Expats in Costa Rica share tips for choosing health insurance in Costa Rica. They discuss the difference between CAJA and private health insurance. Plus, they talk about quality of care, prescription drugs, hospitals and diabetic care. If you have additional advice for newcomers, please take a minute to add it in the comment section below.
Private vs. Public Health Insurance in Costa Rica (CAJA)
Are all expats in Costa Rica eligible for public healthcare? An expat in Cortez explained, "All legal residents and citizens of Costa Rica are eligible to participate in the public healthcare system which is basically free although you have to be a member of the CAJA and pay a % based on the income level you declared when you applied for residency."
"Residency to obtain public health care (CAJA) seems to be taking about 18 months, so you will have to use private care until you obtain residency (if that is what you plan on doing). Even with CAJA, many people continue to use the outstanding private facilities available in and around San Jose (possibly in other areas, but I am only familiar with San Jose). There are many expat health insurance plans available and I highly recommend obtaining one if you are under 70. There may be some available over 70; I don't know. I presently do not have any insurance and have been paying out of pocket for some serious medical issues. I suggest you have a fund of $6-10,000 tucked away if you don't have private insurance or have a high deductible," advised one expat in a report about healthcare in Grecia, Costa Rica.
"National health care may not provide a sufficient safety net - it may require a long wait for medical procedures. Private health care is recommended, but coverage for 'pre-existing conditions' is generally not available except through national health care," advised another expat in a report about healthcare in Tamarindo.
Expat Health Insurance in Costa Rica
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Specialist Care in Costa Rica: Private vs. Public
One expat provided helpful insight into the process of seeing specialists in the public vs private healthcare system in Costa Rica. He said, "If you go private (and either pay through insurance or out of pocket), specialists are easy. They're everywhere and fast, friendly appointments are normal. If you're in the public system, specialists are often where the system breaks down the most. Everybody is assigned to a local clinic, and these are fine, but most local clinics don't have specialists. To see a specialist you're sent elsewhere, and this can take multiple visits simply to make an appointment (you actually need appointments to make appointments) and then when you finally get an appointment, it can be up to a year later. I've also had the clerk lose my file and tell me I needed to start all over again, although in fairness I once saw a specialist on the same day I was sent. Anyway, seeing specialists is often the weakest link in the public health system chain, and many locals just pay private at this point. But sometimes seeing a specialist in the public system is easy. It's a crap shoot."
The Dilemma of Emergency Medical Care in Costa Rica
An expat in San Jose explained the choice of going to a public or a private hospital for a medical emergency saying, "I'm about 2 miles from my assigned public hospital, Calderon Guardia, and roughly the same distance from two private hospitals, Catholica and Clinica Biblica. For an emergency I would go (and have gone) to the public hospital. It has everything 24/7, and there's no payment expected for admission to the ER. The private hospitals don't necessarily have the right specialists on site and sometimes want cash (in the thousands of dollars) up front to be admitted, even in an emergency. I knew someone who died from a heart attack, probably because she went to a private hospital first and didn't have $20,000 cash on her. At the public hospital, the quality of care is ultimately good on what counts--the docs save lives and patch people up--but it's a real zoo. Patients, maybe you, line the halls since ward space is limited, and yes wards are as good as it gets. Don't expect semi-private rooms, much less TVs, telephones, or internet access. It's like a MASH hospital, just larger, but if you need the ER, it will take care of you. You'll just be glad to get out as soon as you can, and vow to go private if it's not a real emergency."
Proximity of Hospitals and Specialists in other areas of Costa Rica
An expat in Grecia said, "There is a CAJA (public hospital) in our town Grecia which is about a 20 minute drive from my house. I have not heard anything good about it. I have heard good things about the public hospital (Hospital Mexico) in San Jose and the private hospitals in San Jose (about 45 minutes from us) are all excellent."
An expat in Tamarindo explained that expats there head to private hospitals and specialists as close as 45 minutes and as far as 5 hours away. He said, "45 minutes to a private hospital, 1 hr 30 minutes to a public hospital (Liberia). Local ambulances provide local emergency care although severe medical issues may require 45 minutes or more to a hospital. Drive 1 hr 30 minutes to see specialists in Liberia. Some medical procedures, such as an MRI, require a drive to San Jose, 5 hours away."
Prescription Medicines in Costa Rica
"The public system dispenses generic medicines free, and getting them is easy. But on the advice of a private doc, I pay retail for a name brand pill too. It costs me about a third or less the cost in the US. No prescriptions are necessary for most meds, and even when they are, you can sometimes sweet talk your way into buying them in a drug store without a prescription. Probably the cheapest drug store is La Bomba, and it won't budge on selling meds it's not supposed to, but most meds that require a prescription in the US don't need one here. For meds that the drug stores really aren't supposed to sell without prescriptions, I go to a more full service drug store and pay a little more. Specifically, I keep a supply of antibiotics on hand that by law need a prescription but I buy without one. Also, just in the way the system works, I know a drug store that sells the morning after pill, even though it's really not suppose to in a Catholic country," explained an expat in Costa Rica.
With regard to narcotics and other pain meds, "Some pharmacies will stock them, but not all... and will usually require a Rx. from CR doctor, who may require that you pay for tests be done to show that you really do require them. You will have to make/pay for a doctors appointment to get a new Rx every month," said one expat. Another added, "Costa Rica has pain clinics, some located within hospitals, throughout the country. These clinics often use sophisticated techniques with pill supplementation. Do a search for: Costa Rica pain clinics or similar." Yet another said, "My wife periodically purchases Oxa Forte and Tramadol at our Farmacia over the counter without a prescription (for her back problems)."
In a discussion about prescription med availability on the Costa Rica forum, a newcomer asked, "My wife has migraines and is currently being prescribed Imitrex (Sumatriptan) for it. This provides her with significant relief. Could you tell me whether or not this medication is available in Costa Rica?" Another asked a pharmacist friend and replied, "They do sell without prescription Imitrex and they also sell without prescription other anti-migraine meds such as Amerge, Axert, Frova, Maxalt and Relpax."
Expats Cannot Ship Medicines and Supplements into CR
Many people moving abroad who need to continue taking certain medications think they can simply have the medications shipped to them from overseas. One expat cautioned, "Be aware that meds and/or food supplements cannot be shipped to Costa Rica by mail or courier, unless you have an import license for every item!! Expensive and time consuming."
Diabetic Care in Costa Rica
A person considering a move to Costa Rica asked about diabetic care in Costa Rica, "Is is difficult to maintain an insulin dependent lifestyle? Obtaining insulin, supplies, costs etc?" An expat replied, "
The question of whether supplies are easy to obtain has been raised before, but not to the cost involved or the ease of getting them. CAJA, the healthcare system here, does NOT provide everything, so I would say that it could depend on where you choose to live [in Costa Rica] once a legal resident so I would advise you to search this out in the area that you are considering living and in person."