Healthcare in Costa Rica

CAJA is the government insurance in Costa Rica.  Every community has a clinic, hospital, or medico somewhere nearby.  Where you live dictates where you go.  If you become a resident of Costa Rica whether it be temporary or permanent you MUST pay into CAJA.  Fees seem to vary widely but I know of three families with temporary residency that pay $50 per month for the family.  The down side of CAJA is long, long waits to have any type of procedure done.  You cannot make appointments, you stand in line.  You must go to the facility closest to where you live.  CAJA will accept existing medical conditions and cover the cost of SOME medications.
There is also a Costa Rica insurance plan called INS which you can join.  This will entitle you to choose what medical facility you want and where you want.  I don't have a cost for this insurance but here is an interesting link.  Above and beyond that there are many private insurance companies such as Blue Cross that will provide coverage for a fee.  They vary widely in what they cover and what they cost.

http://www.therealcostarica.com/living_ … tml#Health

http://internationalliving.com/countrie … alth-care/

http://costarica.com/relocation/health-care/

Thanks for your post TerrynViv

Any Time!!!  We are moving there in early 2014 and have a lot of information and literature in preparation for said move.

You basically have three types of access into health care here. 

Number uno is the social insurance, nicknamed CAJA. It is the universal coverage from the government (truly universal). As TerrynViv noted most people have a local clinic they are assigned to but there is no restriction that you can't visit any clinic you want. This is important, because facilities differ widely in quality around Costa Rica. Some are new with modern equipment, others are over-crowded, old buildings, short of supplies. Getting into the emergency room, if you have an immediate care need, is the usual place to start. If you don't have something urgent you have to make an appointment with a doctor, which depending on what your problem is, could be a year away! Once you are in, however, especially if you get sent to a CAJA hospital in San José, the care is good to very good, sometimes better than in the States. Sometimes if CAJA can't do the job they will pay for you to go to a private clinic (usually this is for life-threatening/altering stuff).

Number two is the private sector, which pretty much works just like in the U.S. except that the cost is about 1/4 to 1/3 compared to the States, and a lot of doctor offices don't open until after 4 PM. The cost to see a doctor is about what you'd pay in your co-pay in the U.S. There is insurance from INS, but also from global companies for about $100/month per person. The doctors are very good and this goes for dentistry here, too.

The last one, is sort of semi-private and just for small problems. It consists of going to any pharmacy, all of which are run by a doctor, who is usually there. It's strictly primary care, you get free consultation and leave with a prescription, if needed. It's really great for the small stuff.

pura vida,

Casey  - A Dull Roar

Thank you Casey for your help

What if you are on tourist visa living in Costa Rica?  What kind of health care can you expect?

agordo wrote:

What if you are on tourist visa living in Costa Rica?  What kind of health care can you expect?

Well, of course, you have all the private side available to you, the pharmacies and clinics. Most larger towns have 24 hour urgent care facilities, too. Expect to pay about 60-75% less than retail in the States. I have heard of travel health insurance, but I don't have any data on how well that works.

If you are living here as a so-called perpetual tourist, you can get on the Caja, too. I don't know if there is any difference in coverage, but I know people who have done it. Caja is glad to get all the funding they can get.

pura vida,

Casey.

Casey, where can you get global private sector insurance for "about $100 per month per person"?  I've been researching global health care policies for Costa Rica and haven't come anywhere near that low of a monthly cost.  The quotes I've seen are 3 to 4 times that amount, with high deductibles.

I'd love to find rates closer to yours!

I don't have that insurance, just heard about it. I have a friend here who has it for his son. It might just apply to Costa Rica. I'm skeptical myself that it can pay much at that monthly rate. I recall reading about some kind of universal insurance (that I'm quite sure doesn't work in the U.S.) for around $2,000, but didn't look into the details.

Besides the Caja we go without insurance here because the private sector costs are so reasonable. Case in point: an abdominal CAT scan is 500 bux. Sounds like a lot until you compare it to the lowest cost provider in Portland, OR (our home state) where it's about $2500.

For emergencies or stuff that can wait a while, we can use the Caja. In fact, you can do a hybrid, getting operations in Caja but the tests in the private sector (because they are faster), which makes self-insuring feasible (for those of us who are not Mitt Romney, lol).

[On edit]: having made a few doctors visits this last week, I forgot to add how much more accessible private care is here. I don't recall every having to fill out a form, for instance. They'll ask questions of course, but none of that long-form stuff asking for medical details you couldn't possibly remember! Also, the doctors are not rushed, so they spend a lot more time with you than the usual 15 mins. you're lucky to get in the States.

don't forget about the "urgent care" facilities - it is also in the public system, and is for things like small accidents; not life-threatening, but requires fairly immediate response (e.g., you badly cut your finger, so you go to the urgent care office across the street from the Calderon hospital)

We don't have a public urgent care facility down here, just the emergency room at the hospital. Caja distributes its resources very unevenly I think and so far Pérez is getting the short end of the stick.

- Casey  A Dull Roar

Personally the Costa Rica system is broken! Its better than some places in the world but don't believe anyone that says it is a good system.
My mother in-law a tica has been waiting two years to see someone for her parkinson's.  We also had a family member die in child birth because of a nurse that ruptured a artery. In costa rica you can't sue the doctors because they are working for the government.

I encourage people to get private health insurance and go to the private hospitals!

redbeard wrote:

Casey, where can you get global private sector insurance for "about $100 per month per person"?  I've been researching global health care policies for Costa Rica and haven't come anywhere near that low of a monthly cost.  The quotes I've seen are 3 to 4 times that amount, with high deductibles.

I'd love to find rates closer to yours!

Tne private insurance INS for example will cost about 2500 USD per person (depending the age) and per year for a stranger  ... not cheap at all.

Scottico, is correct. Get private health insurance. I have been to the big downtown hospital and it was awful! The hospital in Puntarenus is horrifying. If you are on the Caribbean side and require "advanced" medical care, you are better off with a voodoo doctor, because Limon is the worst of them all! Private care is lovely, far advanced than the US and cheaper than you would expect. CIMA is state of the art, BUT CAJA is the only system designed for specially advanced procedures: organ transplants, serious brain/spinal injuries, etc. and that’s where you will go if you need serious care, even if you do have private healthcare. I don’t mean to scare anyone, but you should be prepared. Like when people say “long lines”, if you are admitted, expect to be at CAJA at least 12 hours.

Crenvy also stated that you would have a procedure done in CAJA and then get tests done in the private sector, “you can do a hybrid, getting operations in Caja but the tests in the private sector”. This is technically illegal. The doctors are getting kickbacks from the private clinics for sending you there, even though all the tests (x-rays, CAT scans, etc.) can be done at CAJA. They will tell you that the wait is too long, but his buddy’s private practice down the street can fit you in today. Most people are too scared to argue and pay up.
Knowledge is power.

That's a lot of nonsense about the rationale for the hybrid approach. We know doctors personally that work in both private and public clinics and they are quite honest and professional. There really are not enough medical resources in some of the hospitals to accommodate the large number of patients, thus the wait times for non-life threatening situations.

Let me point out to anyone reading this thread that there are some very good examples here of unhappy ex-pats who look for the bad in everything, think CR is one big conspiracy, etc., and for the life of me I can't figure out why they stay here.

I personally know gringos and ticos who have had very good experiences with the CAJA and it has not been all bad for us, either. You simply have to adjust to what realities are in whatever country you land in. Educate yourself and leave behind your preconceptions based on where you came from and you will have far fewer unhappy surprises.

A Dull Roar

I don’t think anyone on this post is an “unhappy ex-pats who look for the bad in everything, think CR is one big conspiracy, etc”. In fact, that is what I like about the posts on this site. People seem honestly invested in giving people good advice.
CAJA is broken. That is not a big conspiracy. That is the truth. Many doctors work in both CAJA and the private sector, and that is standard for CR. That’s how they make money. Honor and professionalism have nothing to do with it. Doctors referring patients to private clinics to speed up a case through CAJA is illegal and I do not suggest doing the “hybrid”, as it is part of the problem with CAJA. I have family members that work for CAJA and I know what happens, good and bad, and truth be told, the system is on the verge of collapse. If you go there for your medication, stitches, basic care, you will find the treatment adequate, although a bit sluggish. I went in for a basic surgical procedure and it went horribly wrong…on many levels. I will never allow myself to be admitted into CAJA ever again. That is not a “conspiracy” that is knowledge people need to take into consideration when they require medical care.

Hi, my name is Jerry and my wife and I will be comming down there shortly. I have a question on health care, We are going to go for the Pensionado Residence but in between the time we are eligable for the Caja plan what does one do in the mean time? I am a vet so I can gp to the VA if need be, but my wife age 68 does not have anything except Medicare from the states. What advice could you give us? Thanks Jerry

Hi

I am a retired MSW who spent most of his years working as a nurse and for a time, an EMT. I mention these seemingly irreverent historical facts only to give credence to my views. First, once you satisfy the requirements for CR residency you will be required to buy into a social welfare hospital and health care system. Residency may take time. I have been here over 4 years and still I wait. Admittedly, most people have better luck.

The quality of the care is maybe good, but most often bad. People often get docs who work in both the public and private systems. That way they will get meds for free.when it comes to hospitals, I would not want to find myself in one. They are not nearly as clean as any US hospital. You might have waited a year to have your appendectomy only to find yourself in a ward with locals who have not nearly the expectations you might have. And wait? Oh, yes, for a critically important diagnostic test to rule out a lethel condition, you might wait a year. In most cases, expats would go private. There are three good private hospitals with a reputation. They are in  SanJose. I know they have private insurance and that might be the way to go. I know of people who have died either from waiting for an ambulance or the medical mismanagement they received once the ambulance arrived. You are coming to a third world country.

Hi, thanks for the info in regarding health care, I think that we will probably buy her a private policy with high deductable until the other kicks in. We are looking at either Grecia or Antenas as my wife likes the sunny and warmer area a little better. Would you advise to rent a car or buy one?

Here's our experience using La Catolica Hospital in San Jose:
http://keepingyouinstitches.wordpress.c … -catolica/

We are in the CAJA, but use private docs for most stuff. Get our meds from CAJA pharmacy - but not all meds prescribed in U.S. are available here or in the dosages needed.

We have no private insurance. We figure what we would pay in premiums go into a "fund" that we will use if needed.

You are thinking of moving here and think you can rent a car for long term? Not doable. Leasing is available. Since you're on this forum, I guess you are on a budget?

This will determine whether or not you should buy a car. For a ten year old car you will pay $20,000. Figure $100 a month for repairs and maintenance. Can you afford it?

If not live where there is a bus or taxis readily available.

Atenas and Grecia have plenty of place to live where a car is not necessary.

Good luck.

Outstanding info! I never really considered leasing a car, but might be a good option. We have decided to lease our home in Texas for one year and by then we should know if we are suited for this way of life. I hope so ,but my wife has to be convinced first. Thanks again. Jerry

Hi,

In order to help expats and soon-to-be expats, we would like to invite you to share your experience on this topic, with updated info on the healthcare system.

Thank you in advance,

Julie
Expat.com Team

I do not agree with DDTica's statement that doing "a hybrid, getting operations in Caja but the tests in the private sector ... is technically illegal. The doctors are getting kickbacks from the private clinics for sending you there, even though all the tests (x-rays, CAT scans, etc.) can be done at CAJA. They will tell you that the wait is too long, but his buddy’s private practice down the street can fit you in today. Most people are too scared to argue and pay up."

In many cases the reality is that "the wait is too long" with CAJA, but you can get tests done more quickly via the private sector.  I joined CAJA last year and after my first appointment the doctor asked me to get a chest x-ray at the CCSS regional hospital in Nicoya.  I went to the hospital to schedule an appointment, and they said my appointment would be in 5 months! It was not critical for me, but I could have gotten an x-ray in a private facility within a week or two. I did have an MRI on my shoulder at a private facility after I tore my rotator cuff, shortly after making an appointment.  There are numerous stories of long waiting times for such treatments via CAJA.  You can to to any private facility, you need not go to the one suggested by the CAJA doctor, so no kickback need be involved.  Kickbacks are illegal, but there is nothing illegal about making your own decision to get private care or testing.

I believe that the "hybrid approach" is the best approach.  My wife and I are currently paying about $7500 per year for private insurance - it includes coverage in network hospitals in the USA and has a $5000 deductible.  We will soon be eligible for Medicare in the USA and then will buy lower cost health insurance that does not include coverage in the USA.  I use CAJA for routine blood and urine tests and I get prescription meds at no additional costs via CAJA.  I see a private doctor and private test facilities for my shoulder, and my wife has been to a private clinic for some health concerns for which we have greater "trust" in the private facilities.

The biggest problem with private healthcare is that pre-existing conditions are generally not covered or have restrictions on coverage. We bought a high-deductible policy for emergency coverage in the private sector, and we self-pay for routine private health care - the costs are generally quite reasonable relative to comparable treatments in the USA.

bottrader wrote:

redbeard wrote:

Casey, where can you get global private sector insurance for "about $100 per month per person"?  I've been researching global health care policies for Costa Rica and haven't come anywhere near that low of a monthly cost.  The quotes I've seen are 3 to 4 times that amount, with high deductibles.

I'd love to find rates closer to yours!

The private insurance INS for example will cost about 2500 USD per person (depending the age) and per year for a stranger  ... not cheap at all.

$2,500 per person per year is $200/month - a very good rate compared to US costs ($600+/month). It is all relative I guess.

We have private insurance and use the private system... $5,000 for family of 4 - no deductible - comprehensive coverage. http://familyfreedomproject.com/health- … osta-rica/

liisav wrote:

We have private insurance and use the private system... $5,000 for family of 4 - no deductible - comprehensive coverage. http://familyfreedomproject.com/health- … osta-rica/

That's not cheap imho.
But just for comparison my wife and I paid $450/month or $5400 a year for just the two of us last year under Obamacare.
We still had to pay $45 for doctor visits, $45 for xrays and blood tests, and $90 per specialist visit here in CALIF.

We basically wasted that money as we could have gotten everything we needed for under $1000 without insurance.

As an example I had a colonoscopy done and they charged the insurance co. here in CA $18,000.00 - yes, Eighteen THOUSAND dollars - for the same colonoscopy you can get in Costa RIca for $300-600. Then they wanted me to pay certain charges that they said were not covered. I had to fight them to get them to pay those charges and it took me months to get it resolved.

By comparison, health care - even at a private facility - even with no insurance - in Costa Rica is cheaper than WITH insurance here in the USA.

What I think my wife and I will do when we are residents of  Costa Rica is pay the required CAJA and then if need be we'll go to a private hospital like CIMA or Biblica for any needed procedures CAJA won't cover or provide in a timely manner. We won't be able to afford private insurance in  Costa Rica from the sound of it.

There is also the option of catastrophic coverage... in case of emergency. That is more affordable at about $3000 for a family of 4. Insurance is just that - insurance. It's not a waste of money if you have to use it. It doesn't mean you are going to use it though.

We live 4 hours from San Jose and at least an hour from the nearest hospital... in an emergency, we are going to need a helicopter. I'm willing to pay the $3000 worth of insurance for piece of mind. A friend had complications from kidney stones here - youngish guy, maybe 40 - his bill is now over $100,000 - no insurance. Another of the several GoFundMe campaigns for the uninsured that we have contributed to - I don't mind helping since I can; I just don't want to be on the receiving end.

Two other recent friends' issues: Snake bite in a 29 year old -  around $5,000 in bills and unable to work for a couple of weeks; prostate cancer in a 50-something guy, over $100,000... of course it may not happen to me or you, but if it does, I don't want added financial stress.

liisav wrote:

There is also the option of catastrophic coverage... in case of emergency. That is more affordable at about $3000 for a family of 4. Insurance is just that - insurance. It's not a waste of money if you have to use it. It doesn't mean you are going to use it though.

We live 4 hours from San Jose and at least an hour from the nearest hospital... in an emergency, we are going to need a helicopter. I'm willing to pay the $3000 worth of insurance for piece of mind. A friend had complications from kidney stones here - youngish guy, maybe 40 - his bill is now over $100,000 - no insurance. Another of the several GoFundMe campaigns for the uninsured that we have contributed to - I don't mind helping since I can; I just don't want to be on the receiving end.

Two other recent friends' issues: Snake bite in a 29 year old -  around $5,000 in bills and unable to work for a couple of weeks; prostate cancer in a 50-something guy, over $100,000... of course it may not happen to me or you, but if it does, I don't want added financial stress.

I totally get what you are saying. Insurance is for when you need it and when you need it you will be glad you have it.
That said, both in the USA and COSTA RICA, some people simply can't afford it, with or without Obamacare.

We cannot afford to spend $5-6k on health insurance this year and when we are in  Costa Rica next year we will even LESS be able to afford it. At some point when we sell some property we have there, we then may be able to afford it, but until then ... no. Even $3k is $250/month and I know plenty of retirees living in Costa Rica who simply can't afford that, us included. Sometimes economic realities prevent people from doing what is ideal.

Of course, I get that! Having the CAJA will be your back up insurance.

Those who are not residents seem to get into the most trouble... and I think cancer outcomes are definitely better if one can use the private system.

Totally agree with DDTica: "CAJA is broken. That is not a big conspiracy. That is the truth."

From my experience, the public health care system is often sold in retirement publications as this wonderful safety net for Costa Ricans, visiting foreigners and Ex-Pats. Living here for 4 years I see it as an inefficient system that may be well intentioned but is absolutely ineffective when you need care beyond a simple checkup or a vaccination.

Whether you are a foreigner or citizen you will be forced to pay for rationed health care (as a requirement of having permanent residency) that is mediocre at best. As long as you never need any treatment for something serious it’s great. Just ask Costa Ricans where they go when they are sick… if they have the money they will avoid the public hospitals and go to private clinics. Otherwise they are stuck in super long lines waiting/hoping they will be seen and in most cases are put on waiting lists for even the most basic procedures.

For example, I was told I would have to wait 2 years for a simple hernia operation and ended up having it done at the private hospital CIMA for about $5,800 which is essentially what I priced it at in south Florida. CIMA by the way did a very good job and the service was excellent.  I have a relative that needs a cardiac related catheter and was told  it’s a 3 year waiting list.  There is also minimal availability for dialysis. I have friends from Colombia that have paid into the public health care system for about a decade and one of them was recently diagnosed with severe diabetes affecting his kidneys and he requires dialysis every 3 days. While a private hospital (CIMA, Clinicia Biblica, etc.) can provide service, it is very expensive and the public health care system does not have enough dialysis equipment in the country to meet the demand. There are supposedly over 500 people in the country needing cardiac related catheters that are wait listed for their surgery. Bottom line is that in Costa Rica you are forced to pay into a public health care system that is super dysfunctional and if you can afford it you go and pay out of pocket for good service and/or buy a private policy to cover yourself and family. By the way, my friend that needs dialysis went back to Colombia where they also have public health care and as I understand he gets his treatment there without any problems.

In my experience living here I would not count on Costa Rica’s public health system. One benefit is that dental and plastic surgery related procedures are relatively inexpensive but be prepared to budget pretty much what you would pay in the US for most non-dental and plastic surgery related procedures in Costa Rica. For whatever it's worth, I have a family policy with Cigna Global for anything beyond a doctor visit. Unfortunately I bought the insurance after my hernia surgery.

If you can't afford insurance you should have a financial safety net.

For a new resident, remember it could take a year ...or two to be covered by CAJA, and relying or expecting CAJA to cover everything, is asking for trouble.

Wayyyy back at the beginning of this post, a member writes "... have a local clinic they are assigned to but there is no restriction that you can't visit any clinic you want" This is not so, and may be permitted only in the case of a 'life threatening emergency'. It will up to the doctor to decide...
And "..:that non-residents can join". While this may have occurred in the past, it is no longer permissible to do so.

In an emergency a 'tourist' may request aid, but they will be asked for payment, possibly in advance of treatment, Again this will be decided by the doctor ...and it usually one doctor in the EBAIS...in attendance.

Well it seems that the CAJA is indeed a lousy system.
Years ago I was convinced through various  Costa Rica forums that it was GOOD, so either people were exaggerating/lying OR it's gotten much worse.

Thanks for the feedback on this.

Sounds much like Obamacare:
forced to buy crappy insurance.

Hi Samramon... the CAJA is definately the "pink elephant" here in Costa Rica and it is draining their resources in a very big way. The positive thing is that as a Costa Rican citizen you are not obligated to buy any insurance from the caja but as soon as you work for somebody you are dragged into the system as your employer is forced to pay into the system on your behalf.

I've been out of the mix on Obamacare and please correct me if I am misunderstanding this but as I understand at least you can choose your insurance provider and be in compliance with Obamacare. What's interesting is that my Cigna Global policy is applicable in the U.S. but you have to be a permanent resident outside of the U.S.  It's just $400 for my wife, myself and son and covers up to $1M annually for each person.  I don't work in any way for Cigna but it seems the policy is pretty reasonable give it covers my family anywhere in the world while we are traveling.  If we lived in the U.S. I imagine it would be much more expensive for the policy.

I believe most people think the CAJA is fine until they have something serious happen and are disappointed when it doesn't live up to their expectations. I haven't had to use my CIGNA policy as yet so perhaps I may be upset with them or hopefully pleasantly surprised by great service. Supposedly there is no deductible on the Cigna policy but it only covers hospitalization, surgeries, etc. It does not cover a basic doctor visit which in Costa Rica is relatively inexpensive and I didn't feel coverage was justified given the added monthly cost.

Best Regards,
-Mike

Good post, thanks for the info re CIGNA.

I believe you can choose any health care coverage you want with Obamacare but if it is not an employee sponsored one it is going to be relatively expensive.

I am an independent contractor so the cheapest ins. policy I could find that was more than just "catastrophic" illness coverage and didn't have exorbitant co-pays was the one we got from Anthem HMO. I would never have Anthem again. Their employee plan which I had in the past was good but their individual plan which we had last year was lousy and they were lousy in terms of billing and coverage etc.

Anyway as I think I mentioned above we had to pay $450 or so for just my wife and me and that included a $500 subsidy from the government so the actual cost of the policy was around $950/month! Yes, really!
Then we still had to pay $45 and $90 office visits and $45 lab and xrays etc.

The thing with health care is to make sure you eat well, exercise and stay healthy! A catastrophic plan is something we hope we can at least afford when we live in  Costa Rica next year.

Can I ask about pre existing conditions? My husband is type I diabetic. Can I buy private insurance for him with this? Can I get pump supplies there? and humalog. Also, does public sector cover this everyday stuff? I am thinking private might be better? Or are these supplies something we can get from the pharmacy without a prescription? I have never lived abroad and am unsure how anything but U.S.A. insurance works. Thanks.

I am type II, most insurers that I checked with did not cover pre-existing conditions.  CAJA, the national medical system does AFTER you become a resident.  I have had zero problem filling my prescription as long as I am paying for it.  We just showed my prescriptions from Canada to get my meds.  You can find most prescription meds or generic equivalent here but you need to check up front before committing yourself.
Cheers .... Terry

Do your homework... there is nothing cheap about Costa Rica anymore. Ten years ago Costa Rica was inexpensive. Today you will see very high pricing and taxes on top of taxes on top of more taxes. As a simple example... make a product and sell it to a distributor (13% tax to govt.)... distributor sells it to a store (13% tax to govt.)... store sells it to the end user (13% tax to govt.).  So not taking into account any profit margins for the manufacturer, distributor or store, the government's cut will take a $1 product up to $1.44 just in changing hands. If the product is imported (i.e. a refrigerator, phone, etc.) add on the import duties, transportation costs, bribes, etc. The costs also go up due to the high transportation cost on every product in the country resulting from a collapsing roadway infrastructure and inflated fuel prices.

Regarding cars, if it's a new gasoline powered car budget at least 50% of the government's "declared"/inflated value for taxes in addition to the annual vehicle inspection and registration fees that are unavoidable if you want the privilege of driving the car on Costa Rica's roadways. Keep in mind the registration fees are not based on vehicle weight but the government's value of your vehicle... essentially you will pay a penalty on having a decent vehicle. I have seen annual registrations pushing $4,000 for a new Land Rover or as high as $300/year for my 2003 Nissan Pickup.

In my experience, on the average every dollar I bring to Costa Rica gives me about 50 cents in real purchasing power for most goods. What's cheap?... bananas, pineapples, haircuts, salaries and some services are cheaper.  For example a decent private school taught in English for my 4 year old runs about $420/month which is probably cheaper than most day care services in the U.S.

Don't believe the hype... Costa Rica pricing is on a rapid upward trend under the guise of the government's favorite buzz term "valor aggregado" or "value added". I am still trying to find the added value.

Sorry for straying a bit off topic here but there are trade offs in everything and in my case I wouldn't recommend counting on the CAJA for your medical care if you can afford anything better.

Cheers!
-Mike

terrynviv are you on a pump or shots? I think the humalog should be easy to find but am unsure about pump supplies.