Public Healthcare in Costa Rica (CAJA)
Caja Costarricense de Seguro Social (abbreviated as CCSS) but commonly referred to as "CAJA" is Costa Rica's social security system which provides public healthcare. "Once you have gained approval as a pensionado you must sign up with CAJA," wrote one expat.
"You are required to be a legal resident of Costa Rica. Once the application process is almost complete, it is mandatory that you become affiliated with CAJA. This process may take a year or more. Existing conditions and most Rx's are covered, although some are generic, however getting appointments with specialists and surgery can take a long time. Most expats also use private doctors/facilities," wrote one expat.
Long Wait Times for Specialist Care in the Public Healthcare System
"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," explained an expat living in San Jose. Another expat said, "My wife who is a Citizen of Costa Rica was on the list for hernia surgery for 6 years. Missed a call and went to the bottom of the waiting list again. While not life threatening it does demonstrate how long a wait others, especially Foreign Residents may wait." explained one expat.
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Private Healthcare in Costa Rica
"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," commented one expat in a report about health insurance in San Jose.
"The private healthcare networks consisting of Clinica Biblica and CIMA offer great service for a fraction of the cost in the US. Clinica Biblica has an international medicine center, assigns patients a health navigator to help with things like language barriers and offers services that may not even be available in the states. I have had nothing but great experiences there, everything from blood work, orthapedics, dentistry, colonoscopy, endoscopy, stress test and EKG, bone density scans, lipids exams, urinalysis, hearing and eye tests, ultrasounds and more," commented one expat in a report about healthcare in Cortez, Costa Rica.
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Private vs. Public Healthcare in Costa Rica
"Where you live may affect whether you want to rely on caja for all or your medical needs or keep international insurance coverage once you have residency. We have been residents for several years but have kept our international policy with WEA. The caja hospital facilities are not that great in the Nicoya area but some are considered to be pretty good in San Jose. My wife had an emergency and went to a private hospital - it was quite expensive but we only had to pay our deductible. I use caja for routine care and prescription drugs, but we use private facilities for critical healthcare," wrote one expat in a thread about private insurance.
One expat commented, "We have found the caja staff very caring, considerate and helpful. The problem that caja has, is not at this level of care, EBAIS, but trying to get timely appointments with specialists and surgery, if required. We just returned from an early morning appointment with a specialist and was told to return in three months for a follow-up...but there was no available appointments slots for 5 months, which isn't too bad, since he isn't the 'primary' specialist."
"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," explained one expat in a healthcare report about San Jose.
Expat Health Insurance in Costa Rica
Expats interested in expat health insurance should take a minute to get a quote from our trusted expat health insurance partner, CIGNA.
If You Plan to Use Private Doctors and Hospitals, International Health Insurance Can Save You Thousands
While the cost of visiting a private specialist in Costa Rica may be very affordable, emergency care and surgeries at private hospitals may result in a bill that makes you think you're in the US. For that reason, many expats have expat health insurance so that they have the option of going to a private hospital whenever they choose. Below are a few stories of expats who saved tens of thousands with their private insurance.
One expat recalled, "My wife and I have Medicare Parts A & B, which we use for some medical services when visiting the USA and will have in case of major health issues later for which we might want to have done in the USA. We also have international health insurance which covers us 'worldwide, excluding the USA'. (WEA Insurance) It excludes some pre-existing conditions. My wife had an emergency in CR and went to a private hospital by ambulance. Our insurance paid about $34,500 - we only had to pay our deductible. (The hospital originally billed about $70,000, but the insurance company negotiated that down.)"
Another expat recalled a similar experience at a hospital in Liberia,"I will relate a health experience my wife had: She had an atrial fibrillation two years ago while in Tamarindo. I took her to Beach Side Clinic when she complained about heart symptoms early in the morning -, they diagnosed her and then ordered an ambulance to take her to San Rafael Arcangel Hospital in Liberia. We felt that she got very good medical care there. They had to apply an electrical shock her heart to 'reset' the heartbeat, and she was in the hospital for 3 days/ 2 nights. We had private international medical insurance, which the hospital communicated with for our coverage. Although the care was good, there were many issues with the medical bills. The clinic and hospital submitted bills to our insurance that seemed to be very inflated and our insurance company disputed the 'format' of how some bills were submitted. We received bills totaling close to $80,000. (This was more than double the average cost for A-fib emergency care in the USA per a web search.) After about 6 months of issues between the hospital and the insurance company, the claims were settled for a little over $30,000. Not what I would call 'inexpensive medical care'. We do pay into the public healthcare system, and I use it for routine health care and prescriptions (but my wife does not like to use it) - but we always use private facilities for non-routine health concerns. I have heard bad stories about the public hospitals in the Guanacaste area, and would not use them for a major health issue. I should note that we only had to pay the deductible on our health insurance policy - the insurance company covered the remainder of the $30,000 settlement of charges. I do recommend having an international health insurance policy if you want the best health services. And we do have some health issues that are not covered due to pre-existing conditions."
These stories stress the importance of obtaining international health insurance in Costa Rica if you plan to use private hospitals.
Costa Rica Vaccinations
Make sure you are up-to-date on routine vaccines before every trip. These vaccines include measles-mumps-rubella (MMR) vaccine, diphtheria-tetanus-pertussis vaccine, varicella (chickenpox) vaccine, polio vaccine, and your yearly flu shot. "There is no risk of yellow fever in Costa Rica. The government of Costa Rica requires proof of yellow fever vaccination only if you are arriving from a country with risk of yellow fever. This does not include the US. If you are traveling from a country other than the US, check this list to see if you may be required to get the yellow fever vaccine: Countries with risk of yellow fever virus (YFV) transmission. Other vaccinations recommended for expats in Costa Rica include Hepatitis A, Typhoid, Malaria, Hepatitis B and possibly even Rabies. " said the CDC.
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Availability and Cost of Prescription Medicines in Costa Rica
"Many medications can be purchases here with no prescription. The best way is the march in the farmacia, and ask for a refill. If they can't they won't. But I would not even suggest to them or put in the sentence the possibility of needing one, to give them ideas. You may be surprised," advised one expat in a discussion about prescriptions on the Costa Rica forum.
Another expat added, "In general, you can get many medications in CR without a prescription, but most medications will be generic rather than brand name. I don't think that they are any better, but they should meet your needs. I take blood pressure and thyroid medications. I cannot get one of the thyroid medications that I prefer, only the generic version of the most common medication. Pills generally come in "blister packs" with each pill sealed . That is fine for infrequently used medications and is good for protection against humidity, but it can be costly for regularly used medications. For example, my wife takes ibuprofen regularly for back pain - a bottle of 100 pills from the USA is much lower cost than blister packs of individual pills in CR! I now have caja and can get most regular prescriptions at no additional cost."
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