Colombia has a two-tier system, consisting of:

• Entidadas Promotoras de Salud (EPS): mandatory public health insurance, offered by a number of insurance companies
• SISBEN: a free government subsidized healthcare system, which is only for poor or homeless Colombians and will not apply to you as an expat
• Prepagada: private health insurance

EPS is funded partly from payroll contributions, so if you are working in Colombia you will be entitled to public healthcare if you are paying into the system, but it is open to everyone with a Cédula de Extranjeria (local ID) and does not exclude anyone on the basis of age or pre-existing conditions. It is compulsory, so you will not be able to opt out.

Colombian public healthcare is generally considered to be of an excellent standard. The WHO ranks Colombia 22nd out of 191 countries listed, ranking higher than the US, Germany, Canada and Australia, and reports that it has the best healthcare in South America.

Colombia also has 18 of the highest ranked public hospitals (of 44 listed) in South America. However, because of the size of its patient pool, its public healthcare is overcrowded and you may experience lengthy waiting times, both for primary care and for specialist treatment.

If you are a temporary and permanent resident with a cédula, you will be eligible: your cédula is the key which will allow you to do a range of things in Colombia, from signing up for health insurance to opening a bank account.

To obtain a cédula, you will need to make an appointment with Colombian immigration (Migración Colombia) within 15 days of your arrival in the country: you can make the appointment online but you must attend it in person as you will need to have your fingerprints taken. Expats have described this as a relatively straightforward process. You will need to take with you:

• original passport with your original visa
• photocopy of your blood test showing your blood type if this is your first cédula
• photocopy of the data page of your passport
• photocopy of your visa

The cost of the cédula is 196,000 pesos ($58 USD).

Once you have your cédula, you will be able to register for health insurance under the EPS.

Your employer is obligated to register you with the EPS, but make sure that this has been done. If you are self employed and have a cédula, you can sign yourself up. There are various providers, of which SURA, with around 400 hospitals, is the most popular.

Once you are registered you will be signed up with an IPS (Instituto Prestador de Salud), a local health center which will be your primary care provider.

The state health system is comprehensive, covering primary, hospital and specialist care. You may need to make a small co-payment, which will be lower than the Prepagada co-payments (lower than US$10 for a GP’s appointment, for instance, or $16 for emergency care).

You will be covered by state medical insurance as a retiree if you have a cédula. You will need to make contributions into the scheme, which are comprised of 12% of your declared pension income. Expat retirees report having to pay a monthly average of US$70-85.

Medellín, in particular, is fast becoming a popular retirement destination and you will find a number of providers who are bilingual and accustomed to dealing with expats, and medical institutions who are familiar with international health insurance.

If you are a US veteran, Healthcare Colombia (in Sabaneta, near Medellín) has recently opened a clinic offering specialized healthcare services to help US veterans in Colombia with healthcare services and filing benefits claims with the VA in the USA.

As an international student, it is advisable to take out private insurance to cover your stay in Colombia. Contact your educational institution to see if they have in-house cover or can recommend an affiliated insurer.

Your dependents will also need cédulas, but once they have one, they will be able to access the public healthcare system. In addition, they can simply be added to your EPS plan. This includes:

• spouse or permanent partner
• children under 18 years old
• children between 18 and 25 years old, if they are financially dependent on you

The EPS covers both dental and optical care. EPS plans include dental insurance.

Your contributions for EPS will be deducted from payroll. The monthly premium is based on 12.5% of the monthly gross income that you declare to the EPS.

Public healthcare is good but overstretched, with long waiting times. It can take several months to see a specialist, in contrast to 48 hours in the private system, and you do not have to have a referral from your GP. You can also seek treatment out of network, which will not be the case with EPS insurance. In addition, some EPS insurers have proved unreliable and have run into financial difficulties: Saludcoop EPS, for instance, had to be liquidated in 2016.

Since the public system has some limitations, even though EPS coverage is compulsory, expats may choose to take out international health insurance, or local cover in the form of Prepagada, in which case your insurance will be provided by a private network of health care providers and facilities.

The excellent standard of healthcare in Colombia, plus the cost of medical treatment – which is substantially lower than in the USA – has meant that the country has become a destination for medical tourism, with cosmetic surgery, dental care and corrective eye treatment coming top of the list.

Prepagada or independent international cover has a number of advantages:

• a GP’s referral is not needed for specialist appointments, diagnostics, or procedures. You can call directly to schedule an appointment
• no waiting time
• preferential treatment such as private rooms
• Prepagada (and other policies) may include travel insurance for up to 90 days on each trip
• Prepagada is also available as a supplemental policy to EPS, and offers expanded coverage of specialists and hospitals, allowing for a number of treatment and location options

One independent insurance broker has described it as analogous to travelling in first class. However, if you are considering the Prepagada itself, discuss this thoroughly with your insurance broker as you may find that it has restrictions with regard to age or some pre-existing conditions.

Prepagada plans have no deductibles but do have small copayments. Your premiums (for an average 40-60 year old) are likely to be in the region of US$150-275, and copayments vary.

You only need a passport to take out Prepagada plans, and you do not need a cédula.

Prepagada premiums are divided into age brackets: from age 0-14, 14 to 40, 40 to 60 and 60 and up. For a 60-year-old, for example, SURA’s Prepagada premium is approximately 800,000 pesos ($277 USD) per month.

Both international and local providers cover Colombia, including:

• Allianz
• AXA
• Cigna
• Expat Financial
• Foyer Global Health
• Pacific Prime

EPS insurance is offered by many providers, including:

• Aliansalud EPS
• Compensar EPS
• Nueva EPS
• Salud Total EPS
• Sánitas EPS
• SURA EPS

Cédula de Extranjeria – Colombian ID card

Entidadas Promotoras de Salud (EPS) - public health insurance

Instituto Prestador de Salud - local health center

Prepagada - private health insurance

SISBEN – free government subsidized healthcare

Colombia is a Spanish-speaking country and some local EPS insurers, such as SURA, have application forms in Spanish only. Some expats therefore choose to register through a bilingual broker.