Healthcare in Costa Rica for Americans: the Caja and private care

Costa Rica has two healthcare systems side by side: a public one that every resident must join, and a private one that you pay for directly or through insurance. Most foreign residents use both.

The public system: the Caja

The Caja Costarricense de Seguro Social (CCSS), known as the Caja, runs the public hospitals and the network of local clinics called EBAIS.

• Who joins. Everyone with legal residency. Registering is one of the last steps of a residency application, and you show up-to-date payments at each renewal.
• What it costs. A monthly contribution calculated as a percentage of the income you declared to immigration. The rates differ by category and age, and they are revised from time to time.
• Who it covers. The member and a dependent spouse and children.
• What it covers. Doctor visits, prescriptions, lab tests, hospital stays, surgery and emergency care in the public system, without copays. Existing conditions are covered, and there is no upper age limit.

The limits are practical ones:

• You are assigned to a local clinic and referred onward from there.
• Waits for specialists, imaging and non-urgent surgery can run to months or longer.
• Most of it happens in Spanish.
• You don’t choose your doctor.

Private care

Private doctors, clinics, labs and hospitals operate alongside the Caja. The largest private hospitals are in and around San José, with smaller hospitals and clinics in Guanacaste and other areas with many foreign residents.

• You can usually see a specialist within days.
• Many private doctors trained partly abroad and speak English.
• Prices are far below US prices. A specialist visit is often $60 to $100, and procedures commonly cost a fraction of the US price. Ask for a written estimate before anything major.

Insurance

Three kinds of cover are used with or instead of paying directly:

• Local private policies, sold by the state insurer (INS) and by private insurers operating in Costa Rica.
• International policies, which cover you in Costa Rica and elsewhere.
• Travel or short-term cover, for the period before your residency is approved.

See health insurance in Costa Rica for how to choose.

How residents combine them

Need	What many residents do
Routine visits and prescriptions	The local Caja clinic, or a private doctor paid directly
A specialist or a scan soon	Private, paid directly or through insurance
Chronic conditions and long-term medicines	The Caja
Major surgery or hospital care	The Caja, or a private hospital with insurance
Emergencies	The nearest hospital, public or private

Before you are a resident

Tourists and people with a residency application pending are not in the Caja. For that period, which can last a year or more, arrange private or travel insurance. Holders of the digital nomad visa must carry private insurance for their whole stay.

Medicare

Medicare generally doesn’t pay for care outside the United States. Many retirees keep Part B anyway, for visits home and in case they move back. Dropping it and re-enrolling later can mean permanent penalties, so take advice before you decide. See retiring in Costa Rica.

Where you live matters

The big hospitals are in the Central Valley. If you have a condition that needs regular specialist care, check the drive from the town you are considering before you choose it. Some beach areas are three to five hours from San José by road. See the best places to live in Costa Rica.

Pharmacies and dental care

Pharmacies are everywhere, pharmacists give advice, and many medicines that need a prescription in the US are sold without one. Some medicines cost less than in the US and some cost more. Dental care is good and inexpensive, and is paid privately.

Common questions

Do expats get free healthcare in Costa Rica?

It isn't free. Legal residents must join the public system, the Caja, and pay a monthly contribution based on their declared income. Once you are a member, visits, medicines and hospital care in the public system have no further charge.

How much does the Caja cost for residents?

The contribution is a percentage of the income you declared in your residency application, and the percentage depends on your category and age. People commonly report paying from under $100 to several hundred dollars a month. Ask your attorney for a current estimate.

Can tourists use healthcare in Costa Rica?

Tourists can use private doctors and hospitals and pay directly or through travel insurance. Public hospitals treat emergencies and may bill non-members afterwards.

Is healthcare in Costa Rica good?

Costa Rica's health outcomes are among the best in Latin America, and its doctors are well trained. The public system's weakness is waiting time for specialists and non-urgent surgery. Private care is quick and costs much less than in the US.