Can one fee really cover all my healthcare needs?

by Brett Andrews

About Costa Rica Healthcare

The Costa Rica healthcare system is one of the best in Latin America. Thanks to the high quality and low costs, the country has even become a popular medical tourism destination. Hospital facilities can be found across the country, but the most specialized are located in the Central Valley Region. Despite the high quality of care offered by public hospitals, they can be overcrowded and it’s not uncommon for patients to face long waiting periods and delays in procedures. For this reason, many expats prefer to use the private system instead.

Costa Rica uses a universal healthcare system. Registration within the public system (the Caja) is part of the residency process; expats pay 7-11% of their income into this option each month, either direct or through their employer. Self-employed and retired residents pay into the independent worker plan (asegurado voluntario). This monthly contribution covers spouses and dependents, as well.

Pharmacies are widely available throughout the country, especially in cities and towns. Pharmacists are well trained and allowed to prescribe certain drugs but for the use of antibiotics, narcotics or psychiatric drugs a prescription will be needed.

Here are some examples of what residents pay for health services:

Finding a Physician

As best we can determine, Costa Rica has three paths to finding a physician. Under the Caja public system, you receive care from whichever general physician (GP) is available. You’re more likely to find English-speaking doctors under the private system, where residents can select their GP and preferred hospital. Finally, health discount plans like MediSmart offer access to private services through in-network doctors and clinics, much like an HMO in the U.S. 

Public Healthcare

All expats must register under the Caja public healthcare system once they complete the 18-month residency process. This universal healthcare system covers all Costa Rican residents at over 30 hospitals and 250+ clinics at no cost beyond their monthly income contributions. Pre-existing conditions and nearly all medical services are covered for in the public system, which likely contributes to the country’s 80-year life expectancy.

The public and private healthcare systems are roughly on par with each other in terms of quality equipment and physicians. Many doctors will practice under Caja in the mornings and keep private clinic hours during afternoons and evenings. However, long wait times and specialist scarcity under the public system make a mix of public and private coverage an attractive choice for many expats.

Private Healthcare

With its reduced wait times and greater number of English-speaking doctors, expats commonly purchase private insurance to supplement the public Caja plan. Most expats use three private hospitals for their care: CIMA hospital in Escazú, Clínica Bíblica in San José, and Hospital La Católica in San José-Guadalupe. All these facilities are in and around San José, the Costa Rican capital.

Some expats carry global medical insurance from international firms like Cigna. Others purchase private insurance through the Instituto de Seguro Nacional (INS), the government’s private insurance monopoly that may charge lower premiums. In either case, pre-existing conditions tend to get excluded, giving the public Caja health system continued relevance for all residents.

Out-of-pocket Options

With its lower costs for medical services, paying out-of-pocket offers a viable option for many expats living in Costa Rica. Standard GP visits range from $60-$75 USD, while specialist visits and diagnostic tests remain under $100 USD. Most medical facilities expect cash payment upfront. The lower costs for quality healthcare make this a prime spot for medical tourism, with roughly 5 percent of all international visitors coming for some health service. Read out Costa Rica cost of living guide to see what your expat budget may look like there.

Healthcare Checklist

• Schedule final appointments with your primary care physician and any specialists you see.
• Research your medications for availability in Costa Rica and find alternatives where needed.
• Stock up on prescription refills until you can get to the pharmacy in Costa Rica. It’s a dance because you’ll save money by filling your prescriptions in country, but it may take time for you to learn your way around. 
• Print out and keep photographic records of all prescriptions. Bring meds in original packaging with a letter from your doctor detailing your condition, the drug, and its generic name.
• Request your medical records and, ideally, upload them to a cloud server where you can access them anywhere. Alternatively, printouts, desktop files, and thumb drives also work.
• Ask your providers for referrals abroad. You never know!
• Maintain private insurance or have cash on hand to handle medical expenses while you apply for residency.
• After getting your residency, register for your public health insurance policy at your local Caja office.
• For private healthcare, apply for private insurance and get physician names. Visit your expat Facebook group, the U.S. Embassy’s list, or other forums to ask for recommendations. 
• See your family doctor and get prescriptions and referrals.