How Healthcare Works in Costa Rica

Costa Rica operates under a universal healthcare system. Expats can receive care under the public or private system. Both are deemed affordable. This section will explain Costa Rica’s public healthcare system, including the procedures covered and costs. See below if you would like to jump to the private healthcare section.

Costa Rica Healthcare Facts

• Because Costa Rica is constantly upgrading its healthcare system, you can expect to see new facilities to appear regularly.
• Staff medical training is also updated continually.
• Life expectancy in this country is high; nearly 80 years old.
• The most serious diseases in Costa Rica are Chagas Disease, Dengue Fever, hepatitis A and B, leishmaniasis, leptospirosis, malaria, rabies, and typhoid.
• Most medical tourists visit the country to take advantage of the prime quality and affordable dental and optical care.
• It is common to use both public and private health insurance (the private insurance will supplement costs not covered by public).
• Many drugs that typically require prescriptions in other countries do not here. This includes such items as cholesterol medication, birth control, etc.

Does Costa Rica have Free Public Healthcare?

Costa Rica does have free public healthcare, but only for Costa Rican citizens who are most financially in need. This means that residents with a job and expats will have to pay for use of the public healthcare system (expats must provide proof of sufficient financial means in order to live in Costa Rica).

While living in Costa Rica, you will need to pay into the Caja Costarricense de Seguro Social (CCSS). This is usually referred to as simply the Caja. If you work in Costa Rica, the amount you pay will be based on your salary. If you are a retired person, or rentista, who is living off of savings, the amount you pay will be based on the financial amount you declared while applying for your visa.

How does Healthcare Work in Costa Rica?

As an expat, you will need to sign up for the Caja as part of your residency process. You will make a monthly contribution (7-11%) based on your income, even if your income is from a pension or savings rather than a standard salary.

It is also important to note that there are three different types of healthcare facilities in Costa Rica:

• hospitals;
• clinics;
• ebais.

You can find some of the same services in hospitals and clinics such as emergency rooms, general healthcare, and specialist healthcare. Hospitals are open 24/7, whereas clinics typically operate from 7:00 to 22:00.

An ebais provides general care such as check-ups and treatment for minor ailments such as colds, sprains, etc. They are typically only open from 7:00 to 16:00.

How can a Foreigner Sign-Up for the Caja?

You will sign-up for the Costa Rican public health scheme once you are in the country. Once you have applied and been approved for residency, you will take this approval to your nearest Caja office. In addition to this approval, you will also need to bring:

• your passport;
• photocopies of your passport ID page and the page containing your entry into Costa Rica (these copies must be notarized);
• proof of residency approval (plus a copy).

If you are working in Costa Rica, you will also need to present a Registration Request form, which should be filled out by your employer.

Once you have submitted everything, you will be handed a receipt. You need to keep this receipt and present it when you pick up your residency card (because proof of payment to the Caja is required for your permit).

What does the Public Healthcare Cover?

There is very little that Costa Rica’s universal healthcare system does not cover. Foreigners using the public services will find everything from basic check-ups to medical treatments, medicines, and major surgeries to be included in the Caja.

Healthcare Costs in Costa Rica

The monthly costs of public health insurance in Costa Rica varies dependent on each expat’s income. Foreigners can expect to pay anywhere between 7-11% of their monthly income to the Caja. As would be expected with a universal system, the more income you receive per month, the more likely you are to pay close to 11%.

Most expats in this country do not pay more than 57,000 CRC (100 USD) per month. This cost covers both the expat receiving the income and any immediate dependents they may have, such as a spouse or children.

What are the Pros and Cons of the Costa Rican Healthcare System?

Given the low costs and fantastic treatment available, you may be wondering if there are any downsides to Costa Rica’s healthcare system. While the pros are many, there are a few cons expats should be aware of.

Pros

• Pre-existing conditions are covered.
• There is no age limit to enroll and monthly payments often decrease with age.

Cons

• The public health system is often overrun with patients. Expats should expect long wait times.
• Because the public health system is overrun, smaller hospitals and clinics may be understaffed, which can lead to even longer wait times and possibly delayed care.
• Finding a specialist can be difficult, if not impossible. Most residents using the public health system are treated by general clinicians.
• If you do not live in one of the major cities, it may be hard to find English-speaking staff.
• You will not have a choice over which practitioner you see.
• You may only be given generic drugs or medicine produced in Costa Rica.

An Overview of Private Health Insurance

How does private health insurance work in Costa Rica? Although the public system is of extremely high quality and residents and non-residents have access to the same services, both Ticos and expats often opt for private coverage, too. This is because private care often includes shorter wait times, and it is still relatively affordable.

Around 30% of Costa Rica’s population have private insurance. The three most popular private hospitals in the country are Clínica Bíblica in San José, Clínica Católica in San José-Guadalupe, and CIMA hospital in Escazú. It is possible to pay for private treatment with cash.

Do You need Health Insurance in Costa Rica?

It is not mandatory for residents to have private medical insurance in Costa Rica. This is because all legal residents must register with the public CCSS (Caja Costarricense de Seguro Social). Private insurance is supplementary and gives patients access to shorter wait times and choice over general practitioners and specialists. For foreigners, it is also easier to find English-speaking staff at private facilities.

If you move to Costa Rica and are not yet a permanent resident, it is advisable to acquire private insurance. This will help subsidize costs should you need medical attention. However, costs in Costa Rica are relatively low, and private hospitals will still see you even if you do not have insurance (public or private).

Types of Health Insurance Plans

The Costa Rican government holds a monopoly with private insurance plans in the country. If you are unable to register with the CCSS due to your residency status, you can sign-up for the Instituto de Seguro Nacional (INS).

It is also possible to use international private health insurance plans, such as Allianz, Cigna, Blue Cross Blue Shield, and others. If you do choose to use an international provider, make sure that you select a plan that allows for coverage outside your home country.

How to get Health Insurance in Costa Rica

You can register for private health insurance online. If you have a job in Costa Rica that offers health insurance coverage, your employer should take care of this for you. Often, you will be asked for a valid ID, financial information for direct payment, and medical history. Both foreign and local health insurance is recognized at private hospitals in Costa Rica, although the amount that is covered may vary.

To sign-up with INS, you can do so either online or via phone. Requirements will vary depending on your age. If you are under 55 years old, you should only need to fill out an application, an authorization for the company to view your medical history, and a health declaration form. If you are over 55, you may be asked for extra documentation subject to the company’s discretion.

Be advised that people over 70 years of age cannot be insured by the INS.

Health Insurance Cost in Costa Rica

How much is health insurance in Costa Rica? The average cost for private health insurance through the government-back INS is 34,000-141,500 CRC (60-250 USD) per month. The range of this amount is determined by age, gender, and other factors, such as underlying conditions and your own coverage needs. Private health insurance plans from other international providers will typically be more expensive than the INS.

The INS covers about 80% of medical costs. This includes basic check-ups, surgeries, both major and minor procedures, and prescription medication.

Costs at Private Facilities

If you do not have private health insurance, but still wish to use a private facility, the costs will not be exorbitant. Regular doctors’ visits are around 34,000 CRC (60 USD). Seeing a specialist will cost less than 57,000 CRC (100 USD). Even items such as x-rays and ultrasounds will only run about 42,400-45,000 CRC (75-80 USD).

Using Private and Public Health Insurance in Costa Rica

It is common to use a combination of public and private insurance in Costa Rica. Some expats choose to visit a private doctor for something more specific or time-sensitive, but then do a follow up through a public facility. The care you will receive between either institution will be the same.

How to Find a Doctor or Dentist

Do you need to know how to find a doctor or a dentist in Costa Rica? The medical practitioner you visit depends on whether you use only public health insurance, or opt for private, too.

The Myth about Doctors in Costa Rica

Although Costa Rica is known as a hotspot for medical tourism, people may assume that this has everything to do with the cost rather than the care. There is a general perception that medical professionals in this country, and in developing countries in general, are not as qualified as doctors and nurses in Europe and North America.

On the contrary, the quality of care people receive in the Pura Vida country is on-par with many developed nations. The country continually requires staff to go through training in order to update and perfect medical practices.

When visiting a doctor in Costa Rica, you will find that many either studied or worked abroad. Because of the proximity, they have most commonly done this in the US. It is also common to find English-speaking professionals, especially if you are in one of the bigger cities in the country. Be sure to ask about this when making your appointment, even if you go to a public facility.

How to Find a Family Doctor

If you use only the public health system, you will not be able to have a regular family doctor. Public health does not allow residents to request a specific doctor, or even if you do specify your practitioner, you are not guaranteed to see them. However, it is important to keep in mind that all medical professionals in this country are highly skilled and qualified.

If you use private insurance, it may be possible to see the same doctor when you want. Private hospitals and clinics allow insurance holders to request practitioners.

How to Find Specialists

To find a specialist in Costa Rica, you will need private insurance. The public health scheme largely only has general practitioners available. This is one of the downsides to Costa Rica’s public system.

How to Find a Dentist

Costa Rica is one of the top ten countries in the world for dental tourism. As mentioned, medical practitioners here are highly qualified. You will find that dentist will have the latest equipment and may even have tools they have imported from abroad. Popular procedures, and their average cost, in this country include:

Procedure CRC USD Dental implants 760,000 1,300 Root canals 204,600-292,300 350-500 Orthodontics (2 yrs) 876,900 1,500 Full mouth rehabilitation 5,261,400-7,599,800 9,000-13,000 Dental esthetics (1-20 crowns) 292,300 500

Because dental services are so popular in this country, it is easy to look up recommended dentists in your area online. There should be online reviews you can peruse, and it is even worth giving each office a call.

Average Wait Time to See a Doctor in Costa Rica

Wait times are one of the biggest reasons Costa Rican residents opt for private healthcare over public.  If you visit a public facility, you will typically wait in a first-come-first-serve queue. This can take several hours. Waiting for a specific type of surgery can also last several weeks.

Often, residents choose to use a combination of public and private services in order to speed up wait times. For example, if you need x-rays, you can take them at a private institution, which will be faster than going to a public facility. You can then bring the scans to a public doctor to continue the treatment.

Giving Birth in Costa Rica

Do you need to know what giving birth in Costa Rica for non-residents is like? Whether this is your first time having a child or your second or third, ensuring you know about pre- and post-natal care in your new country is essential to the health of the mother and child. Below, we walk you through the information you need in order to give birth in the Pura Vida (“pure life”) country.

Having a Baby in Costa Rica as a Foreigner

All children have a fundamental right to healthcare in Costa Rica. This includes fetuses, and this right then extends to the pregnant mother as well. So, what does this mean in terms of giving birth? Can a foreigner give birth in Costa Rica without health insurance?

Yes, you can.

Expectant mothers who have moved to Costa Rica and are not yet a part of the public health system are automatically given all the rights of a local resident. This means all of the pre- and post-natal costs will be completely covered.

Giving Birth: Public vs. Private Care

Women can safely give birth in Costa Rica using either public or private care. There are pros and cons to both. For example, although giving birth through the public system is free, expats will be assigned a doctor and a nurse who will attend them throughout their entire pregnancy. Depending on where you live in the country, these medical professionals may speak limited English, or none at all. Some expat women have also complained of hospitals being understaffed and feeling like they did not receive the utmost care during their delivery.

If you choose to give birth in a private hospital, you will have the option of selecting your own OBGYN. Private hospitals are also typically larger than public ones. The drawback to private care is that it will costs money. However, the costs are low, and may even be affordable without any insurance at all.

The Cost of having a Baby in Costa Rica

If you give birth in Costa Rica without health insurance and decide to use a private hospital, you will need to pay out-of-pocket for each appointment and procedure. Pre- and post-natal appointments will be similar to other doctors’ visits, which are around 34,000 CRC (60 USD) per visit. Delivery fees will vary depending on the type of birth you choose:

• vaginal delivery: 1,131,900-1,697,800 CRC (2,000-3,000 USD);
• C-section: 679,100-792,300 CRC (1,200-1,400 USD).

If you have private health insurance, it may be possible to have these costs subsidized. This amount will vary dependent on your plan.

Midwives, Epidurals, and Water Births

Expats should note that midwifery is not a recognized profession in Costa Rica. While the practice is not forbidden, it just means that there is no official qualification for it in the country. Some midwives choose to earn their certification abroad and then return to the Latin country to practice. If you are interested in a midwife, ask your doctor or fellow expats in the country.

Epidurals and water births are possible in Costa Rica, but they are not common. If you prefer either, you will need to go to a private hospital. You should also confirm the use of either with your doctor, as well as verifying that your chosen hospital can provide these services.

Benefits of Giving Birth in Costa Rica

In addition to receiving free public care even if you are not only the country’s public health insurance, another benefit is that childbirth classes are included in this coverage. Childbirth classes can be for men and women. In fact, the father of the child cannot be in the delivery room unless he has taken one of these classes.

Children born in Costa Rica are also given free standard vaccinations. Parents may also receive these vaccinations, such as hepatitis A and B, if they previously have not.

Giving Birth in Costa Rica for Citizenship or Permanent Residency

Any child born in Costa Rica is automatically considered a citizen, regardless of the nationality of the parents. Even if the parents are permanent residents, the baby will still be considered a citizen.

Foreigners will need to decide whether they want dual citizenship for their child or not. While Costa Rica allows dual citizenship, other countries, such as China, Singapore, and Japan, do not.

Is Abortion Legal in Costa Rica?

Abortion is illegal in Costa Rica except in cases where the mother’s life is in danger. An abortion is not permitted in the case of rape, incest, or if the child is proven to have a birth defect.