Cartagena

Decent for routine and most acute care, but not Bogotá- or Medellín-level. The go-to private facilities are Hospital Bocagrande (Castillogrande) and Nuevo Hospital de Bocagrande, plus Serena del Mar (a newer high-end complex north of the city affiliated with US institutions); private hospitals have modern equipment and some English-speaking staff, at roughly 50-70% below US prices. Expats and nomads use private care via SURA, Colsanitas, or Seguros Bolívar plans. English is common in private hospitals, scarce in public ones. For the most complex surgery or specialist care, expats fly to Bogotá (~1.5h) or back to Miami (~3h). Telemedicine in English is available (e.g. DoctorsForExpats).

Tropical and hot all year: daytime 86-90°F, nights 77-79°F, and humidity averaging ~80% (peaking ~83% in Oct). There's no cool season — only a drier one (Dec-Mar/Apr, the pleasantest, lower humidity) and a wetter one (May-Nov, peaking Oct) with short, sharp afternoon downpours rather than all-day rain. A/C is essential and runs constantly, spiking electricity bills. Sea breeze in Bocagrande/Castillogrande takes a slight edge off.

Tourist Cartagena is generally safe by day with normal precautions; violent crime against foreigners is uncommon. The walled Old City, gentrified Getsemaní, and Bocagrande/Castillogrande have a strong police presence. Real risks are petty: pickpocketing in crowds, aggressive vendors, taxi overcharging, rare scopolamine drugging, and fake-police 'money inspection' scams. Numbeo Crime Index ~52 (moderate-high). Avoid Old City side streets and Manga late at night, plus outlying neighborhoods like Nelson Mandela. Colombia's overall US State Dept advisory is Level 3, though Bolívar/Cartagena isn't restricted. Women alone report it manageable with big-city caution; app taxis advised after dark.

A real but smaller and more transient expat scene than Medellín — North American and European retirees, second-home owners, digital nomads, and hospitality workers, skewing toward those who love heat and Caribbean culture (more Brazilians and Italians than Medellín, locals note). Active Facebook groups and tourist-oriented services help, but this is a working Colombian port city, not an English bubble: outside hotels, restaurants, and private clinics, functional Spanish is genuinely needed.

Rafael Núñez airport (CTG) has nonstop service to Miami (~3h, American and Avianca, roughly daily) and seasonal/limited nonstops to other US points; most other US routings connect through Miami, Bogotá (~1.5h, very frequent), or Panama City. Good for Florida-based family; everyone else connects. Compared with Medellín or Bogotá it has fewer direct long-haul options, so build in a connection for the Northeast, Texas, or West Coast.

Colombia taxes tax residents (183+ days in any 365-day window) on worldwide income, and there is NO US-Colombia income tax treaty and no totalization agreement. Foreign pension income is exempt up to 1,000 UVT/year (~COP 52.4M, roughly US$14,000-14,500 in 2026); pension income above that can be taxed at Colombian progressive rates. Other foreign income (investment, etc.) is taxable once you're resident. US citizens still file US returns and rely on the Foreign Tax Credit (Form 1116) to avoid double taxation. The interaction is genuinely complex — get cross-border tax advice before becoming a Colombian tax resident. We are not tax advisors.