Healthcare in Costa Rica

By almost any standard, Costa Rica has some of the best healthcare in Latin America. Not only that, but the country’s public and private health systems are constantly being upgraded—new hospitals, new equipment, and improvements in staff training. Despite the advancements, costs are low in comparison to those in the U.S. and even some European countries. Healthcare costs are about a third of what you’d pay in the U.S. Private doctors, for instance, rarely charge more than $60 a visit, even for house calls. Specialists run $80 to $100 per visit.

Drugs are also much less expensive. Prescriptions are often unnecessary in Costa Rica. You can easily buy many medications in pharmacies that would require a prior visit to the doctor in the U.S. Some big exceptions are drugs that could become addictive and antibiotics. Some pharmacies are allowed to prescribe medicines, including on-the-spot injections.

As in any other country, the quality of care in Costa Rica varies from hospital to hospital and region to region, and the system itself can be confusing to newcomers. The best medical facilities are the private hospitals in the San José area of the Central Valley. Adequate healthcare is available at both private and public facilities throughout the country, but finding it can often be challenging. That’s one of the reasons why many year-round foreign residents with healthcare needs prefer the Central Valley to the coast, but today, the situation is changing, with more facilities in other locations.

When deciding on what part of Costa Rica to settle in, it’s a good idea to ask local residents about the nearest healthcare facilities and their experiences in using them. (This is particularly important if you have a condition that needs regular medical attention.) Also, take some time to visit a nearby hospital and find out if it will serve your particular medical needs, as well as accept your health insurance policy. Many private facilities do take U.S. insurance, but you should also check with your provider to see if your policy is international.

The Public Healthcare System

The Caja Costarricense de Seguro Social, known as Caja, is the government agency that operates 29 public hospitals and 250 clinics. Foreigners living in Costa Rica—legal residents only—can join the CCSS and get unlimited treatment (everything from check-ups to prescription drugs to major surgeries) by paying a small monthly fee based on approximately 6% to 11% of your monthly income. A spouse is considered a dependent and is covered under that monthly fee. Tourists and visitors can use Caja facilities only in emergencies.

For information, contact Caja Costarricense de Seguro Social, CCSS Central offices, Second Avenue, between streets 5 and 7, Diagonal to the SE corner of the National Theater, San José; tel. +506 2539-0000; website: www.ccss.sa.cr.

It is mandatory for residents to pay into the Caja.

The Instituto Nacional de Seguros (INS) also provides private health insurance policies which entitle citizens and foreigners access to doctors, private hospitals, laboratories, and other medical facilities. INS is a government-owned insurance company. For information, contact Instituto Nacional de Seguros, Calles 9 y 9b, Avenida 7, Apartado 10061, San José 1000; tel. +800-835-3467; website: www.ins-cr.com.

Other private insurance companies also serve the Costa Rican market for health insurance, as well as provide coverage for homes and vehicles. There are now several alternatives to INS, if you want to buy private insurance.

The consensus among expats is that public hospitals and clinics generally provide adequate care, but they’re often put off by crowded waiting rooms, modest furnishings, and long waits. Although the doctors often speak English, staff generally speak very little. Wait times for non-emergency testing and procedures can also be months. And if you read the Costa Rican press, you might think that public hospitals are in dire trouble. That’s because the media gives far more attention to problems at public hospitals than they do to those at private facilities.

The Caja and You

We’re always talking about the great medical care that is available in Costa Rica, and how the universal healthcare system (the Caja Costarricense de Seguro Social, or Caja) is open to all residents without exclusion for pre-existing conditions. But what exactly is joining the Caja all about?

To gain residency in Costa Rica, you must qualify through one of three common methods:

• Pensionado: Requires proof of a lifelong pension (e.g., Social Security) of at least $1,000/month (401Ks do not qualify).

• Rentista: Requires a $60,000 deposit into a CD, providing $2,500/month in income over two years.

• Inversionista: Requires a minimum $150,000 investment in Costa Rica, including real estate purchases.

Each category covers the applicant, spouse/partner, and dependent children. Residency and enrollment in the Caja (public healthcare system) are linked but separate processes.

Once you receive your “resolution”—the document that says you’ve been approved for residence—you still don’t get your residence card (your cédula) until you join the Caja. It’s mandatory. First, you have to go to the bank and pay a couple of fees as part of the process—they amount to about $160. Then you take your resolution and the receipts for the fees to the Caja. Next there is a short interview with the Caja case officer to determine the amount you will be required to pay each month as your premium.

Your monthly income (based on whichever of the three residence methods you qualified under) is used to calculate your monthly Caja payment. It’s based on a sliding scale:

• $1,000 and under is 5.18%.

• $1,000 to $2,000 is 6.24%.

• $2,000 to $3,000 is 8.02%.

• Over $3,000 is 10.69%

However, during your interview, you are given the opportunity to amend your gross income to a net income (deducting things like insurance, food costs, medical expenses, taxes, prescriptions, etc.). It is this new net amount that is then used to calculate your monthly Caja payment.

This payment is for you as a couple. And within the Caja, a same-sex couple can qualify together under one income.

Once you have signed up with the Caja and made your first payment, you will receive a receipt that you can take to the local post office to complete the final step of your residence. They’ll take your picture and send off the necessary paperwork, and in a couple of weeks, you’ll return to pick up your cédula (it’s very similar to getting a driver’s license in the U.S.).

Private Healthcare

It’s difficult to find an expat who doesn’t think that Costa Rica’s private hospitals are as good as those back home. The five general hospitals with a full range of services typical of those you’ll find at home are:

• CIMA Hospital, in Escazú just off the Autopista Próspero Fernández; website: www.hospitalcima.com. With nearly 200 doctors in dozens of specialties, CIMA became the favorite hospital of American expats soon after it opened in 2000. CIMA, which stands for Centro Internacional de Medicina, is owned by the International Hospital Corporation of Dallas, Texas, and is affiliated with Baylor University Medical Center, also in Dallas.

• Clínica Bíblica, Calle 1 y Avenida 14, San José or Ruta 310, Pozos, Santa Ana; website: www.clinicabiblica.com. Clínica Bíblica is a nonprofit private hospital with an excellent reputation, especially in surgical, pediatric, and maternity. The hospital, established nearly 90 years ago, is Joint Commission International accredited, and affiliated with the renowned Evergreen Hospital in Washington, Florida Hospital, and Jackson Memorial in Miami.

• Hospital La Católica, San Antonio de Guadalupe, Goicoechea, San José; website: www.hospitallacatolica.com/en. Usually called the Clínica Católica, the hospital was founded by the Franciscan Sisters and is located in a suburb of San José. Clínica Católica has a full range of hospital services that you’d likely find in a large U.S. hospital, including emergency care. Many expats who have been treated at Clínica Católica say it is one of the warmest and most responsive hospitals they have experienced. Though private, Clínica Católica is substantially less expensive than CIMA and often less expensive than Clínica Bíblica.

• Hospital Metropolitano, San José and locations throughout the country; website: www.metropolitanocr.com. These private hospitals have facilities offering a wide range of care, including specialists in many disciplines, surgery, emergency care, physical therapy, and more. They are affiliated with the Medismart Insurance plan offering deep in-program discounts. Locations include San José, Quepos, Huacas, Liberia, and Santa Ana.

• Clinical Hospital San Rafaél Arcángel, 100 Este 25 Sur de Escuela Ascención Esquivel, Calle 3, Provincia de Guanacaste, Liberia; website: www.hcsanrafael.com. This modern private hospital serving the Guanacaste province works with 70 different medical specialists. It has surgery facilities up to international standards and a 24-hour emergency room. It’s the largest private hospital in the province.

Assisted Living in Costa Rica

As North Americans, we’re highly accustomed to assisted living facilities for the elderly, but in Costa Rica, the concept is still very new. Culturally, the children and the elderly are the two highest revered and respected demographics in the country, and it is considered an honor for family members to handle caregiving... a duty, a rite of passage. You care for your elders, and your children will do the same for you when you need it. Most elderly in Costa Rica who are unable to live independently live with family members and receive the care they need.

If that care includes the necessity for medical attention, it’s much more common in Costa Rica to find families hiring nurses or doctors to make home visits, for example, rather than seeking a facility where their loved one would go and live.

However, with the steady influx of expats, tourists, and foreign influence, some assisted living facilities have popped in Costa Rica, in and around the capital of San José in the Central Valley. There have also been signs the government now recognizes assisted living and senior care as a priority healthcare sector, so the potential for continued growth in the near future is high. If this is something that’s going to be of high interest to you, absolutely plan to make a trip and visit these places in person—for the facilities themselves and the care available could be very different from a traditional assisted living facility you would be accustomed to finding back home. Whether or not something available suits your needs is a very individualized and personal decision.

Some examples include Verdeza, Carlos María Ulloa Nursing Home, and José Pujol Marti Retirement Residence.

Note: We at International Living are not able to make recommendations for specific facilities, because again, what you may be looking for could be very different from the next person, but we can at least point you in the right direction to find more information.