Most prospective expats thinking about health care in Costa Rica already know that this is a nation that has universal health care for all residents and citizens. What you may not know, though, is that there are myriad other or supplemental coverage options for visitors and expats that are well-worth investigating. To help you along your journey towards the pura vida, here are a few topics that you may or may not have encountered about protecting yours and your family’s physical and financial health.

Why Expats Choose Costa Rica for Health Care?

The US health care system is the most expensive in the world. Many opt to leave the country for medical procedures rather than pay for high insurance premiums. US companies have begun sending their employees outside of the border to save on health care costs. This is a problem indicative of affordability rather than quality ⁠— the latter of which the US is at the top of the world.

Just in the last ten years, many US citizens’ medical costs have almost doubled. And most other first world countries ⁠— even those that offer universal health care ⁠— have expensive elements within their health care systems. Whether it be high taxes, inflated prescription costs, or years’-long waiting lists for non-urgent procedures, there is no perfect system out there.

Costa Rica’s universal health care system, called Caja, is a great base option that can also be supplemented with affordable additional private health care options from within Costa Rica or purchased internationally. Read on to learn the basics of each of these options.

Universal Health Care (Caja) in Costa Rica

Caja, or Caja Costarricense de Seguro Social, is a required opt-in universal health care program for all residents and citizens of Costa Rica. Residents have the same options as citizens when it comes to health care in Costa Rica. Anyone who pays into the Caja program has access to full public system coverage, no matter the cost. Caja covers almost everything including ocular and oral health but the system is overdrawn and wait times can be long and inconvenient. Caja does not cover anything cosmetic but it will cover surprising things like mental health and physiotherapy ⁠— two prominent health needs that are often not covered in private or public health care options around the world.

Costa Rica's Caja universal health care system is considered to be good on a global scale for its facilities, equipment, and staff. In San Juan de Dios Hospital in San Isidro, patients can have open heart surgery for free with one of the nation’s best cardiologists. This same procedure may be offered by the same doctor in a private hospital in Costa Rica at a cost of around $10,000 USD, although you can expect longer wait times in the public system.

As a successful applicant, you can sponsor a dependent on Caja, such as your spouse or partner, and any children under the age of 18 (or up to 25 if they are studying). Personal Caja plans (including dependents) are based on 12.7% of the applicant’s declared annual earnings or pension. Caja requires proof of income when applying for the program in order to determine the monthly rate.

When going outside the Caja system

In a catastrophic health event, Caja may not be able to offer the care options that an expat might want or expect. If you do choose to go to a private hospital or clinic in Costa Rica on your own — even if you pay into the Caja system — you will need to pay out of pocket without the option of being reimbursed. However, if you first visit a general hospital in Costa Rica that does not have the best options for your health care needs, they may likely refer you to a private clinic or hospital that can offer the appropriate care. In this latter scenario, Caja will cover the full cost. Caja supported hospitals will often choose to take their intensive care patients to the best private clinics in Costa Rica but the public system doctors must refer you if Caja is to cover the cost.

For this reason, many expats in Costa Rica choose to purchase additional private health care coverage on top of Caja. Depending on their circumstances or preferences, they may choose a medical discount program like MediSmart or full-coverage private insurance with one of Costa Rica’s many reliable providers (more information on both below).

Caja in the workplace

Accidents and illnesses are managed differently in Costa Rica’s health care system. Experiencing an accident at home may be treated differently than experiencing one at work or at a private establishment. For those who own a business in Costa Rica in which they pay employees, they will be required to purchase additional Caja insurance policies for their employees that cover them during work hours. This is the equivalent of a worker’s compensation program. Costa Rican employees, therefore, do not personally pay the whole of their Caja health insurance. In Costa Rica, the employer pays for the majority of their employees’ Caja and the employee will pay the remaining 30%.

Private Insurance in Costa Rica

Residents in Costa Rica who are looking for supplemental coverage to Caja’s public health care system and also those who want to invest in Costa Rica real estate but don’t want to become residents may benefit from purchasing private health insurance in Costa Rica. Private health insurance offers protection against unexpected events such as injury or illness and may cover portions of regular health expenses.

Most health insurance in Costa Rica gives you access to a wide network of medical providers from the most prestigious hospitals in the country. Reliable (albeit different) private health insurance policies are available in Costa Rica from INS, Blue Cross Blue Shield (BCBS), BMI, and Panamerican Life, to name a few. Costa Rica’s main private insurance provider, INS, covers all private clinics in Costa Rica with its comprehensive health plan. Companies like Blue Cross Blue Shield will cover a lower quality of clinics, while the international brand BMI also offers full coverage. Private hospitals in Costa Rica will list who they accept coverage from on their websites.

Each insurance provider in Costa Rica is different and their plans and fees will depend on your age and health. Some will cover pre-existing conditions like high blood pressure and thyroid disease, although this will incur additional costs to their standard premium and/or higher deductibles. They may also offer limited coverage of up to 6 months of the year in the US and abroad.

The most basic health insurance plans cover outpatient and hospital expenses of up to $100,000 USD per insured. Typical annual rates for private health insurance in Costa Rica can range from around $100 per month with a $500 deductible for younger applicants with no pre-existing conditions to around $300 per month at a $5000 deductible for someone in their 60s. A young family of three may be looking at the same rate as a retiree, but even at the higher rate, expats in Costa Rica with private health insurance are often paying less than half of what their medical expenses would be in their country of origin.

Group discounts for private insurance

Most private insurance providers in Costa Rica offer group discounts for corporate entities that are tied by business transactions. The applicants must be signed under the same corporation and need at least ten members in the group to apply for private health insurance together for a lower annual group rate.

Liability insurance in Costa Rica business

A typical place of business in Costa Rica will not have liability insurance. It is not required by law to have liability insurance because every citizen and resident already has universal health care,.Costa Ricans will simply use their own Caja in case of injury, regardless of where the injury took place.

Foreigners come with different expectations of the system. If you are a business owner hosting many foreigners in your Costa Rica business, it is advisable that you have liability insurance. For instance, if you are renting your Costa Ballena property on VRBO or Airbnb, it is advisable that you purchase liability insurance to cover any accidents or injuries in the same way you would with any business in the US, Canada, Europe or elsewhere. Within Costa Rica’s health care system, a policy of $100,000 is typically enough to cover the standard business’ liability in case of an accident or injury on your property. People cannot sue for a huge settlement in Costa Rica since the courts will only rule to cover medical costs and not other damages like emotional distress, which plaintiffs can sue for in other countries.

Global Health Insurance Providers

International insurance providers offer cross-border expat health insurance plans. A retiree looking to live in Costa Rica for more than 5 years can expect to pay around $250 per month for comprehensive health insurance plans with a company like BDAE, which includes worldwide coverage, and much less when excluding the US and Canada coverage.

US Medicare is not accepted long-term in Costa Rica. Medicare subscribers can be covered outside of the US for 60 days at a time after which you pay out of pocket and can be reimbursed. Available in the US to people 65+, younger people with disabilities, and people with End-Stage Renal Failure, Medicare is generally viewed as good but many still choose to have supplemental insurance or to go outside of the US medical system for certain procedures.

The basic health care insurance option for tourists in Costa Rica is to purchase travel insurance. Some health insurance purchased in the US, like with Blue Cross Blue Shield, will reimburse 100% of health care costs in Costa Rica (minus the deductible). However, it is important to keep receipts and to be diligent with keeping records because they may question every penny.

Prepaid Medical Plans

Monthly membership subscription programs like MediSmart are not your typical health insurance plan. Rather, they are a type of prepaid medical plan that gives subscribers access to discounts within more than 45 medical fields and for more than 500 medical services with top-level health care providers. MediSmart offers discounts on doctors’ visits, tests, surgeries and procedures, and medications, plus some veterinary options.

Many retired expats are happy with a prepaid medical plan in conjunction with the Caja public health care system in Costa Rica. This type of discount coverage health plan is available to all with pre-existing conditions, even those not covered by a traditional insurance plan.

Pay As You Go Health Care in Costa Rica

Out of pocket medical costs in Costa Rica are considered very reasonable when cross-compared globally. Those who want to avoid insurance brokers' fees prefer this option. For those thinking to pay for their health expenses privately as they come up, here are a few things to note:

Private clinics and hospitals are often half the price or less than what you would pay in the US
Pain management and many other forms of medication can be relatively expensive in Costa Rica
Many forms of medication are available over the counter, especially in smaller towns
Not all doctors can write pain pill prescriptions
Always get two to three options on pricing for any non-emergency procedures if you can
It is a good idea to validate the license of your private doctor
Make sure that any broker you work with is licensed and works with a solid company

Preventative Health Care

One of the best things that Costa Rica has to offer your health is the abundant access to fresh air, water, and food that we have, especially in the less populated regions like the Southern Zone. By honoring our health with pure and natural food, we give ourselves the best insurance available: prevention. Many expats love to indulge in power-packed smoothies made with the freshest ingredients. We regularly use foods like organic papaya, banana, mango, lemon, ginger, moringa leaf, turmeric, flaxseed, and bee pollen, all of which are “high-vibe” superfoods that can be sourced locally throughout most of the year (especially if you freeze your mango harvest!) When we honor our bodies with pure and natural food, we give ourselves the best health insurance available!

We are grateful for the many options that Costa Rica’s health care system provides. Whether you choose Caja, private health care, or to go out of pocket, there are many pluses to the various options in Costa Rica when compared to most of the countries from which expats migrate. If you have some more in-depth questions about health care or life in general in Costa Rica, send us a message at sales@osatropicalproperties.com and we will answer as best as we can. Or we will put you in touch with one of the experts in our extended network of contacts in Costa Rica.

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