Healthcare in Paraguay: no CAK, IPS for employees and your own policy for the rest
Paraguay is not on the list of countries with which the Netherlands has healthcare agreements, so you do not stay insured through the CAK. If you work as an employee in Paraguay, you fall under the IPS, for which you pay 9 % of your wage; as a self-employed person you can insure yourself voluntarily. Public care from the Ministry of Health is free. Anyone who does not work arranges a policy with a medicina prepaga or an international insurer.
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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.
If you go to live in Paraguay, your Dutch health insurance ends and the CAK does not take it over. The CAK lists the countries with which the Netherlands has healthcare agreements: the EU, the EEA, Switzerland, the United Kingdom and eight other countries. Paraguay is not among them. In Paraguay itself there are three routes: the IPS if you work as an employee, public care from the Ministry of Health, which is free, and a private policy.
| Who | Where insured | What it costs |
|---|---|---|
| Employee in Paraguay | IPS, through the employer | 9 % of your wage; the employer 14 % plus 2.5 % |
| Everyone | public hospitals and centres of the MSPBS | free, according to the ministry |
| Retiree or anyone not working in Paraguay | medicina prepaga or international policy | premium set by the insurer |
| Dutch basic insurance | ends on emigration; no CAK for Paraguay |
Why does the treaty with Paraguay not help?
The Netherlands and Paraguay have had a social security treaty since 2008. Thanks to it you receive your full AOW in Paraguay; see AOW, pension and tax. But the treaty is about benefits, and according to its definition a benefit is a cash benefit or a pension. It says nothing about paying for care. That is why there is no form that carries your Dutch insurance over to Paraguay, like the S1 within Europe.
How does the IPS work?
The Instituto de Previsión Social is the social insurance for employees. In the general scheme you pay 9 % of your wage. Your employer pays 14 % and 2.5 % on top of that. Your employer registers you; as a foreigner you hand in your Dutch identity document and your carnet from the migration service for that. If you work, a registration with the IPS also gives you the proof of income for the residencia permanente; see working in Paraguay.
We found no scheme at the IPS for foreign retirees who do not work in Paraguay in the IPS documents. So do not count on it.
What is public care worth?
The Ministry of Health (MSPBS) wrote in May 2026 that no employee or third party in the public network may ask for payment, for an appointment, an operation or any other treatment. The migration law says that migrants have equal access to care, and that care may not be refused to anyone because his residence status is not in order.
That says something about access, not about waiting times or about what is available in your region. Find out which hospital is near you and what it does, before you decide whether you want your own policy.
What do you look out for with a prepaga?
A medicina prepaga is a private care provider you pay for in advance. The law counts it among the care providers, and it falls under the Superintendencia de Salud. Anyone who starts without registering in the Superintendencia's register commits an offence under Ley 2319, and the heaviest penalty is removal from the register. The Superintendencia can also stop the enrolment of new members in case of financial trouble.
Before you sign, ask which existing conditions the prepaga excludes, up to what age you can join and whether the premium rises with your age. Check that the prepaga is in the Superintendencia's register, and only let your cancellation in the Netherlands take effect once the new policy is running.
Do you need insurance for your residence?
Health insurance is not on the list of requirements the Dirección Nacional de Migraciones publishes for the residencia temporal. So you are free to choose, but also responsible yourself. See the residence routes.
What do you arrange in the Netherlands?
You cancel your health insurance when you deregister; see cancelling your health insurance without a gap. Let your new policy start on the day the old one ends. If you take medicines with you, read medicines across the border.
How this fits into your preparation is set out in the route to Paraguay.
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 Paraguay 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.
- CAK — the treaty countries for healthcare, Paraguay is not among them — hetcak.nl
- Treaty Netherlands–Paraguay on the export and enforcement of social security benefits — cash benefits, not care — wetten.overheid.nl
- IPS — questions and answers for employees and employers, with the contributions — portal.ips.gov.py
- Ley 98/92, article 2 — employees compulsorily with the IPS, voluntary insurance for the self-employed (BACN) — bacn.gov.py
- Ministerio de Salud Pública — public care is free, nobody may ask for payment — mspbs.gov.py
- Ley 6984/2022 de Migraciones, articles 5 and 8 — equal access to care for migrants (BACN) — bacn.gov.py
- Ley 2319 — the Superintendencia de Salud supervises medicina prepaga (BACN) — bacn.gov.py
- Superintendencia de Salud — the register of care providers and prepagas — superintendenciadesalud.gov.py
- Dirección Nacional de Migraciones — the requirements for the residencia temporal, without an insurance obligation — migraciones.gov.py
- CAK — the treaty countries for healthcare (Dutch page), Paraguay is not among them — hetcak.nl
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