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Healthcare Options for Expats in Costa Rica

DoctorWhat is Costa Rica’s Healthcare like?

Last year, as reported by local news in San Jose Costa Rica, 100,000 persons traveled to Costa Rica for medical procedures. Majority of the patients were US citizens seeking relief from sky-rocketing costs of healthcare in America.

Medical tourism is booming in Costa Rica.  Why?  Because healthcare is world-class without the world-class price tags.

You might ask, well how good is it, really, comparing to US?

It turns out that Costa Rican healthcare system is highly rated (even higher than the U.S.), with universal health insurance and excellent public and private hospitals.  Back in the early 2000s, the World Health Organization (WHO) rated Costa Rica’s general health higher than that of United States of America.  Life expectancy is also longer in Costa Rica, despite the fact that healthcare spending is 87% less per capita. Comparing Unicef’s evaluations of USA and Costa Rica healthcare systems clearly shows that, in the last decade, the countries are very comparable.   You can see the unicef reports for yourself: USA and Costa Rica.

And frankly the fact that Americans are flocking in the thousands to Costa Rica for medical procedures, speaks for itself.

Excellent quality aside, prices are what really draw Americans in search of healthcare options to Costa Rica every year.  Persons traveling to Costa Rica receive the same quality (at least) of medical services for a fraction of the cost.  Lower labor costs and absence of malpractice suits keep the prices of healthcare down in Costa Rica.

The reality is that Costa Rica’s reputation is growing for high quality, affordable, and accessible medical services. Some say that Costa Rica is a solution to the health care crisis in the USA. I’ve read that certain American insurance companies send individuals to other countries for major medical procedures (they often include airfare), in an effort to save money.  Costa Rica has many advantages like being the closest foreign medical destination to the United States with cheap airfares and many United States trained doctors – who, by the way, often speak fluent English.  There is no big culture shock for American citizens to come to Costa Rica.

Options for foreign residents (gringos) Health Insurance:

  1. None
  2. National Public Health – CAJA – Costa Rica’s private system
  3. Private Insurance
    a.   INS – National Insurance Institute.  The governmental insurance company.
    b.   International Health Insurance Policy
  4. US based Insurance – like Medicare

Let’s look at these one at a time.

1. None – no insurance

Recently an expat told me that I need to “get rid of my American mind set”, when it comes to insurance.  He said that we are too dependent on the concept of health insurance.  He said that instead, because healthcare is so cheap, many choose to use to forgo buying any insurance.  Simply use the public health system for everything and pay as you need for the private health facilities for anything major.  Considering that the costs are so low, he said that he chooses to be his “own insurance company”.  Now, I must admit that is a very foreign concept to me but after some research, I realize that this may not be a totally bad way to go.  If one is in good health, and has some savings, rather than paying insurance premiums it may be easier and even cheaper to just pay for healthcare as you need it. This also assumes that you are not planning on getting a permanent residency status which would require you to buy the public health plan. I’m not sure if I am sold on this concept but it is one option.

2. National Public Health:

In Costa Rica the public insurance is mandatory for everyone, citizens and foreign residents alike.  The typical cost for two persons (retirees) is $50-60/mo.  It covers just about everything and from what I understand the quality is quite good. There are also no preexisting conditions to worry about.  The catch is that as any other public system – which is relied upon by a majority of the population – it’s often criticized for long wait times and delays in treatment.  Nonetheless, many choose it as their main option or in addition to private options.  I recently read a story of an American couple that uses it for basic and emergency care only and rely on other insurance for all major medical procedures.  This obviously is a personal choice.

3. Private:

a) INS – National Insurance Institute, the governmental insurance company.
I know, I know, it seems odd that the government offers a “private” insurance option but it does.

Their private plans include dental work, optometry, well-visits and annual check-ups.  Eighty percent (80%) of the costs are covered for prescription drugs, certain medical exams, sick visits and hospitalization. Surgeon and aesthetician costs are covered in full. The private medical insurance costs range from $60–$130/month per person.  The premiums depend on gender, age, and other factors.  Here is the catch: unlike the public CAJA, this insurance does not cover pre-existing conditions and there is a yearly maximum spend limit.

b) International Health Insurance Policy:
There are several International Health Insurance providers.  They offer international insurance policies that cover your needs in Costa Rica but also in the rest of the world – this can be a great option if you like to travel and want to be covered no matter where you’re visiting. These medical insurance policies cover the medical expenses due to an accident or sickness.  I’m told that the premiums for this type insurance are only a bit higher (but still very reasonable) than INS but cover more and the lifetime limits are much higher. Premium depends on the coverage and can vary according to the carrier.  Here is the cool thing: they cover you when you are visiting US, as long as it’s for less than 30 days! – based on Bupa International Insurance.

4. US based Insurance –Medicare
Some expats choose to continue their US based insurance.  For those that are eligible, Medicare is the obvious choice.  I do not exactly understand why one would choose this option but some do – I suppose this stems from the mistrust of any health system outside of US and strong belief that our healthcare system, although not available to everyone, is better than most. This, I think, is a false belief.  In 2010, The Commonwealth Fund compared healthcare in Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom – the U.S. health care system ranked last or next-to-last on five dimensions of a high performance health system.  You can read the report here: http://www.commonwealthfund.org/Publications/Fund-Reports/2010/Jun/Mirror-Mirror-Update.aspx
Furthermore, this last option offers premiums that are generally higher than all the options above.  There are also costs associated with flying back and forth to the US for treatment, in addition to paying premiums, deductibles, co-pays, and housing costs.  I would venture to say that this option would be more expansive than no insurance at all in Costa Rica.

What is cool about all this is that expats can pick and combine any of the above.  One can for example, combine the public healthcare with private insurance.  I don’t know about you but that all sound good to me!  I wish we had the same here in the US.  OK, I wish we just had options…

You may also like our other posts on Costa Rica.


About Joanna

is a Polish American living in Arizona with her husband Tim. She is a founding partner of JTR Tech and she is proud to be a professional geek. She had dreamt of living abroad for many years. So, she and Tim created AbroadDreams.com to document the process of making their dream of moving abroad come true. They spent 2 years in Puerto Rico and several months in Spain and Poland. Now they are exploring the American Southwest.

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  1. HI again (I just left another comment over on your Costa Rica food post). I actually mentioned health care on that comment since I hadn’t yet stumbled across this post. Having lived in Costa Rica from ’06 to ’12 I’ll add my 2¢ and reinforce what Michael and Josephine have said. There *can* be some very good health care options in CR, but the widely touted wonderful “free” CAJA and “world class medical” are distinctly overblown sales pitches. We do have friends there that use the CAJA almost exclusively with good results, but they are the exception not the rule (to the extreme, in fact) and you should definitely presume you’ll need to private pay. The INS insurance not only doesn’t cover pre-existing conditions, they typically refuse to pay almost any attempt at a claim (based on various friends’ experiences) by coming up with some way to say it was pre-existing even when it wasn’t. It *is* true that the costs for private pay will be much less than private pay medical in the U.S. so as long as you have savings and are prepared to pay, it’s not bad. We did find overall (private pay, NOT our experiences with our local CAJA hospital) the doctors to be good quality, nice to work with, took their time with you, etc. etc. so that’s definitely a plus.

    Good luck in your research. If you have any questions about CR or would like to “talk” further to a real-life expat (ex-expat in this case) feel free to email me privately.

  2. Having lived here the last two years, I would say that healthcare used to be cheap here, but the CAJA now interviews everyone applying for residency and asks questions regarding your net worth and income. They are now tying the payment to whatever they think you are worth. If you live an Escazu or Santa Ana that alone can raise your payment. Also, the Caja is good for basic healthcare, but is not necessarily ideal for any advanced procedures, or procedures where you want to have something done sooner rather than wait 1 or 2 years for an appointment. My impression of most Caja doctors, is they would prefer to leave as earliest as they can and work in a private practice on the side. I agree the private healthcare here at hospitals such as Cima, or Clinica biblica seems well rated, but is certainly not cheap, although probably still cheaper then the US.

    • Hi Michael,
      Thanks for your comment. I’ve not heard that about CAJA before but it is great info!
      I had expected that healthcare in CR seemed too good to be true. Still not bad but definitely not perfect!
      I have HMO here in the US and I can’t say that it’s much different. I have to wait for 2-4 months for any non-emergency procedures, they tell me which doctors I can see, and how much the visits can cost. I do not have an option to see anyone outside of their network, not even with referral. I guess there are always pluses and minuses to each story.
      Thanks for reading.

  3. Your overview has some facts but mostly colored with hopeful thoughts. private healthcare here in CR is very good and indeed cheaper than US, but surgeries can still run $ 20,000 or more. My BUPA private healthcare policy runs $10,000 per year….certainly ” a bit more” than national options. Also your monthly payments for CAJA can be a great deal more given the age and status of the individual. nice ideas, all, but sorry, too misleading!

    • Hi Josephine,
      Thanks for your comment. No misleading intended. All the CAJA information I obtained directly from them. I do not have the exact numbers for myself from BUPA yet but I have requested a quote. All the other numbers I received directly from expats living in CR or the insurance websites.

      • We have lived here for 20 years and I do dislike seeing prospective residents given false info on life in Costa Rica (garnered by interviewing some unknow sample of “expats”). I think you cannot defend your information until you personally spend a year or two in Costa Rica….clearly you have not done so…ergo ” San Juan” Costa Rica. Yes, there is a moral obligation to publish the facts and when confronted with the possibility of disinformation, listen instead of giving a poor defense.

        • Hi again,
          Thanks for the correction. You are right, I am looking at this purely through a future expat lenses and I do not have firsthand experience. As such, I can rely only on the data available via internet, the companies themselves, and other expats. Since I am contemplating relocation to Costa Rica I am hoping to get the facts straight because if nothing else, they will guide my own decision. As such, I’d be very interested in getting input from as an expat, like yourself, that has many years of experience of dealing with the local system. Would you be willing to help me get the information right? If so, please let me know and I will email you directly. Thanks for commenting. Joanna