Technical article

Health Cover for a Retiree in Chile and Colombia: Two Public Systems, Two Layers

How does health cover work for someone who is retired and has just arrived?

By Neil Solomon · 6 min read

Picture a couple named Mark and Joan. Both are 64. Mark has a pension from a US employer. They are comparing Santiago and Medellín, and the first question is the same for both. How does health cover work for someone who is retired and has just arrived?

Colombia: a public layer and a private layer

Colombia's health system has a contributory part. A Ministry of Justice page says: "Si es empleado, trabajador independiente o tiene capacidad de pago, deberá afiliarse y cotizar al régimen contributivo." The foreign papers it lists for joining include the foreigner's ID card (cédula de extranjería), a passport and the special stay permit (PEP). The subsidised part is for people who score in levels I and II of a government survey called Sisbén. A retiree with a pension would most likely look at the contributory side. That last point is my reading.

On the rate, the tax and pensions unit (UGPP) says a pensioner's health contribution has "una tarifa del 12%". For independent workers it says "IBC total x 12,5%". An older Ministry guide, with a 2004 cover date, gives 12% for both. I show both because the pages differ, and the 2004 one is far older.

My arithmetic, as an example only: a monthly pension of US$3,000 at 12% would be US$360. The UGPP page does not say how a foreign pension is counted, so I cannot confirm that this is how it would work.

The second layer is voluntary. The 2004 guide says: "La afiliación a la medicina prepagada, los seguros de salud o los planes complementarios es voluntaria." It adds to the public cover and does not replace it.

Visas bring insurance in a different way. Resolution 5477 of 2022 asks for a health policy for several visitor visas, for example tourism: "Póliza de salud con cobertura en el territorio nacional contra todo riesgo en caso de accidente, enfermedad." Digital nomads and students are asked for one too. The Cancillería page for the Visa M Pensionado (no date shown) asks for a lifetime pension "en monto no inferior a tres (3) salarios mínimos legales mensuales vigentes", certified, apostilled and translated. It also asks for proof of "cubrimiento de salud en Colombia, o con póliza de salud" for the stay. The same page says the visa does not let the holder join Colombia's social security system, except under bilateral or multilateral agreements. So for this visa the page points to a health policy or other cover, and it does not point to the contributory system.

Chile: Fonasa or Isapre

Chile gives a choice. The Superintendencia de Salud says that in Fonasa "la cotización" is 7% of gross monthly pay, and that "Fonasa tiene solamente un Plan único con dos modalidades de atención." In an Isapre, the same page says the 7% is also required, and a plan priced above it means the member pays the difference. Fonasa's own page says: "En Fonasa, la cotización siempre es del 7%, independientemente de la cantidad de cargas legales."

The two differ in who decides. Of Fonasa the Superintendencia says: "Fonasa no considera las preexistencias como un impedimento para ingresar a la aseguradora." Of an Isapre it says the insurer "podrá establecer limitaciones a la cobertura de determinadas patologías preexistentes", and that joining takes a private contract.

Fonasa lists "Las personas que gocen de pensión previsional" among those who may affiliate. For foreigners it says: "los ciudadanos extranjeros que han solicitado un permiso de residencia pueden acceder al régimen de prestaciones de FONASA."

For a foreign pension, two more official pages help. The Superintendencia de Salud page (modified 2 April 2026) lists for a foreigner with a pension from the home country: ID card or passport, and "el formulario de convenio con extranjeros" from the Superintendencia de Pensiones. ChileAtiende (Superintendencia de Pensiones, updated 17 March 2026) says this route is for someone living in Chile and pensioned "en un país con convenio" (a country with a social security agreement). The certificate shows the foreign pension amount and is used "para fijar el monto que te corresponde pagar como cotización en Fonasa." Fonasa asks for it to be renewed once a year. Neither page gives a rate for this route. The Superintendencia de Pensiones page for the United States settles the question of the agreement: Decree 459, published in the official gazette on 1 December 2001, promulgates the social security agreement between Chile and the United States. The page says people who live in Chile and receive only a United States pension can join Fonasa. They go to the Superintendencia with a certificate from the United States liaison body (the Social Security Administration) that states the date the pension was granted and its amount, their latest pension payment statement and a copy of their Chilean identity card. The Superintendencia then issues a health contribution certificate to present to Fonasa to pay the contribution. It can be done in person at a regional office or online (read 11 October 2026).

Side by side

What is left open

• Colombia: how a foreign pension is counted for the 12%. The visa page says the pensioner visa does not give access to the contributory system except under agreements, and the pages I read do not name a United States agreement, so a retiree on that visa should plan on a health policy.
• Chile: the rate on a foreign pension, which the certificate process sets, and what an Isapre would charge or accept. Plan prices and age limits are set by each insurer and no official page lists them.
• Dates. Several of the pages carry none.