Health insurance in Costa Rica for expats
Private and international cover, and how it fits with the public system.
Medicare and most US health plans don’t pay for care in Costa Rica. What you need instead depends on your immigration status, your age and how much you want to rely on the public system.
The kinds of cover
- The Caja (CCSS). The public system. Joining is mandatory once you have residency, and the monthly contribution is based on your declared income. It covers existing conditions and has no age limit. See healthcare in Costa Rica.
- Local private insurance. Policies from the state insurer (INS) and from private insurers operating in Costa Rica cover treatment at private hospitals and clinics in the country. They are usually the cheapest private option and generally don’t cover care in the US.
- International insurance. These policies cover you in Costa Rica and other countries, sometimes including the US at a much higher premium. They suit people who travel or want the option of treatment at home.
- Travel or short-term insurance. For a scouting trip, or the months between arriving and your residency being approved.
Who needs what
| Your situation | Usual approach |
|---|---|
| Tourist or scouting trip | Travel insurance |
| Residency application pending | Private or travel cover until you can join the Caja |
| Digital nomad visa | A private policy that meets the visa’s requirements |
| Resident | The Caja, often with private cover or a budget for private care |
Many residents pay for routine private care themselves, which costs far less than in the US, and insure against large hospital bills.
What changes the price
- Your age. Premiums rise steeply after 65, and some insurers stop accepting new customers at a set age.
- Existing conditions, which may be excluded, surcharged or subject to a waiting period.
- The deductible you choose.
- Whether cover includes the US.
When to arrange it
Get quotes before you commit to moving, especially if you are over 65 or have a health condition. Buy the policy a month or two before the move so it is active the day you arrive, because the Caja doesn’t start until your residency is approved.
What to ask a broker
- Which hospitals near where I’ll live accept this policy directly, without me paying first?
- How are my existing conditions treated, in writing?
- Up to what age can I renew, and how have premiums risen for people my age?
- Does the policy meet the digital nomad visa requirements, if that is what I’m applying for?
- Is emergency evacuation included?
- Does it cover me on visits to the US?
Common questions
Do I need private health insurance if I have the Caja?
It isn't required. Residents are covered by the Caja for everything in the public system. Many add private insurance, or pay private doctors directly, to avoid public waiting times for specialists and non-urgent surgery.
Can I use Medicare in Costa Rica?
No. Medicare generally doesn't pay for care outside the United States, so you need other cover while you live in Costa Rica.
Is health insurance required for the digital nomad visa?
Yes. Digital nomad visa holders must have a policy that covers them, and any family members, in Costa Rica for the whole stay, with at least the minimum cover set in the regulations.
This page is general information, not professional advice. Rules and amounts change, and officials apply them differently. Confirm the details with the relevant authority or a qualified professional before you act on them.