Healthcare in Panama: no CAK, but a counter at the Caja de Seguro Social
Panama is not on the treaty country list, so your Dutch basic insurance stops when you leave and no CAK contribution takes its place. What there is: a voluntary affiliation with the Caja de Seguro Social for anyone not compulsorily insured, a medical of B/. 47 and a minimum base of B/. 300, and the statutory 20 percent discounts on consultations and medicines for pensionados.
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Written and checked by Auke on , against the sources at the bottom. Is something no longer right? Report it below and I'll fix it.
In Panama you are not insured for healthcare through the Netherlands. Panama is not on the treaty country list of the foreign scheme, the scheme that keeps you insured through the Netherlands when you live abroad on a Dutch pension or benefit. So your basic insurance ends on the day you deregister, and the CAK plays no part.
What you buy instead is your own choice:
- a private policy, local or international;
- a voluntary affiliation with the Caja de Seguro Social (CSS), Panama's social insurance.
That voluntary affiliation is open to natural persons who are not compulsorily insured. It comes with a passport as identification, a medical of B/. 47 and a minimum base of B/. 300 (B/. is the balboa, which is on a par with the dollar).
The pitfall is the order. Anyone who first sells their house and only then looks for cover finds out too late what an insurer thinks of their age and their file.
Why is there no CAK route?
The CAK's foreign scheme applies only in treaty countries. Anyone living there on a Dutch pension or benefit pays a contribution to the Netherlands and receives care under the package of the country of residence. NederlandWereldwijd publishes that list, and Panama is not on it.
That means two things at once:
- No Zvw contribution (the contribution for Dutch health insurance) is withheld from your AOW.
- There is no Dutch safety net any more.
NederlandWereldwijd says it plainly: if you cannot keep your Dutch health insurance, take out insurance yourself in your country of residence, or an international policy if the local cover is not enough.
Which routes are there?
| Route | For whom | What the source says |
|---|---|---|
| CSS, compulsory | everyone employed in Panama | the employer registers you within six working days of starting work |
| CSS, voluntary (group B) | natural persons outside the compulsory scheme | passport or cédula, sworn statement of assets, medical of B/. 47, base of at least B/. 300, registration takes about six months |
| Adding family members | spouse and children up to 18, students up to 25 | marriage and birth certificates with apostille |
| Private, local or international | anyone who does not want or cannot get CSS | the insurer decides acceptance and premium; NederlandWereldwijd names the international policy as the alternative |
Can you join the CSS as a pensionado?
The CSS has a voluntary scheme. Group B of it is meant for natural persons who do not fall under compulsory insurance. The requirement list explicitly names the passport as identification for foreigners.
This is how registration works:
- You submit a sworn statement of assets.
- You pay half of the admission medical, B/. 47.
- You choose a base of at least B/. 300 on which you pay contributions.
Anyone who later wants to pay more or less must first have contributed for three years on the first base. The medical for family members is then free. According to the service the registration takes about six months.
What the requirement list does not say is which premium stands against that and exactly which care you get. You ask that at the CSS counter in Clayton. And think of the period before: six months without cover is not an option, so the private or bridging policy keeps running meanwhile.
What do you pay less with a pensionado card?
Here the law helps you, even if you are privately insured. Law 6 of 1987 gives jubilados, pensionados (retirees) and older people discounts that the consumer authority ACODECO enforces:
- 20 percent on doctors' consultations and on medical, technical and surgical services;
- 20 percent on medicines;
- 20 percent on bills from private hospitals and clinics;
- 15 percent at the dentist and the optometrist;
- 20 percent on physiotherapy;
- 10 percent on prostheses and aids.
You show your cédula (the Panamanian identity card) or your pensionado card. According to ACODECO a permanent resident without a pension also falls under the scheme. What that saves in a year is in the pensionado discounts.
Which order prevents the gap?
Ask the acceptance question before every irreversible step. A private insurer decides for itself on acceptance, exclusions and premium, and the CSS registration takes months. So request an offer in writing, with the conditions in black and white, before you sell your house or deregister. And cover the gap: between the last day of your Dutch policy and the first insured day in Panama there should be a bridge that carries medical costs in Panama.
The practical chain is therefore:
- first an offer from an insurer;
- then the deregistration in the Netherlands, with the cancellation of the basic policy on the same day;
- then arrival with a running policy;
- and only after that the choice whether the CSS comes in as a second layer.
How you end the Dutch policy without a gap is in cancelling your health insurance without a gap; what happens to your AOW is in the article on pension and tax. The whole journey is in the step-by-step plan for Panama.
In Vertrekklaar this is phase 1 of 5 of the journey, step 1.2: the same steps, but for your situation — in your order, tickable, and with the deadlines watched. See the whole journey to Panama or go straight to step 1.2 in the open plan.
What this rests on
The facts in this article come from these official pages. Rules change. When in doubt, go by the source, not this article.
- NederlandWereldwijd — the treaty country list of the foreign scheme: Panama is not on it — nederlandwereldwijd.nl
- NederlandWereldwijd — arranging your own health insurance abroad, local or international — nederlandwereldwijd.nl
- Panamá Digital — Caja de Seguro Social, the voluntary affiliation (group B, medical B/. 47, base B/. 300) — panamadigital.gob.pa
- Panamá Digital — Caja de Seguro Social, the compulsory affiliation of employees within six working days — panamadigital.gob.pa
- Panamá Digital — Caja de Seguro Social, adding family members of foreign insured persons — panamadigital.gob.pa
- Panamá Digital — ACODECO, the discounts of Law 6 of 1987 on healthcare and medicines — panamadigital.gob.pa
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