Health Insurance in Costa Rica: Your Options

When you live in Costa Rica, one of your day-to-day concerns will be your health: how to stay healthy and what to do, if you ever get sick. With this on your mind, your thoughts turn to in-surance: What are your health insurance options in Costa Rica?

In a word – many! Since Costa Rica’s private health insurance market opened up a few years ago, your options have grown. And grown and grown and grown. Today, dozens of companies offer an array of coverage and options.

Quick Note: If you carry insurance in the U.S. or in another country, check to see if your policy covers you in Costa Rica. (And, if so, check to see what, exactly, is covered.) Many international insurance policies offer coverage here, and if you go back and forth, from Costa Rica to abroad, keeping your health insurance can be an excellent (and convenient) option.

Caja Costarricense de Seguro Social (aka CCSS or “La Caja”): Let’s start with the super basic: la Caja, the Costa Rican public health system. When you become a resident of Costa Rica, part of the application and eventual renewal process is your affiliation with the Caja (it’s required).

Strictly speaking, the Caja offers every healthcare service you’d ever need. Practically speaking, the system probably works differently than what you’re used to: Service is centralized; there are long wait times; and the lines can be even longer. Most Kalia homeowners find that the Caja offers top-notch preventive healthcare – e.g. yearly well visits, blood work, monthly prescrip-tions, etc. – and emergency care, for example if you were to have an accident. Additionally, the Caja covers all preexisting conditions.

For all other health needs, we recommend you visit a private doctor, clinic or hospital. You’ll enjoy highly attentive service, great bedside manner, fast results and other benefits this way. Here are the basics of private healthcare options in Costa Rica:

Private Pay: If you’re from the U.S., you’ll be pleasantly surprised at the cost of private-pay healthcare here. A basic office visit will run you about $40 out of pocket, while basic bloodwork can cost $20, antibiotics run $10 for a full course, and surgery typically comes in at 25%-40% of the equivalent cost in the U.S.

Many experts find a happy medium between the Caja’s preventive and emergency healthcare, and a sprinkling of private-pay office visits. That said, if you’re interested in something a little more robust, look no further than private insurance:

INS: This government-owned insurance company was once the only private offering in Costa Rica. Their monopoly faded a few years ago, but INS is still the big daddy of Costa Rican private insurance. There are many brokers in our area and what’s more, INS offers some of the best coverage in the country, with a huge network of affiliated doctors and clinics.

That said, with all private insurance in Costa Rica, know that you’ll have to pay 100% of your bill upfront; you’ll later submit your receipts for reimbursement (typically, about 70%-80% of the total, but it depends on the bill and your individual policy). Also know that most private insurance carriers do not cover preexisting conditions.

BlueCross-BlueShield: After INS, BCBS is one of the most popular expat choices for private health insurance. Coverage is wide, reimbursement is relatively simple, and terms are similar to what you’re used to, since BCBS is an international insurance company with many decades in the business.

Other Private Insurance: Dozens of other insurance options have cropped up in the last five years, each offering a slightly different variation on the same thing: health insurance. With eve-ry option, you’ll pay your bill upfront, then request reimbursement of your bills – office visits, prescriptions, tests, etc.

Medismart: One of the newest (and most innovative) options is Medismart, a plan offered through the Hospital Metropolitano in San José. In a nutshell, for a small monthly fee (about $10 per person), you’ll get a substantial discount (usually 40% to 80%, depending on the proce-dure) on all things medical.

The catch to Medismart is that the discount plan is available only at the Hospital Metropolitano. Upside: If you’re already going to be in town, say for a bimonthly shopping trip, plan a pit stop. And, if you’re contemplating a big procedure, you can either drive into the Central Valley or take a cheap flight (usually less than $75 per way); the savings on big medical bills will more than pay for your gas or flight.

Have questions about health insurance in Costa Rica? We live here, we talk to lots of ex-pats, and we have all the local connections – we know what you want to know! And we’re happy to share the knowledge, so please get in touch. Call (800) 219-0310 or email us with questions.