Colombia’s healthcare system is known for its mixed public-private model, offering residents access to both mandatory public insurance through the EPS (Entidades Promotoras de Salud) system and optional private insurance. Each type serves different needs and demographics but shares common goals in ensuring medical access and improving health outcomes.
Key Differences
1. Structure and Accessibility
The EPS system is mandatory and provides universal health insurance to all legal residents, including expatriates with a valid residency ID (cédula). Administered by both public and private companies, EPS ensures everyone has access to a standard set of benefits.
In contrast, private insurance is optional, primarily used by wealthier Colombians or expats seeking enhanced service quality, faster access, and premium facilities.
2. Funding and Cost
EPS operates under two financing models:
- Contributory Plan: Employees contribute 12.5% of their income (8.5% by employer, 4% by employee).
- Subsidized Plan: Funded by government taxes for low-income and unemployed individuals.
Private health insurance is paid out-of-pocket, with annual premiums ranging from $350 to $900 USD, depending on age, health status, and coverage level. It does not rely on wage-based contributions and is not income-adjusted.
3. Benefits and Services
Both EPS plans (contributory and subsidized) offer the same essential benefits, including:
- Consultations
- Diagnostic imaging
- Lab tests
- Maternity and preventive care
- Medications
- Surgery and hospitalization
Private plans, however, often go beyond this by offering:
- Faster access to specialists
- No referral requirements
- Access to elite private clinics
- More advanced treatments or exclusive facilities
- English-speaking services (especially for expats)
4. Speed and Quality of Care
EPS may involve longer wait times, especially in rural or less affluent areas. Though service quality is relatively good, delays in specialist care or diagnostics are common.
Private health insurance offers shorter wait times, greater comfort, and priority access, especially in urban centers like Bogotá, Medellín, and Cali.
5. Eligibility
EPS is open to all legal residents and does not discriminate based on pre-existing conditions or age.
Private insurance may exclude older individuals (60+) or those with chronic illnesses, or charge significantly higher premiums.
Key Similarities
- Range of Services: Both systems cover essential medical services, including preventive and curative care, hospitalizations, and medications.
- Regulation: Both public and private health insurance providers are regulated by Colombia’s Ministry of Health and Superintendencia Nacional de Salud, ensuring minimum quality standards.
- Provider Overlap: Some companies like SURA and Sanitas offer both EPS plans and private/prepaid plans, allowing patients to move between public and private services more seamlessly.
Top Public Health Insurance Providers (EPS) in Colombia
Colombia’s public health insurance system, known as Entidades Promotoras de Salud (EPS), is a cornerstone of the country’s commitment to universal healthcare. This system guarantees that all legal residents—Colombian citizens and expats with residency—have access to affordable, comprehensive medical services. Although EPS is a unified public model, it is administered by various private and public entities, allowing residents to choose from several different providers. Below are five of the most prominent EPS providers in Colombia, evaluated on cost, coverage, accessibility, financial features, and user satisfaction.
1. EPS SURA(Official Website: https://www.epssura.com)
- Cost: Part of the Contributory or Subsidized Plan depending on income. Employees contribute 12.5% of gross salary, while low-income residents may qualify for full government subsidies.
- Available Services: Offers all mandatory EPS services, including consultations, diagnostics, lab work, medications, maternity care, hospitalization, and surgeries.
- Open for All: Yes—open to all residents with legal status. SURA also provides some of the best customer service and coverage in urban centers.
- Core Financial Features: Financed via salary-based contributions (for contributors) or government support (for subsidized enrollees). No co-pays for most services under the subsidized plan.
- Consumer Satisfaction: One of the highest-rated EPS providers, SURA consistently scores above 80% in user satisfaction surveys, noted for efficient service and digital accessibility.
2. EPS Sanitas(Official Website: https://www.epssanitas.com)
- Cost: Standard EPS pricing applies—salary-based contributions or free under the subsidized scheme.
- Available Services: Comprehensive coverage including preventive care, chronic disease management, emergency services, pediatrics, and mental health.
- Open for All: Yes. Strong presence in Bogotá, Medellín, and Cali.
- Core Financial Features: Similar to other EPS plans—funded by employer/employee contributions or fully subsidized for low-income individuals.
- Consumer Satisfaction: Sanitas ranks highly with satisfaction rates between 75%–80%, particularly for urban access and modern facilities.
3. EPS Coomeva(Official Website: https://www.epscoomeva.com.co)
- Cost: Included in EPS scheme—no added cost beyond payroll deductions or government coverage.
- Available Services: Full standard EPS services plus good support for outpatient and specialist care.
- Open for All: Yes, though availability and reputation can vary by region.
- Core Financial Features: Supported by public funds or payroll contributions. Offers co-payment options for certain elective services.
- Consumer Satisfaction: Generally positive, with ratings around 70–75%, though some variability in service delivery times is reported.
4. EPS Compensar(Official Website: https://www.compensar.com/salud)
- Cost: Covered by EPS structure; no extra cost beyond the regular EPS system.
- Available Services: Offers strong services for primary care, health promotion, vaccination, maternity, and senior care.
- Open for All: Yes. Especially strong in Bogotá and central Colombia.
- Core Financial Features: Payroll contribution or subsidized government funding depending on user income. Offers user-friendly online services and appointment scheduling.
- Consumer Satisfaction: Well-rated, scoring around 80%. Known for efficient systems and patient-centered care.
5. EPS Cafesalud (now integrated into Medimás/EPS Salud Total)(Official Website: https://www.saludtotaleps.com)
- Cost: Part of the same EPS financial framework. No separate premiums required.
- Available Services: Full EPS benefits, including emergency care, maternal health, and rehabilitation services.
- Open for All: Yes. Available nationwide but with varying performance by location.
- Core Financial Features: Government-backed for the subsidized plan, payroll-based contributions for others.
- Consumer Satisfaction: Historically lower (around 60–65%) due to administrative restructuring and past service inconsistencies.
Top 5 Private Health Insurance Providers in Colombia
In Colombia, private health insurance serves as a complementary or alternative option to the public EPS system, offering faster service, broader provider choice, and access to top-tier private clinics and hospitals. These plans are particularly popular among expats, high-income individuals, and those seeking specialized care or international coverage. Below are the top five private health insurance providers in Colombia, detailing cost, services, eligibility, financial structure, and customer satisfaction.
1. Colsanitas(Official Website: https://www.colsanitas.com)
- Cost: Varies by age and coverage; average monthly premiums range from USD $80 to $200.
- Available Services: Offers prepaid medicine (medicina prepagada) including direct access to specialists, elective surgeries, advanced diagnostics, maternity care, and premium hospital networks.
- Open for All: Generally open to all, though older individuals and those with pre-existing conditions may face limitations or higher premiums.
- Core Financial Features: Flat-rate premiums with co-payment options for certain services. Offers packages tailored to individuals, families, and corporate clients.
- Consumer Satisfaction Score: High, with satisfaction ratings over 80% for prompt service, exclusive clinic access, and quality care.
2. SURA (Seguros Generales Suramericana)(Official Website: https://www.segurossura.com.co)
- Cost: Monthly premiums from USD $50 to $150, depending on age and coverage.
- Available Services: Offers a range of voluntary private plans including preventive services, chronic disease care, specialist visits, hospitalization, and emergency services.
- Open for All: Available to residents, but health status and age may affect eligibility and pricing.
- Core Financial Features: Fixed monthly premium with optional add-ons. Offers reimbursement plans and a wide private provider network.
- Consumer Satisfaction Score: Consistently rated above 80%, praised for broad coverage, efficiency, and digital tools.
3. Allianz Care(Official Website: https://www.allianzcare.com)
- Cost: International-level premiums from USD $100 to $300/month, depending on region, age, and plan type.
- Available Services: Full-spectrum international health insurance with access to private hospitals in Colombia and worldwide, emergency evacuation, wellness, dental, vision, and maternity care.
- Open for All: Tailored to expats and frequent travelers; open to all with flexible underwriting.
- Core Financial Features: Annual deductibles, direct billing at partner facilities, and global claim support. Premiums vary based on geographical coverage.
- Consumer Satisfaction Score: High among expatriates, with satisfaction rates around 85%, particularly for support and global coverage.
4. AXA (AXA Global Healthcare)(Official Website: https://www.axaglobalhealthcare.com)
- Cost: Premiums range from USD $90 to $250/month, based on age, health, and international coverage zone.
- Available Services: Comprehensive private health insurance with options for routine care, inpatient and outpatient services, mental health, maternity, and travel coverage.
- Open for All: Primarily serves expats and high-income individuals; open enrollment with pre-existing conditions assessed.
- Core Financial Features: Customizable deductibles and co-insurance options; direct settlement at major hospitals.
- Consumer Satisfaction Score: Around 80%, praised for multilingual support, claim speed, and reliable global network.
5. Cigna Global(Official Website: https://www.cignaglobal.com)
- Cost: Premiums start at USD $100/month and can exceed $300/month based on customization and global zone.
- Available Services: International medical insurance including hospital care, outpatient treatment, specialist access, wellness checks, and evacuation services.
- Open for All: Designed for expats, digital nomads, and globally mobile individuals; easy enrollment online.
- Core Financial Features: Flexible plan tiers, add-ons for dental/vision, choice of excess/deductibles; 24/7 multilingual customer support.
- Consumer Satisfaction Score: Among the highest, with satisfaction rates of 85–90%, especially for expats seeking seamless international care.
READ MORE: Private and public health insurance of Brazil (Make informed choices)
