists, visitors, and those on temporary visas. If you are “slow traveling” or vacationing here on a temporary visa issued solely by your passport, you are not eligible for any of these benefits.

Furthermore, as of October 22, 2022, those maintaining ANY Retirement Visas will no longer be eligible to enroll in the EPS system. Retirement Visa holders must maintain a separate Colombian prepegada (private) or a global international medical plan that covers them for the entirety of their visa term in Colombia.

It isn’t entirely clear whether those who received their Retirement Visa before the change in law will be “grandfathered” or continue their EPS coverage, so when your renewal comes up, always consult an immigration lawyer about current requirements. Laws, regulations, administrative procedures, and policies change regularly, sometimes with little or no transparent communication to the public.

I applied for my first M Spousal Visa from the Orlando Consulate in June 2022, moved here full-time in November 2022, and enrolled in SURA EPS as a beneficiary of my Colombian spouse. His SURA EPS premium payments are coordinated by his employer, who deducts our premiums through monthly payroll deductions and remits them to SURA on our behalf.

I just completed my M Spousal Visa renewal in May 2024 from Medellín, and with the renewal, I maintained my current SURA EPS with no lapse in coverage.

My situation is very different from most expats. Since I’m my spouse’s beneficiary, I’m not required to register with EPS as a contributor (and remit my premium payments directly to EPS). I’m not employed or have a regular income source, so I’m enrolled as a beneficiary.

Most expats and retirees must register directly with EPS and pay their monthly premiums to the EPS provider (unless they are employed by a Colombian company OR listed on their spouse’s plan as a beneficiary).

So what is EPS, prepegada, SURA?  I will expand on all of this below.

Understanding Colombia’s Two-Tiered System

Colombia’s approach to healthcare is a clever blend that ensures coverage for everyone in the country.

I’ll break down and explain the two main tiers below:

Régimen Contributivo (Contributory System): If you’re living and employed in Colombia, you’ll most likely fall under this system. Think of it like employer-provided insurance in the US in comparison. You and your employer make contributions, and this funds your healthcare needs.

Régimen Subsidiado (Subsidized System): The government steps in for those who are unemployed, low-income, or part of vulnerable populations. It’s Colombia’s equivalent to Medicaid or Medicare.

Regardless of your tier, the key players are the EPS providers –  your chosen health insurance provider.  Think back to the days of HMOs in the U.S.

They are your managed care plan – a medical clinic or group consisting of your primary care doctor who is an employee of the HMO (often owned by the HMO insurance provider, like Kaiser Permanente, for example).

Your EPS primary care physician coordinates, oversees, and manages your medical care, including referrals to specialists, outpatient referrals for procedures & labs, and writing prescriptions.

Well-known options include SURA, Nueva EPS, Mutual Ser, and Sanitas.  You can choose your EPS provider, although the choice is limited to the providers servicing your city.

Universal Coverage and What You Get

Near-universal coverage (around 95%!) is one of Colombia’s greatest healthcare triumphs. Both the contributory and subsidized systems offer the same comprehensive benefits:

  • Doctor’s visits (general practitioners and specialists)
  • Hospitalizations and procedures
  • Diagnostic testing (lab work, X-rays, etc.)
  • Medications
  • Preventative care (checkups, screenings)
  • Dental and vision care

Affordability: A Major Plus for Expats

Like the U.S. Medicare and Medicaid systems, the Colombian public EPS scheme provides essential, necessary, and critical care to those without insurance or who cannot afford a comprehensive medical policy and a system laced with bureaucracy. Contribution rates to your EPS are income-based, and the subsidized system is there for those who genuinely need it.

I can’t overstate the affordability of healthcare here. Compared to the US, it’s a breath of fresh air!

I paid cash (did not utilize EPS or insurance) to a top-notch dental facility with English-speaking doctors and staff to clean my teeth. The total cost to see the dentist for the exam and have the hygienist clean my teeth was $43.00!  Similarly, a visit to an English-speaking doctor trained in Texas for my annual physical was only $58.00!

Cash-pay patients can be advantageous in Colombia to avoid the EPS bureaucracy, just like in the U.S.

Since most people utilize some sort of insurance for their medical expenses here in Colombia, the insurance companies, in effect, dictate the level, quality, and type of care you receive. Their goal is motivated by profit and profit margin and reducing their overall expenses. Therefore, they approve the least costly treatment plan, not necessarily the doctor’s prescribed or preferred medical care for the patient.

Paying cash directly to a provider during service eliminates the “insurance red tape.” The provider can provide more efficient, quicker, and better-quality care without them or the patient fighting with insurance companies to get the care they need.  Sound familiar?  It is, for those of us from the U.S.

The costs are manageable and reasonable, even if you initially use private clinics or pay out-of-pocket before securing residency.

Quality of Care: It Surpassed My Expectations

Colombia invests significantly in hospitals and clinics, resulting in modern facilities nationwide. Doctors here are incredibly well-trained, often completing part of their education abroad, and are usually multilingual.

Finding fluent English speakers amongst your physicians, especially in larger cities, will be relatively easy.  Conversely, more rural towns tend to have only Spanish-speaking professionals across all sectors (not just healthcare). Consider your current language level when moving abroad.

Those not fortunate enough to live in a city with an English-speaking doctor can always bring a trusted friend or family member who speaks Spanish—especially advantageous if your friend or family member is a native Colombian!

Lastly, patients who do not “self-advocate” for themselves will inevitably receive lower-quality care and be subject to being taken advantage of, rather than those who do advocate for themselves, research all options, and are mindful of the expectations, policies, and nuances of the system, BEFORE they step into a clinic or hospital.

Challenges: What Expats Should Know

No system is perfect, and here’s where expats should be mindful:

Rural Disparities: Access to care can become trickier in remote regions. If you plan to move to a rural area, research local healthcare availability.

Wait Times: The public system sometimes has longer wait times for non-urgent procedures.

Bureaucracy: There is bureaucracy to navigate, but it gets easier once you understand how things work.  My SURA EPS is full of bureaucracy, especially when filling prescriptions for maintenance medications.

Private Insurance: A Supplement Worth Considering

While the EPS system is excellent, private health insurance can be an intelligent add-on, especially if you want to maintain your choice of doctors, enjoy faster service for non-urgent needs, and are relatively healthy.

The private system in Colombia, known as prepegado (prepaid or private), is similar to private insurance and employer-sponsored plans in the U.S.

The significant difference for prepegadas relative to U.S. employer-sponsored plans is that U.S. employer plans are required to offer a “guaranteed issuance without medical underwriting clause.” In contrast, Colombian individual prepegado and employer-sponsored prepegado plans require the insured to undergo medical underwriting.

What do we mean by this?  Colombia does not have laws guaranteeing policy issuance for those with pre-existing or chronic conditions.

If you have a complex medical history, be prepared for intense medical underwriting by the insurer, which likely results in denial of coverage.  Those offered a plan expect higher premiums to cover chronic or preexisting conditions.

Navigating the System as an Expat

As a non-resident, you may need to pay for some services out-of-pocket initially. Once you obtain your residency visa and cédula (national ID), you can join an EPS if it is still available.

Ask other expats in your area for recommendations, and remember that your EPS can help arrange doctor visits, prescriptions, and more.

Don’t be afraid to ask questions—most Colombians are friendly and willing to assist. If your Spanish is fluent, the actual EPS entities and your private insurer can also help!

Final Thoughts

Colombia’s healthcare system is a success story, especially considering its affordability. Consider Colombia as an expat destination, knowing that the system will manage and meet your healthcare needs at a surprisingly low cost with an excellent quality of care and where you will find professionals and people to help support you along your way!

AUTHOR’S DISCLOSURE: The topics discussed in this article contain accurate information at the time of publication, are for informational purposes only, and are based on my experience(s). The Colombian government regulates immigration, healthcare, and tax law. You should consult a licensed attorney and tax accountant before acting on the above article and its contents.

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Working Remotely From Colombia – A Perspective From A New Expat

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In this guest post, Daniel Arthur shares his journey from office job to remote worker, which allows him to live his Unconventional Life in Colombia. Here is his story…

My remote work journey began long ago, several years into my career, and shortly after graduating from college. I’ve been working remotely for over twenty years, long before it became popular.

Back then, there were only three options for folks who wanted to work from home. They consisted of people who owned their businesses or were self-employed, freelancers, or W-2 wage-earning employees who worked for companies who valued their employee’s contributions to the company, invested in their success and career trajectory, and were sensitive to their employee’s overall quality of life.

I was very fortunate to convince my employer back in 2007 to agree to this arrangement. My experience could be a model for current and future expats wishing to work abroad.

This article consists of my experiences (and success) in approaching my employer with a solid business and action plan to grant my request to work remotely 100% of the time.

Establish Location Independence Before Moving Abroad

Medellin ParkI have worked remotely since 2007 in the U.S. and now in Medellín.

My professional career has lent itself to “remotability” while not tying me to a particular location, even in the finance and banking profession, where customer relationship management and interaction primarily represent 80% of one’s daily job function and duties.

I never liked going to the office and only did it for the first ten years of my career. I dreaded the Southern California commuter freeway and traffic, the stress associated with getting out of bed three hours before my start time, rushing out the door, the office politics, the “cliques” that were in the office, having my boss or others standing over my shoulder while I worked, etc.

Over a long holiday weekend back at the end of 2006 as I sat on the sofa watching TV – dreading going to work the following Tuesday. I knew I had to begin developing a plan to present to my leadership that would allow me to work from home 100% of the time.

Establishing location independence as early as possible in your tenure with a company is the key for many expats desiring to work remotely abroad.

Furthermore, domestic stateside employees can benefit too from approaching their employer and manager about flexible work arrangements as soon as the right opportunity presents itself (no later than a year into your employment with the company –I waited for nine to do so –but I believe more employers are open to at least entertaining a conversation now about the topic of remote work).

Find or Have Your Employer Support Before You Move

Remote work in a cafeEngaging your employer in an initial discussion before committing to expat life is critical.

If you intend to keep your current job and be successful, you want their support and agreement, and this might involve a difficult discussion with your direct manager, who may or may not be willing to work with you.

Working for finance banking remotely was virtually unheard of, and management’s primary concern was it involved adverse risk to the company, especially in handling and potential exposure of customer information that I had access to.

It took me over a year of planning and creating a proposal with my manager and over nine months later for risk management, legal, and human resources to convince my company to approve my remote work arrangements.

I worked with my manager in drafting my proposal because involving them, in the beginning, was critically important. You want your manager to be your ally and advocate because they will directly evaluate your work and performance off-site.

Suppose you don’t believe your manager will support your desire for permanent remote work arrangements and location independence. In that case, you should strengthen your relationship with your manager and leadership team before moving abroad.

Engage The Assistance of A Legal and Tax Professional

TaxesBefore moving to Medellín late last year, I engaged a competent immigration attorney and tax professional.

While not required, hiring dual-licensed professionals in both your home country and your intended destination country is highly encouraged.

I lived in Florida before moving to Colombia, so running a Google search for local professionals in my area was a relatively simple process.

I shared my long-term goals and plans with the professionals I hired and sought their advice on remote work, nomad life, and the appropriate legal and tax strategies I needed to have in place before boarding the plane.

While my situation was pretty straightforward (being married to a Colombian national), both professionals recommended that I maintain tax residency in the U.S.

My tax advisor, in particular, noted that both countries tax worldwide income, both countries require personal income tax returns filings with the IRS and DIAN, and both allow deductions for foreign income earned abroad; I would still maintain my eligibility to collect Social Security upon retirement in the U.S.

Plan For The Unexpected To Happen At Any Time With Your Remote Job

I don’t have the same remote job as when I moved to Medellín last year. This past April, I became the latest victim of corporate downsizing and was told over a Zoom call that my job was now redundant.

I had anticipated this scenario could happen several years before I decided to move abroad. Given in the last year that many companies were downsizing, this became even more relevant. Despite the current state of the economy, I was confident I had built up my skills and abilities over the years into new possibilities.

The next day after that Zoom call, I immediately began seeking freelance opportunities by contacting my network and offering my service. I pitched several consulting gigs and received two offers, which I immediately accepted.

Years prior, I had implemented a solid savings and investments strategy that was firmly in place. I turned to other ideas to generate income should I ever become unemployed at any point in my career (i.e., backup plan, savings, investments, passive income streams, etc.).

Final Thoughts

I’m blessed beyond measure to be able to work remotely for over ten years. At age 47, I’m proud of my professional accomplishments, and a large part of my success is directly related to the opportunity and confidence of my leader to work remotely many moons ago.

Despite being laid off within a short time of moving abroad, I’m confident that the time I invested in the above long-term strategies has helped me tremendously.

I would encourage anyone who has ever dreamed of moving abroad to forge ahead and turn their dream into a reality. With the proper support in place, anything is possible.

You can read about my transition from Orlando to Medellín, living abroad for the first time, and find out more about me by visiting my Medium page by clicking here.

My Unconventional Marriage In Colombia: Celebrating Marriage Across Borders

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In this guest post from Daniel Arthur, he recounts his marriage to a Colombian and the process for a gay couple to get married in Colombia. Here is their story…

In September 2017, I met my lifelong partner in the most unconventional way. We met online through a language-learning mobile app called Tandem.

I suppose it isn’t unconventional to meet someone online, especially in these times! Many successful couples have met online, formed an immediate connection, and subsequently married four years later.

We took the conservative approach to marriage in the beginning. About the three-year mark in our relationship, we contemplated marriage. We decided to delay it to allow us to complete our academic endeavors. I was finishing my Master’s while my partner was completing his Bachelor’s.

What Made Our Marriage “Unconventional”?

View of Medellin Colombia cityscape with blue sky and a few white clouds.Two compelling reasons come to mind. We are a same-sex couple who are married and living together in Medellín, Colombia, and we successfully married during the worldwide COVID-19 pandemic.

The uncertainty of the pandemic made us ever more cautious, nervous, and anxious. Our primary concern was how potential notarías would treat us or if they would even perform the marriage.

While we are a confident and loving gay couple, we were mindful that marrying in a predominantly conservative and Catholic country could inevitably present challenges.

Planning, Logistics, and Documents

Colombia has no national standards and guidelines for marriage. The notaría, religious minister, or priest has sole discretion in determining the requirements and what documents they accept. All couples, both same-sex and heterosexual, face this challenge, regardless of the sexual orientation of the parties.

We married in my partner’s hometown of Barranquilla. It wasn’t our first choice (we wanted to marry in Medellín), but having contacted several notarías in Medellín, all of them referred us back to a notaría in my partner’s birthplace.

After researching, calling around, and gathering information, we chose Notaría Primera de Barranquilla. He was the only notaría in the city who met our timeline requirements and was willing to marry a same-sex couple.

We met with his staff in July 2021, where they collected our documents, explained the process, and set our date.

Our notaría required we meet the following requirements and provide the following documents:

  1. Provide a photocopy of my U.S. Passport data page with six months of validity remaining.
  2. Provide a certified copy of my U.S. Birth Certificate from the State of California apostilled within three months of our marriage date, accompanied by a Spanish translation. The translation was required to be done by a Colombian translator residing in Colombia.
  3. Provide a Single Status Affidavit issued from the State of Florida apostilled within three months of our marriage date, accompanied by a Spanish translation. The translation was required to be done by a Colombian translator residing in Colombia.
  4. Provide a notarized copy of my Colombian partner’s Cédula de Ciudadanía (national I.D. card)
  5. Provide a notarized long-form copy of my partner’s Registro de Nacimiento (birth certificate) issued within three months of our marriage date. Note: Colombian Registro de Nacimiento comes in long and short form. Notariás require an extended long-form for marriage.

In addition to submitting the required documents, we had to complete a marriage license application, pay a fee of approximately 200,000 COP, supply our fingerprints, and have our photo taken at the office.

Our Wedding Day

View of Barranquilla Colombia cityscape at sunset.

The day began like any other. We awoke to blue skies and a pleasant day in Barranquilla. The weather was perfect — not too hot, not too cold, no rain, and no humidity.

Notarías in Colombia tend to designate one day a week for marriages & ceremonies. Our ceremony was on a Saturday. We were the first couple on his schedule at 10 a.m. We arrived about ten minutes before the scheduled time.

Due to the pandemic, the notaría limited us to four individuals who could attend. We were told in advance by the notaría of this política (policy). We had two of our attendees crank open their iPhones. They streamed our wedding ceremony live on WhatsApp and FaceTime for the rest of our friends and relatives to watch.

Civil ceremonies in Colombia are very similar to those in the U.S. The notaría introduces the couple to the attendees, the couple takes an oath, and finally, vows taken by the couple. The ceremony was less than an hour in length.

After the ceremony, we went to brunch with our guests at a local cafe near the notaría’s office. We feasted on a wine, cheese, and meat platter as our entrada (appetizer). The main course consisted of eggs, bacon, french toast, pancakes, waffles, and fruit. We were “stuffed” and “satisfied” afterward!

Final Thoughts…

We were glad we decided to get married when we did. It was never our intention to have an extravagant wedding. We promised to keep our budget to within $5,000 or less. The COVID precautions and limitations in place helped us achieve this objective, with both of us having large families.

View of El Poblado Medellin Colombia cityscape.Although we would spend one more year apart (my lease in Orlando expired the following November), the one-year gap gave us plenty of time to plan our relocation to Medellín.

As of November 2022, we reside full-time in Medellín in barrio Laureles and couldn’t be happier.

You can read about my transition from Orlando to Medellín, living abroad for the first time, and find out more about me by visiting my Medium page by clicking here.