January 2024 update: We have learned from our attorney that new expats who are awarded the “M” (for Migrant) visa are no longer eligible to sign up for Colombia’s EPS healthcare system. People like us, who already hold M visas, are allowed to stay enrolled. We don’t know the status for other types of visas; best to talk to an immigration attorney to find out.
Healthcare was a big motivator for us to become expats.
When we first started germinating the idea of retiring outside the U.S. (at least 15 years ago), we weren’t yet at an age where we needed a lot of healthcare services. But we knew that day would come – and we had no faith (we still don’t) that the U.S. would ever adopt a universal and affordable healthcare system like basically the rest of the developed world.
But why Colombia? As our adopted home for five years now, this country ticks many of our boxes – not the least of which is its excellent, affordable healthcare system. The WHO has ranked Colombia’s health system above Canada, Australia, and the U.S. for metrics such as affordability, accessibility, and quality of care. The system is considered the best in Central and South America, and it’s improving every year. In fact, 26 of Latin America’s best hospitals are located in Colombia, according to a 2021 ranking by América Economía. Many physicians are multilingual, and there are growing numbers of clinics specializing in serving the foreign market. As such, Colombia is gaining a reputation for medical tourism including transplant surgeries, dental work, and cosmetic procedures.
Here’s an interesting article about how Colombia weathered the COVID-19 crisis (very well) and what lies ahead for the healthcare system here:
It’s taken a bit of patience and a pile of trial and error, but we finally feel we have the Colombian healthcare system wired (mas o menos!). This post has a lot of detail, but we’re gearing it towards new Colombian expats (or the expat-curious) who may not be sure exactly where to start. In other words, this is information we wish we’d had when we first moved here! Of course, this is our experience, and your mileage may vary.
Colombia healthcare basics
Entidades Promotoras de Salud (EPS) is Colombia’s national healthcare system, funded by the government. More than 97% of citizens and legal residents (including resident foreigners like us) are enrolled in EPS – the very definition of universal healthcare. EPS is delivered through contracts with several private insurance companies, the largest and most highly rated of which is SURA. Like the other providers, SURA operates several of its own facilities and contracts health care services out to other private clinics and hospitals. As resident foreigners, we chose SURA.
EPS is the mandatory basic-level system, available to everyone. But in addition, residents can purchase complementary plans that offer additional benefits. John and I are enrolled in a SURA complementary plan called 60+ (because it’s tailored to old farts like us). This gives us several extra benefits that aren’t available with basic EPS: direct access to certain specialists, a private room if we need to be hospitalized, and emergency in-home care, should we ever need it. There’s also another layer called planes prepagados (prepaid plans), which is basically private health insurance that can be purchased by anyone, resident or not. The prepaid plans vary widely according to age, pre-existing conditions, and scope of coverage. They tend to be more expensive because they give patients the latitude to go to doctors and healthcare facilities of their choice.
Finally, everyone has the option of going outside the system and paying out of pocket to visit a private doctor. We’ve done it a few times, and the biggest reason is that it can sometimes take weeks or even months to get an appointment with a SURA specialist. Even the private doctors are inexpensive (the average cost of a private consult is $30-$50 US).
Our favorite things About Colombia’s healthcare system
The doctors are very hands-on. A typical office visit goes like this: The doctor comes out to greet you, and then you sit at his/her desk while he/she (not a nurse) takes your medical history and asks questions. Then the doctor (not a nurse) takes your vitals and does any other necessary examining. We have never felt rushed by any doctor, SURA or private – they take the time it takes to get a complete understanding of your complaint and how to address it. Many of the doctors we’ve seen have shared their email addresses and even private WhatsApp numbers, in case we had questions later.
Also, many of the doctors speak some level of English (particularly the specialists, who are required to study English in medical school).
Appointments are punctual and streamlined. There’s usually no waiting (and waiting, and waiting) for an appointment to begin; in fact, we’ve learned that if we show up early, we might be seen early. And there’s no sitting in the waiting room filling out reams and reams of HIPAA forms and other paperwork.
Dental and vision care are covered. One thing we think is crazy about the U.S. system is dental care, which is treated separately from regular healthcare and requires a separate and costly insurance policy. In Colombia, both dental and vision care are part of the regular SURA service. It’s an example of the holistic approach that healthcare providers take here.
Care is very accessible. We don’t have to drive far to reach world-class clinics and hospitals. And things are now even more convenient with the opening of two SURA clinics right here in our town, El Retiro. They’re small, but they can handle minor emergencies, routine doctor visits, and lab work. They even offer dentistry (which will come in handy next time John loses a crown!).
Quality of care is excellent. We have no complaints. The SURA doctors are thorough, follow through on their commitments, and offer comprehensive and effective treatment plans. The clinics are as clean and modern as anything we’ve seen in the U.S., and the equipment is the state of the art.
Test results are available within a day or two (with a couple of exceptions) and they’re automatically sent to patients via email, text, or both. It’s also easy to download test results from the SURA website.
Most medications are available over the counter and at a very low cost. Example: I can walk into any pharmacy, anywhere, and buy a three-month supply of my thyroid medication for about $20 (that’s about a third of the price for the generic drug in the U.S.). It would be even less if we used the SURA pharmacies (but they’re kind of a hassle and put a limit on refills).
Our not-so-favorite things
Preventative care takes some legwork. There really is no concept here of a primary care physician who coordinates every aspect of a patient’s care, and preventive medicine really isn’t a thing. It’s on us to get orders approved for things like routine mammograms (orders usually require a visit to the SURA general medicine doctor). Then it’s on us to go out and get the test scheduled and done. When test results are ready, they’re sent to the patient, not the doctor – and it’s on us to make an appointment with the doctor to discuss the results. The flip side: Taking ownership of your health is a good thing, we believe!
Making appointments can be challenging, especially if you’re not fluent in Spanish. I’ve gotten pretty good at making appointments over the phone (since the basic vocabulary is always the same), but it’s always an adventure. The good news is that more providers are now offering automated appointment systems online or through WhatsApp. It’s fast and easy, for instance, to get an appointment with a general medicine doctor on the SURA web portal.
Seeing a SURA specialist has some red tape and can take a while. Unless you have a complementary plan, you have to get a referral from a SURA general medicine doctor first. Example: When I was first diagnosed with hyperthyroidism, I had to visit the SURA doctor for a referral to an endocrinologist. And then I found there were no open appointments for at least four months! I couldn’t wait that long, so I went instead to a private endocrinologist (he saw me the following week) for about $40. Although our SURA 60+ complementary plan allows us to make appointments directly with specialists, the list is pretty limited (no endocrinology or gynecology, for instance). I guess they figure old ladies don’t need gynecology!
And here’s another wrinkle. Let’s say the private specialist orders up some lab work. Unless you want to pay for those tests out of pocket at a private lab, you have to go to the SURA doctor to get orders. Sometimes SURA denies the order if not enough time has elapsed since the last test. More than once, I’ve had to pay out of pocket at a private lab for testing my endocrinologist wanted. It’s still really inexpensive – a thyroid ultrasound cost about $35, and an extensive round of blood work was about $40.
The SURA computer system is a mystery. There are at least two different portals for accessing SURA services, and their data are not always in sync. Plus, there does not seem to be a universal electronic medical record. Every time we visit a SURA doc, we can count on spending some long minutes sitting at the desk while he/she types in our history info. The same info we gave last time. If it’s tedious for us, I’m sure it’s no treat for the doctors!
What about major health crises?
John and I are fortunate – we’re relatively healthy and (so far) have not had major medical emergencies or surgery in Colombia (cue the loud knocking on wood!). But here’s an anecdotal story from our friend Byron, a former SURA EPS member. In 2018, he and his wife Mariah moved from Panama to Medellin just a few months before we did. And then a scary thing happened (in his own words):
“My heart attack in January 2018 landed me in Pablo Tobón Uribe hospital, the only Joint Commission hospital in Medellin. We had SURA EPS at the time. After my ER visit, a stent placement, four nights in an ICU, and a night on a step-down floor, plus all meds, food, nursing care, and attention, at checkout we were handed a co-pay bill of, wait for it, $5.00 US. (Not a typo) Five bucks. And the medical care was world-class.”
The upshot is that we know we can walk into any emergency room in Colombia and know we’ll be covered by SURA. Pretty reassuring!
Here’s the part you’re probably waiting for. What do we pay?
Residents pay for EPS on a sliding scale, based on income. For us, that’s about $100 US a month (with slight variations according to the exchange rate). Occasionally there will be a copay for a SURA doctor visit or lab test, but it’s never more than about $1.50.
Here’s a partial listing of stuff we’ve had done through SURA EPS, at no additional charge:
- Numerous visits to the general medicine docs
- Colonoscopies for both of us and endoscopy for John
- ER visit for me when I broke my ankle (yes, it was FREE!)
- Vision exams (frames cost extra but are discounted)
- Dental exams and cleaning
- Visits to a GI doctor, orthopedist, dermatologist, ENT doc, and general surgeon (to evaluate a hernia John has)
- Three different sets of x-rays for my ankle
- Other imaging including ecocardiograms, thyroid and abdomen ultrasound, thyroid nuclear scan, and bone density scan
- A holter EKG monitor for John
- A boatload of blood work for both of us
- A hearing test for John
In addition, we pay $125 a month for the complementary 60+ plan and an additional $25 a month for Dr. House, a 24/7 in-home medical service. (NOTE: Dr. House is only available to clients in El Oriente, the region just to the east and south of Medellín.) That comes to about $250 a month for comprehensive coverage, for both of us. With no deductibles and no coverage denial for pre-existing conditions.
Our out-of-pocket costs are also extremely low compared to U.S. prices. In addition to my endocrinologist, John sees a private cardiologist (also about $45 a visit). When I broke my ankle, I didn’t want to wait too long after getting my cast off to start physical therapy – so I paid about $225 for 15 PT sessions from a private provider. Altogether, our private medical costs for 2023 have totaled about $1,000. Add to that about $700 for prescribed medications.
Grand total for 2023: About $4,000 for both of us (including SURA premiums and out-of-pocket costs).
A few more tips
If your Spanish is limited, get some help. When we first arrived in Medellín, we found a godsend in the form of Juan Camilo Aguilar. He’s not only an excellent driver and tour guide, but he’s also great at helping new expats get things done – things like opening a bank account, working through the visa process at Migración, and signing up for EPS coverage. We know people who even use Juan and his wife Paulina as interpreters in medical appointments. Juan’s WhatsApp is +57 316 833 4225.
Write down your medical history and then translate it into Spanish. Make sure you include past surgeries, conditions you’re currently being treated for, medicines you’re currently taking, height/weight (in cm and kg) and family history. It’s a great tool to hand to the doctor, especially if he/she doesn’t speak English. They always appreciate the extra effort!
Always show up early to appointments, as we mentioned. One time, we showed up well over an hour early and the doctor was able to take us almost right away. Fridays seem to be much quieter days at SURA, so go for Friday appointments.
Some parting thoughts
The U.S. simply must get its healthcare act together. If we were still in the states, John would now be enrolled in Medicare and I would be paying through the nose for some kind of health insurance policy (I have a year to go before I’m eligible for Medicare). Even if I were still working, I’d be paying my share for my company’s plan. In addition to my insurance, John would have the monthly Part B Medicare deduction from his social security (about $174), and he’d be paying more for the supplemental insurance needed to fill all the holes in the basic Medicare
coverage. Factor in copays and deductibles. And dental insurance, which can be around $200 a month (apiece). It’s hard to know exactly what our yearly healthcare outlay would be, but we can safely assume it would be several times more than the $4,000 we’re paying here. We honestly don’t know how people manage in the U.S., even with insurance.
John and I have found a healthcare approach that works for us. That means using the SURA services as much as we can, and using private providers as necessary. Are there ways to save even more money? Of course – we will probably go back to SURA for dentistry now that it’s offered in El Retiro (we currently use a private dentist in Medellín). We could use the SURA pharmacy to fill our prescriptions. And we could go back to the SURA eye clinic instead of our local optometrist. Often, the decision to go private boils down to convenience as well as necessity.
We’re all in for Colombia. The healthcare system is one of so many things we love about our life here. The overall cost of living, fantastic climate, beautiful scenery, and – above all – our wonderful Colombian friends all add up to nirvana, at least for this time in our lives.