You don’t have to be close to retirement age to start dreaming of a new life in Costa Rica. This gorgeous country boasts beautiful natural landscapes, outstanding biodiversity, and a mild climate — all within a short flight from the United States. And its healthcare system is frequently cited as one of the most comprehensive and affordable in the world, something that’s always top of mind for retirees. In fact, Costa Rica’s system is ranked 36th in the world by the World Health Organization, above the United States, Cuba, and New Zealand.
If you’re dreaming of retirement in paradise, these are some important things to know about healthcare in Costa Rica.
1. Costa Rica Introduced Public Healthcare In The 1940s
Universal health insurance has deep roots in Costa Rica. It’s been a part of Costa Rican culture for about 75 years and citizens are understandably proud of what their country has accomplished.
However, while the system is indeed comprehensive and affordable, it’s far from perfect. Common complaints surround bureaucratic red tape, long wait times that just seem to get longer, and a gap in the standards of care between urban and rural facilities. In particular, many rural facilities are very basic and long overdue for an upgrade in infrastructure, diagnostic equipment, and even staffing levels. Expats moving to Costa Rica may find that healthcare facilities are more crowded and less private than what they’re used to.
2. There Are Private And Public Options
The public healthcare system in Costa Rica is nicknamed “La Caja,” a short form of “Caja Costarricense de Seguro Social” or the “CCSS.” It is funded primarily through payroll taxes. The rate you pay is based on income and averages 7percent–11 percent.
In addition to “La Caja,” there is a second system known as “INS.” This is short for “Instituto de Seguro Nacional.” It is a form of private health insurance run by the Costa Rican government. People who chose INS can expect coverage for dental work, optometry, and annual check-ups. They’re also allowed to visit private hospitals and clinics.
3. Expats Are Part Of The System
It’s not just Costa Rican citizens who are part of the public healthcare system. Anyone with residency papers must become part of La Caja. It’s important to note that this applies to expats with legal resident status (such as those in a residency program like pensionado or rentista). Just because you visit the country each year and think of yourself as “living” in Costa Rica part-time doesn’t mean you’re a legal resident.
Not all expats with residency status like the idea of mandatory enrollment in La Caja. If you’re already planning to carry private insurance from a company at home, it can seem like unnecessary paperwork to enroll in a system you don’t plan on using. But there are a lot of benefits to the program. A big one is cost. Many private hospitals demand large cash payments upfront before you are admitted. They don’t automatically bill every private insurance company directly, putting some patients in a tight financial situation. However, public emergency room visits are free of charge and there are only minor costs associated with some incidental expenses (like purchasing items like a knee brace.)
4. Patients Can Mix Things Up
In some countries, public healthcare or private healthcare is a definitive choice. You must be in one program or another. It’s different in Costa Rica, where many people (including expats) opt to mix both. La Caja is popular because the costs are low and there is a strong emphasis on preventative care and community wellness. The INS is well regarded because there are shorter waiting times and good access to a wide range of specialists. Happily, the two systems (usually) work well together. It’s common for patients to have their x-rays done at a private facility to avoid a long wait and then have the results sent to their regular doctor in the public system. On the other side, specialists working in the INS system know to write their prescriptions for La Caja- based pharmacies, as their patients will save money.
Patients can also carry their own private health insurance via an independent company that’s not the INS. This is pretty common among expats, who often have insurance with their work benefits or another professional association. Note that if you use this kind of private insurance, you usually have to pay upfront for all care and then get reimbursed later.
5. Costs Are Reasonable (But Not Always Free)
Citizens and legal residents have 100 percent coverage for all medical procedures, appointments, hospital visits, and prescription drugs through La Caja. However, there may be some minor incidental costs for non-prescription products (like vitamins) and possibly administrative requests (like having a complicated form filled out for work.)
Patients who are not part of La Caja (like tourists and short-term expats) will find that healthcare costs in Costa Rica are very reasonable compared to other countries. Most doctor visits and diagnostic tests like ultrasounds and routine blood work are under $100 (and sometimes much, much less.) In fact, routine checkups to complex surgeries, costs are generally 25 percent to 33 percent of the price a similar procedure would cost in the United States. But remember, when it comes to complex procedures, 25 percent of a huge bill is still, in fact, a pretty big bill! Many expats who don’t really feel the need for a lot of healthcare but who also want to guard against unexpected bills can opt for an insurance plan that has a high deductible and low premiums. That way they’re covered for any serious situations but take on the costs of day-to-day health matters.
6. Understanding Health Discount Plans
There’s public healthcare, government-run private healthcare, independent private healthcare…. and then there are health discount plans! Here’s what that term means.
As mentioned above, the La Caja and INS systems work well together. This is thanks, in part, to the fact that doctors know both systems well because they work in both systems. Many doctors who work in the public healthcare system also run their own part-time private practices. A patient who isn’t enrolled in INS can still see a doctor in private practice but they’ll have to pay. However, a health discount plan makes these visits more economical. For a monthly fee, patients get discounted appointments, blood tests, x-rays, and other diagnostic services. It’s a good choice for patients who know they need to see their doctor regularly and want continuity of care with the same physician regardless of whether the setting is a public or private one.
7. Going To The Doctor Might Actually Mean Going To the Pharmacist
What’s more efficient than the public and private systems combined? Often it’s a trip to the neighborhood pharmacy. In non-emergency situations, this is usually the most efficient choice. Pharmacists are authorized to give consultations, make medical recommendations, and refer patients to other caregivers (like a specialist or emergency room doctor) as needed. Pharmacists play a crucial role in Costa Rica’s healthcare system, are afforded a high degree of esteem, and are often called “doctora” as a sign of respect.
8. And Sometimes, Going To The Doctor Means The Doctor Goes To You
Amazingly, house calls still exist and they play a big role in Costa Rica’s medical system. The next step up from visiting a pharmacist for non-urgent medical concerns is to visit one of Costa Rica’s small public community clinics, known as EBAIS. Some EBAIS schedule in-clinic appointments by an online program. Others use the old-fashioned first-come, first served method. But medical team members also see patients via house calls. They follow up on previous visits to monitor patients’ progress. And they even fulfill public health mandates, doing everything from checking up on vaccination records to addressing housing needs to assessing the health of pets. All around, they do amazing work!