Escazu, Costa Rica
Escazu, Costa Rica
Escazu, Costa Rica

Guide to Healthcare in Costa Rica

15 Expats Talk about Healthcare and Health Insurance in Costa Rica

By Joshua Wood, LPC

Last updated on Sep 15, 2020

Summary: Expats living in Costa Rica talk about healthcare, proximity to hospitals and specialists, quality of medical care in Costa Rica, availability of prescription medicines and more.

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Expats in Costa Rica offer insight into the quality of healthcare in Costa Rica, proximity to hospitals, cost of health insurance and more.

What are medical services in Costa Rica like?

When we asked expats and global nomads about the quality of medical care in Costa Rica, they replied:

"Yes. I have private insurance through Cigna global and access to several both public and private hospital, and clinics," commented an expat living in San Isidro de Heredia, Costa Rica.

"The medical care here is excellent - ONLY IF YOU GO PRIVATE.! It is CRITICAL TO HAVE PRIVATE HEALTH INSURANCE in Costa Rica. I have quite a long story, but when we first arrived I was hit by a taxi cab. I ended up in a PUBLIC hospital. At that point, I did not care how badly beat up I was, I just had to get out there. It was beyond disgusting... including bathrooms with NO SOAP or toilet paper. Anyway, it led me to a new "career path" when I went on the hunt for Private Health Insurance. I found an very import niche that needed to be filled for expats. We expect clean hospitals, with up to date equipment, and it always helps to have talented bi-lingual doctors. This can be found in the private hospitals in Costa Rica. Specifically - CIMA in Escazu. Top notch - but you will pay for this service. I found an insurance company perfectly suited for expats which allows them to choose any hospital or doctor they wish outside of the US. For my policy, I chose one which includes US coverage. It is a FRACTION of the cost I was paying in the US. I am not old enough for Medicare, but Medicare will not cover you outside of the US anyway. I knew my friends needed this type of coverage as well, so I asked if I could get involved in representing this insurance. So even though I consider myself technically "retired". I am very active in assisting expats with their health insurance needs," said another expat in Escazu.

"The area has several local physicians which offer quality care. Additionally, specialized physicians in the area of dermatology, dental, obstetrics, psychology visit the area once a month from the Central Valley. Excellent medical care is available in the Central Valley 90 minutes from Hermosa and Jaco," remarked another in Playa Hermosa de Jaco.

"My insurance provides coverage at Hospital Biblical, a private hospital with an excellent reputation. It is not close: two buses and a short walk. Or a 6,000 colon cab ride ($11.50). Minor things like colds, infections, etc I go to the pharmacy," explained one expat.

"To use the socialized medical system in the area, you do not need to be a resident of Costa Rica (Residente). The hospital will accept all patients. It is not a large hospital and some procedures will be referred to either the closest national care hospital or one of the private hospitals in the Central Valley. However, there are many private care physicians in the area who will treat you and/or make referrals to more specialized care in other parts of the country. The local hospital has an emergency center," commented an expat living in Quepos , Costa Rica.

"In Costa Rica, you must be a resident of the country to qualify for CAJA also know as the national socialized medicine. Additionally, this is not an option but a requirement of your residency here. The monthly fee is calculated based on your income. The local clinic also known as EBAIS is centrally located. If you are in the area, familiarize yourself with it's location. If you are not a resident, there are several private care physicians in the area and they are well educated and professional. If you do not speak Spanish, there are many that are bilingual. I know of at least one that has a 24 hour facility for emergencies. Additionally, specialists from the Central Valley visit these private care facilities on a monthly basis so if you need specialized care, it is available. At present, a general office visit in a private care facility is $40-$45," said another expat in Playa Jaco.

"If you're a resident you pretty much have to enroll in the Caja, the public health system, and if you aren't, you can't. So there's that. Whether or not you enroll in the Caja, if you have the funds, private insurance is nice. INS, the state insurance company, sells a pretty good policy for not too much money, and (ahem) it's darn near customary not to mention pre-existing conditions on the application. After a year or so INS doesn't care, and it does pay. Blue Cross and others have now entered the market, but I doubt they're as lax as INS. Of course, you can always pay out-of-pocket for private at prices about a third of US prices, but even a third adds up. Me, I'm only in the Caja now, since I let my INS policy lapse, but that's because I'm poor. People of some affluence usually do both--private for ease and comfort, public as a backup. Oh, in the Caja plan on speaking Spanish. Most Caja docs will know a little English and a few will be fluent, but the system operates in Spanish and you can't count on anyone speaking English. In the private system almost everybody speaks English," remarked another expat in San José.

"Costa Rica has excellent medical care with a two prong system, both public and private. 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. A tip for expats is to show evidence of enough income to qualify for their residency programs but perhaps not to show all your income if not needed to qualify. (You have to show proof of a pension, annuity or government program that pays you at least $1000 per couple to qualify for their pensionado program). If you don't qualify by those means, you can also apply as a rentista, (renter), an inversionista (an investor) or as a foreign sponsored national with a work visa. You can also marry a Costa Rican... Keep in mind that there is also a private healthcare network available, which is often the preferred option to many expats. There is often a waiting time to get seen under the public system, even things like lab work might take longer than you want to wait. The private healthcare system is generally available immediately and insurance can be purchased to cover you in those facilities. You can also often offer to pay at the CAJA and be seen quicker than those not paying for service. In an emegency, the CAJA will take anyone. Costa Rica uses a local clinic methodology where they locate clinics nearly everywhere based on population needs. These clinics are referred to as the EBAIS clinics and can be found in nearly every town of any size. Major operations, whether in the public or private healthcare system, will likely be performed in San Jose. The private healthcare networks consisting of Clinica Biblica, CIMA and Hospital Mexico, 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. I have stuff done that I could never afford to do in the states and pay a fraction of the cost I would in the US. The facilities are all impeccably clean and the doctors don't seem to be afraid of their patients and lawsuits. In our area in the southern Pacific region of Costa Rica, we have one of the newest CAJA hospitals in all of Costa Rica. The Hospital de Osa is an 88 bed, 80,000 square foot facility complete with emergency room, pharmacy and more. I recommend everyone should try the Costa Rican healthcare system to see what we are missing in the US," explained one expat in Cortez.

"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," said another expat in Tamarindo.

"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," remarked another expat in Grecia.

What do you think about the cost of medical care in Costa Rica?

"After 17 years in Costa Rica, my experience has been that national public healthcare insurance via the national system is very good. The monthly payment is based on your declared income at the time of your application for residency in Costa Rica. If you do not feel comfortable using the national system, you can purchase private insurance at rates less than the US with varying degrees of deductibles. There are many bi-lingual agents registered in Costa Rica to help you. Additionally, consider private care at your cost. A private care physician office call is generally under $50 and many procedures are substantially less than you would pay in the states. I have heard many times that the cost of an entire procedure here in Costa Rica is the same as the deductible in the states. Many people use this information to their advantage and visit Costa Rica for a medical vacation! ," commented an expat living in Quepos , Costa Rica.

"I had private health insurance in Costa Rica for several years prior to being a member of the socialized medicine care. It was less expensive that the states. In many cases, your private health insurance will allow you the hospital of your choice," said another expat in Playa Jaco.

"I was paying around $100 a month for my INS policy, but crossed into the next age bracket plus filed a few claims and my premium doubled. It was still a good deal, but too much for me. The Caja tax is around $100 a month for a pensionado, unfortunately much higher for rentistas. It's set by your income, and most expats just pay according to the income requirements of their residency type. Caja services, including generic prescription meds, are 100% covered, so you never pay more than your monthly tax. Private docs are realistically $80 a visit. You hear of lower prices, but if you go to a specialist (including an internist) plan on $80. As a rule of thumb, pretty much everything else is around 1/3 the price it is in the US," remarked another expat in San José.

"Amazingly inexpensive. My personal experience with costs without insurance include a colonoscopy that was quoted at $3300 in the states that was done in Costa Rica for $300. I have a number of crowns in my mouth that I paid $300 to $400 including the root canal and crown," explained one expat in Cortez.

What are emergency services like?

When we asked about emergency services, members in Costa Rica wrote:

"The closest hospital is on the outskirts of Quepos and is named Max Teran Hospital. There is an emergency room and the quality of care is very good. As it is a national care (part of the socialized medical care system in Costa Rica) you will not find the same amount of services as in a top of the line private care facility in the states. However, the staff is professional and caring. Be aware, not all staff members will speak English. Hospital Max Teran is a public hospital but accepts patients who are not in the public health care system. All are treated the same with the exception that a person on the national care system is not required to pay at the time of discharge. If the staff feels your condition is better treated at another facility, they will discuss this with you and make recommendations on other options available to you," commented an expat living in Quepos , Costa Rica.

"The closest is EBAIS Jaco and this is one of the offices in the socialized medicine of CR. There is an emergency room, lab facility and pharmacy at this location along with general medicine physicians. The emergency room service is generally very quick! If your condition warrants more specialized care, you will be stabilized and transported to Puntarenas Hospital known as Monsenor Sanabria. This higher level of hospital care is one hour from Jaco. For private care, the 24 hour facility will assess your condition and either treat you at their facility or transport you to the hospital of your choice in San Jose in the Cental Valley. This is approximately 90 minutes from San Jose. Private hospitals in San Jose are CIMA, Biblica, Catolica, Metropolitan," said another expat in Playa Jaco.

"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," remarked another expat in San José.

"We are located almost across the highway from the Hospital de Osa in Cortez. It is a public hospital, 80,000 square feet and offers everything we need for the entire region," explained one expat in Cortez.

"45 minutes to a private hospital, 1 hr 30 minutes to a public hospital. Local ambulances provide local emergency care although severe medical issues may require 45 minutes or more to a hospital," said another expat in Tamarindo.

"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," remarked another expat in Grecia.

Are their specialists in the area or do you need to travel to see a specialist?

"Periodially the area has specialized medicine physicians that treat local residents and they arrive generally once per month at a private care physician's office in Quepos. This is a good option for general procedures of dermatology, obstetrics, etc. For more options and specialized care, the Central Valley of CR is the best option. There are multitudes of physicians in the Central Valley specializing in every aspect of health care. The quality of care is exceptional and if you choose to pay for this through private pay, the cost is substantially less than the US. From the Quepos area, this región is approximately 2.5-3 hours from Quepos. However, Quepos has a public airstrip with several flights per day and it is not uncommon to fly to the Central Valley for consultation. The flight is 20 minutes in duration," commented an expat living in Quepos , Costa Rica.

"We have been to CIMA and Catolica. Both these facilities are excellent! The physicians were profesional, thorough and well educated. The care was better than what we experienced stateside. The physician followed up with us after our care for several weeks. And we were given private cell phone numbers to contact in case of complications. My husband spent three nights at CIMA in Escazu near San Jose. He had a private room (all rooms in this facility are private!) with attached private bathroom. There was a sofa in the room which turned into a bed so that I was able to spend the day and evenings there. The hospital cafeteria was excellent! Yes that's a surprise and gives an upscale meaning to hospital food! This is one instance where we decided to have treatment at a private facility vs. the socialized medicine. Be aware that at these facilities, you will need to submit a credit card or private health care card in order to be treated. The cost was dramatically less than if this procedure was done stateside. It is very common for residents to use the socialized medicine for some issues, private health care for others (which means you pay out of pocket) and also have another health insurance policy for others health issues," said another expat in Playa Jaco.

"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," remarked another expat in San José.

"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," explained one expat in Tamarindo.

"I have not needed to do that so far, so I have no information except from friends, all who have been HIGHLY pleased with their specialists in San Jose," said another expat in Grecia.

Are most prescription medications available in Costa Rica?

"Common prescriptions are readily available at the many pharmacies in the area. (farmacia) Generally you will not need a prescription for anything other than extreme narcotics. In the event you need a higher level of prescription, a physician will write this for you after a consultation and appraisal of your health. There is no rule of thumb that all prescriptions are less/more or the same pricing you may have experienced in the states. Some are substantially less! And others more. If you are on the public healthcare system (national CAJA), prescriptions are free and are dispensed at the public hospital after a consultation with the physician associated with the hospital. There is no charge for the physician's appointment at the public hospital as long as you are a legal resident," commented an expat living in Quepos , Costa Rica.

"If you are enrolled in the CAJA (socialized medicine), prescriptions are free at the local clinic after being prescribed by the CAJA physician. Sometimes generic forms of the medicine are available. If you are on a very specialized prescription, you may need to purchase this at a local pharmacy (farmacia) and you would be required to incur the expense but generally most medicine is available thru the CAJA. If you choose to purchase your prescriptions outside of the CAJA system, there are at least ten farmacias in Jaco and the surrounding area. You will not need a prescription for most any medicine with the exception of intense narcotics. If you need something of that degree, a private care physician can prescribe them for you. Some prescriptions are higher costing than the US such as Allegra, simple asprin, etc. Generally speaking if you can purchase it stateside in a bottle of (for example) 365 pills it is less expensive to do so as packaging here is by individual blister pack pills. Other meds like Lyrica and Eliquis are dramatically less expensive than the states. Resident discounts are generally offered in the amount of 10% at farmacias for local residents," said another expat in Playa Jaco.

"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," remarked another expat in San José.

"Prescriptions are easy to get and easy to fill. Many drugs requiring a perscription in the US don't need one in Costa Rica. I have found that most drugs are 1/3 to 1/4 of the price than in the US," explained one expat in Cortez.

"Most are available locally at a nearby pharmacy. Most are available without a prescription, except narcotics. Generic "prescription" drugs are lower cost but typical OTC drugs seem to be more expensive (ibuprofen, aceotminophen)," said another expat in Tamarindo.

"For most meds, you can simply see the pharmacist. I get most of my refills by simply asking for them. They are not expensive but they are not cheap -- one b.p. drug I take cost about $1/pill; another drug is $2/pill. When I came here, I had been on two narcotic pain meds for 13 years. It was impossible to find Vicodin in Costa Rica and very difficult to regularly find MS contin (and then only as an injection). My doc switched me to Oxycontin which I hated, so I decided to detox and get off the pain meds -- because I am no longer working, I find that I can handle my chronic pain issues with other drugs and yoga. But be forewarned about narcotic meds if you feel you need them here," remarked another expat in Grecia.

"I'm about two miles from both a public and a private hospital, but for emergencies you definitely want to go to a public hospital. The private hospitals don't necessarily have the staff onsite and want to be paid upfront. The ER room at the public hospital is a zoo (no one likes it) but once you convince the intake person that you're really sick the care is as good as anywhere in the world, just without the creature comforts. Convincing the intake personnel that you're really sick though can be a challenge. They're surrounded by people with the sniffles who really shouldn't be there. It helps to arrive by ambulance or to be bleeding or at least to have a heart attack," commented an expat living in San Jose, Costa Rica.

"Playa Jaco has a Red Cross station in addition to local public clinic. In the event of illness or injury, you will be treated at the local clinic and transportation to a higher level of medical care is provided. There are also many private physicians in the area which will provided specialized medical care. I have found the level of care to be excellent. The Central Valley is only 90 minutes by vehicle and this area of Costa Rica boasts the highest level of care in the country and in many cases Central America," said another expat in Playa Jaco.

"The Hospital de Osa, a new hospital with 88 beds, 80,000 square feet, an emergency room and lots of doctors is located just 15 minutes down the coastal highway. There are also local clinics and dentists in Uvita, the next town to the north. You won't have open heart surgery in this area, but almost anything else is possible," remarked another expat in Ojochal.

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About the Author

Joshua Wood Joshua Wood, LPC joined Expat Exchange in 2000. Joshua has a BA from Syracuse and a Master's in Clinical and Counseling Psychology from Fairleigh Dickinson University. Some of Joshua's more popular articles include Pros and Cons of Living in Portugal, 10 Best Places to Live in Ireland and 5 Best Places to Live in Spain. Connect with Joshua on LinkedIn.

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Escazu, Costa Rica
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