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

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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Daniel Arthur

I’m Daniel, an “unconventional” living in Medellín, Colombia, with my Colombian partner. I was born and raised in Southern California. I have a Bachelor of Arts from California State University, Long Beach (1995) and a Master of Science in Higher Education from the University of Miami (2000). I am a former “corporate worker” with 25+ years of experience in finance, banking, wealth planning, and tax.

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