Costa Rica Health Insurance for Expats: Caja vs Private

Moving to Costa Rica as a resident means joining its public health system, even if you never plan to use it. The real decision is what private insurance, if any, to add on top.

For legal residents, Costa Rica health insurance starts with the Caja, the public system run by the Caja Costarricense de Seguro Social (CCSS). Enrollment is mandatory for residents, and you pay a monthly contribution based on your declared income, often around 7% to 11% for retirees and rentistas. The Caja covers doctor visits, hospital care, surgery and formulary medicines with no deductibles, but non-urgent specialist care can take months. Many expats add a private plan from INS or another insurer, or an international policy, for faster access to private hospitals. Tourists can’t join the Caja and need travel medical insurance instead.

This guide covers how the Caja works, private insurance options and costs, private hospitals, and what tourists and digital nomads need.

Option	Who it’s for	Rough cost	Main trade-off
Caja (CCSS)	All legal residents (mandatory)	About 7% to 11% of declared income for most retirees and rentistas	Broad coverage, long waits for non-urgent care
Local private plan (INS, ASSA, Pan-American Life, others)	Residents who want faster private care	About $80 to $150 a month for a healthy 40-year-old; much more after 60	Pre-existing conditions usually excluded
International plan (Cigna, Bupa, Allianz, GeoBlue)	Expats who want coverage in several countries	About $100 to $500+ a month	Highest cost; rises steeply with age
Travel medical insurance	Tourists and short-term visitors	Per trip	Short-term only

Public system

How the Caja Works for Expats

Costa Rica’s 2010 immigration law made Caja enrollment a condition of legal residency. You sign up after you file your residency application, and you need to stay current on payments to renew your residency. Our guide to the DIMEX residency card covers that process.

What it costs

Residents who aren’t on a Costa Rican payroll, such as pensionados and rentistas, pay a percentage of the income they declare. Most retirees report paying roughly 7% to 11%, so a $1,000 monthly pension works out to about $70 to $110 a month. The CCSS sets the exact rate when you enroll, and it can change. Salaried employees pay through payroll instead. A contributor can usually add a spouse and dependent children.

What it covers

• Visits to your local clinic, called an EBAIS, and referrals to specialists
• Hospital stays, surgery and emergency care
• Lab work and imaging
• Prescriptions on the Caja’s approved medicine list, picked up at Caja pharmacies
• Prenatal care and childbirth

There are no deductibles or co-pays. Dental care beyond basics and eye care are limited, and you’re assigned a clinic and hospital based on your address.

The downside: waits

Emergency care is generally fast, but non-urgent specialist appointments and elective surgery can take months. Clinic visits often mean arriving early to get a same-day slot. Medicines on the list can run short at times. That’s the main reason many residents add private coverage.

Private care

Private Health Insurance in Costa Rica

Private insurance doesn’t replace the Caja for residents. It sits on top of it, so you can use private hospitals and see specialists without waiting.

Local plans

The state insurer INS sells medical plans, as do private companies such as ASSA, Pan-American Life and BlueCross BlueShield Costa Rica. Plans can cover Costa Rica only or add regional or international coverage. Expect a deductible and co-pays, often around 20% when the insurer bills the hospital directly.

• Cost: roughly $80 to $150 a month for a healthy adult around 40, rising sharply after 60.
• Pre-existing conditions: usually excluded.
• Age: a new policy after 65 can be hard to get or very expensive.
• Waiting periods: some benefits, such as maternity, have waiting periods of 10 to 12 months.

International plans

International insurers such as Cigna Global, Bupa, Allianz and GeoBlue cover you in Costa Rica and elsewhere, often with medical evacuation. They cost more, roughly $100 to $500 or more a month depending on age, deductible and coverage. They make the most sense if you split time between countries or want treatment options back home.

Paying out of pocket

Some residents skip private insurance and pay cash for private visits, using the Caja for anything major. Private care costs far less than in the US. A general doctor’s visit runs about $50 to $80 and a specialist about $80 to $150. The big private hospitals also sell membership plans that discount services, but those aren’t insurance.

Hospitals

Private Hospitals in Costa Rica

• Hospital CIMA (Escazú): the largest private hospital, with a 24-hour emergency room and English-speaking staff in most departments.
• Clínica Bíblica (downtown San José): one of the oldest private hospitals, with a 24-hour emergency room.
• Hospital Metropolitano: several locations in the San José area, known for more accessible pricing, and expanding to other regions.

Most major private hospitals are in the Central Valley. On the coasts, you’ll find clinics and a Caja hospital in each province, but serious private care usually means a trip to San José. Private ERs often ask for a deposit before treatment, even if you’re insured.

Visitors

Health Insurance for Tourists and Digital Nomads

• Tourists can’t join the Caja. Caja hospitals treat emergencies, but uninsured visitors are billed, and private hospitals expect payment up front. Get travel insurance that includes medical coverage and evacuation. Our guide to travel medical insurance for Costa Rica covers what to look for.
• Digital nomad visa holders are exempt from the Caja but must carry private health insurance as a visa condition.
• Residency applicants should keep private or international coverage until their Caja enrollment is active.

Choosing

Which Setup Makes Sense?

• Caja only: the lowest-cost option for healthy residents who don’t mind waits for non-urgent care.
• Caja plus a local private plan: the most common setup. You keep the Caja as a safety net for major illness and medicines, and use private care for speed.
• Caja plus an international plan: for people who travel often or want treatment outside Costa Rica.
• Caja plus paying cash: works for routine private visits, as long as you accept that the Caja handles anything major.

For more on living here, see what to know about moving to Costa Rica, our guide to retiring in Costa Rica and how pharmacies work in Costa Rica. Keep our list of Costa Rica emergency numbers handy, and check the vaccinations for Costa Rica before you arrive.

Good to know

Costa Rica Health Insurance FAQ