Discover our special feature on health insurance in Costa Rica
Costa Rica stands out for having the most efficient and modern healthcare system in Latin America, ranking among the top 20 in the world. This excellence is reflected in moderate costs and quality care, contributing to the overall good health and high life expectancy of its population. The reputation of the Costa Rican healthcare system makes it a sought-after destination for medical tourism. However, local or international health insurance will be essential for optimal reimbursement in the private sector, where rates are relatively high, or to obtain a visa.
| Healthcare expenditure par capita and per year | $ 953 |
| Annual indexing of health care expenses | 7.86% |
| CFE hospitalization reimbursement rate | 31% |
| Number of insurance companies available | 15 |
| Annual cost of hospitalization coverage for a 30-year-old | € 672 |
| Annual cost of hospitalization coverage for a 50-year-old | € 1,284 |
Costa Rica, known for its pleasant climate, political and economic stability, significant investments in education and cutting-edge technologies (particularly in the field of information technology), and the dynamism of its tourism sector, also boasts the reputation of having the best healthcare system in Latin America. This makes it one of the favorite destinations for expatriates.
This reputation is based on quality infrastructures in both the public and private sectors, competent medical teams, specialized and often bilingual, as well as affordable rates compared to other countries in the region. For example, healthcare costs in Costa Rica may represent only a quarter of those practiced in the United States. Due to all these advantages, Costa Rica has become a preferred destination for medical tourism.
Each year, the country welcomes a growing number of medical tourists, attracted by a wide variety of medical specialties: orthopedics, surgery, dermatology, plastic surgery (50% cheaper than in the USA), fertility treatments, dental care, or even detoxification. It's no fewer than 70,000 medical tourists per year who come from all over the Americas, including Canada and the United States, where medical care is notoriously expensive.
Finally, in terms of health security, Costa Rica may be subject to endemic diseases such as Zika, dengue, or chikungunya. To protect oneself, it is advisable to take precautions against mosquitoes. More generally, it is recommended to protect oneself from the sun and to be cautious about the water one drinks and the food one eats. Depending on the region of residence, vaccination against yellow fever may be mandatory.
Costa Rica is a country that enjoys a well-balanced healthcare quality between the public and private sectors, thanks to good cooperation between the two. Public health expenditures represent a significant percentage (27.46%) of the country's total healthcare spending. This synergy is reflected in patient care habits, which frequently combine public and private services. For example, it is common to consult in the public sector, undergo examinations in the private sector, and then continue with follow-up care in the public sector.
This collaboration between the two sectors is also observable in the practices of physicians, many of whom work part-time in both public and private settings. They are generally trained internationally, particularly in the United States, Canada, or Europe, ensuring high qualifications. However, there are more healthcare professionals in the private sector, which creates differences in waiting times between the public and private sectors. However, it's important to note that quality and level of expertise come at a cost, and healthcare in the private sector in Costa Rica is not the most economical.
The Caja Costarricense de Seguro Social (CCSS) is responsible for providing care exclusively in the public sector. However, in exceptional situations where a medical specialty is not available or a patient requires specific medical equipment, a public hospital may refer the patient to a private facility (with coverage). Waiting times can be significant in the public sector, contributing to residents' dual use of both public and private services.
The CCSS manages a network of 30 public hospitals (10 general, 7 regional, and 13 peripheral), as well as 250 clinics throughout the country. Quality standards are satisfactory, although some facilities in rural areas could benefit from modernization. In the private sector, the most reputable hospitals are the international hospitals CIMA (in Escazu), Clinica Biblica (in San José), and La Catolica (in San José-Guadalupe). CIMA, in particular, offers a wide range of specialties. Overall, expatriates tend to be satisfied with the quality of care, especially in San José.
In the public sector, the doctor is assigned to you during the consultation, and it's not possible to choose your practitioner. For example, in EBAIS (Basic Teams for Comprehensive Health Care), it's recommended to visit the medical center as early as possible to register with the secretariat. The secretariat determines consultation times based on the day's waiting list. If necessary, the doctor may refer you to a clinic or hospital. It may be advisable to be accompanied by a translator if you do not speak Spanish.
However, in the private sector, you can choose your doctor, especially based on the language they speak. However, if you are insured with a local company, a network of care may be imposed, and the choice of doctor will be limited to those listed by your insurance. Before subscribing to a local health insurance policy, it's important to inquire about the practitioners and facilities covered. International health insurance policies, on the other hand, offer complete freedom of choice.
A consultation with a general practitioner costs on average between $ 50 and $ 75, while a consultation with a specialist ranges from $ 90 to $ 110 depending on the facility and the doctor's specialty. These fees may seem reasonable for an American or Canadian expatriate, but relatively high for a French expatriate. Therefore, it's important to choose your health insurance according to your needs, the frequency of your care, and the level of reimbursement desired. Although occasional healthcare expenses in Costa Rica may not represent an excessive financial burden, regular medical care requires health insurance.
It is possible to consult a specialist without consulting a general practitioner beforehand. However, it's necessary to make appointments in advance with practitioners unless it's an emergency. Emergency services are open 24 hours a day, and the emergency number is 911. Lists of doctors are generally provided by consulates to facilitate healthcare procedures for newcomers.
It's important to know that healthcare services are often payable in advance in Costa Rica, and proof of solvency may be required by the hospital or clinic before you are admitted. Having health insurance can help alleviate these constraints while covering the relatively high costs of care.
Basic hospitalization costs at least $ 400, while more complex procedures such as angioplasty or hip replacement surgery can reach $ 12,000, and cataract surgery costs $ 1,700 per eye. The cost of a day of hospitalization in the private sector varies depending on several factors, including the type of hospital, the nature of the intervention, the type of room, and the requested services. Examinations such as an MRI cost between $ 75 and $ 150, which remains affordable but can add up if you are uninsured and paying out of pocket.
Prescribed medications are mostly generic, and it may be useful to know the names of the molecules to find equivalents to your usual prescriptions. Pharmacies (farmacias) are accessible and well-stocked, and many medications are available without a prescription. However, a prescription will be necessary to obtain reimbursement for your medications from your health insurance.
Dental care in Costa Rica is world-class and remains affordable compared to private rates on the American continent, which generates increasing dental medical tourism. Dentists are highly qualified, and the materials used are FDA-approved and imported from the USA. Prices vary depending on the location of care and the nature of the service. For example, a basic dental cleaning or filling costs on average between $ 66 and $ 140 (full cleaning). An advanced examination with panoramic X-ray averages $ 200. For a dental implant, expect about $ 800, and for a dental crown, around $ 470.
Overall, prices in the private sector in Costa Rica are relatively high, comparable to those practiced in some European countries. Insurance for hospitalization and routine medical expenses is strongly recommended. If you have dental needs, insurance with optical-dental coverage would be justified to moderate your out-of-pocket expenses.
In Costa Rica, maternity-related care is generously covered. Pregnant women affiliated with the CAJA (Costa Rican Social Security Fund) receive free care and are considered priority patients, and newborns are taken care of from birth. Coverage is comprehensive: monthly check-ups, tests, and even dental appointments.
However, many expatriates opt for private hospitals and clinics to benefit from greater flexibility in care, the choice of their doctor, and more advanced tests, such as a 4D ultrasound. In public facilities, appointments are "take it or leave it," and the doctor is assigned.
In the private sector, the cost of childbirth varies depending on the facility and the doctor. Generally, for a complication-free delivery, you should budget between $ 1,000 to $ 1,500 for hospital fees, as much for the doctor's fees, and $ 150 to $ 200 per day for the room; representing a total cost of $ 2,500 to $ 3,500 on average. Costs can become exponential in case of complications. Prenatal consultations in the private sector cost between $ 50 and $ 80, including ultrasound.
If you plan to give birth in the private sector to take advantage of these benefits, it's essential to have health insurance to reduce your expenses. Moreover, in Costa Rica, it's also possible to consider a home birth, for a reasonable cost starting from $ 2,000, including prenatal and postnatal care.
The Caisse des Français de l'Étranger (CFE) allows you, as a European citizen, to benefit from basic French health coverage when living out of EU. The CFE health insurance reimburses all types of expenses in Costa Rica, such as medical, surgical, hospital, dental, optical, laboratory, and other services, within the limits of the rates applied in zone 4 of the CFE.
However, the CFE operates as a primary reimbursement basis and does not cover all of your medical expenses. This limitation is significant when considering Costa Rica, where the reimbursement basis for hospitalization is only 31% of the bill amount, and 45% for pharmacy bills (which may be capped at the rate applied in France). Consequently, at least 69% of hospitalization costs and 55% of pharmacy costs remain your responsibility.
Depending on your needs and financial means, you have several options: trust the local public system, opt for CFE coverage alone with the resulting out-of-pocket expenses, subscribe to a complementary insurance with CFE or a first-euro contract. Expatriate insurance in addition to CFE (or first-euro) guarantees 100% coverage of your hospitalization expenses, regardless of the healthcare facility, and provides additional reimbursement for your routine expenses, especially for those seeking good reimbursement in the private sector.
The CFE contribution is calculated based on your age and the number of people to be covered (individual or family). The CFE provides coverage internationally for its MondExpat members. However, it does not offer repatriation assistance.
In Costa Rica, the healthcare sector is managed by the Ministry of Public Health, and the Caja Costarricense de Seguro Social (CCSS), commonly known as "La Caja", is the institution responsible for health insurance as well as old-age and death insurance. Established in 1940, this social security organization aims to provide medical care to all permanent residents (pensionado, rentista, or inversionista) and Costa Rican citizens. In 2016, it already covered 85% of the country's population, and today it reaches 90%.
It's important to note that permanent residency in Costa Rica is generally obtained after approximately 18 months, and affiliation with the CCSS is not immediate unless one is employed by a local company. Before affiliating with the CCSS, expatriates can only benefit from care in public hospitals in cases of emergency.
The Caja is funded by taxes from employees, employers, as well as the state. Employees have a contribution of 7% to 11% of their monthly income deducted directly at the source, depending on their income bracket. For example, this represents $ 105 to $ 165 per month for an employee earning $ 1,500 per month. Self-employed workers and retirees contribute as Asegurado Voluntario. Affiliation of permanent residents with the CCSS has been mandatory since 2010.
CCSS affiliates benefit from very low-cost care, or even free care (without copayment) in the public sector. Coverage includes all types of medical care, from hospitalization to medications, and extends to the spouses and children of insured individuals.
The Costa Rican Social Security system has a particular feature known as EBAIS, or Equipos Basicos de Atención Integral de Salud. These are medical teams, sometimes mobile, accompanied by a doctor, implanted throughout the country in the form of medical centers, to provide advice and basic care (especially in rural areas). The 1000 EBAIS teams are responsible for vaccination campaigns, sanitation issues (potable water), and ensuring minimum access to healthcare for all.
The last pillar of social security is the Instituto Nacional de Seguro (INS).
For many years, the National Insurance Institute (INS) held a monopoly on local health insurance in Costa Rica, but the sector has recently opened up to competition. Now, residents have a choice among several insurance companies, such as BMI, ASSA, or MAPFRE. INS offers attractive insurance plans to non-residents, which operate in the private sector. For approximately $ 50 per month, medical expenses are covered at 70% for routine medical care (consultations, tests, medications) and hospitalization, while surgery and anesthesia costs are covered at 100% up to $ 17,000. The out-of-pocket expenses for the insured vary depending on the nature of the care.
Local insurances operate in partnership with a network of providers, including hospitals, doctors, pharmacies, or even laboratories. Members must refer to a specific list of healthcare providers in this case. Moreover, the coverage of local insurances is generally limited to the national territory, unlike international health insurances, which offer global coverage. Additionally, repatriation assistance may not be included in the guarantees of local health insurance contracts, which can be restrictive for an expatriate.
The prices of private insurances vary greatly depending on several factors, including the age of the insured, chosen deductibles, the network of care, the level of reimbursement, as well as medical history. Some contracts do not cover retirees beyond a certain age; for example, INS plans cannot be subscribed to beyond 74 years.
Employers are not obligated to offer private insurance in addition to the contribution to the CCSS. It will be necessary to subscribe privately if you wish to be covered in private healthcare facilities. The choice between local or international health insurance will depend on your habits and health needs, as we will detail below.
For tighter budgets, there are "discount" health plans that allow beneficiaries to obtain discounts on certain treatments and avoid being uninsured.
Costa Rica is renowned for its quality public healthcare system, but only permanent residents benefit from free health insurance. Moreover, while the public system is effective, it's common to turn to the private sector, which can be costly and restrictive in terms of upfront payments or payment guarantees.
In this context, subscribing to expatriate health insurance in Costa Rica offers numerous advantages and allows for adaptation to local particularities. First and foremost, the country requires health insurance for any visa application, whether it be for work, digital nomadism, study, or temporary residence. Although there is a significant offering of local insurances, these contracts often come with limitations or conditions that don't meet the needs of expatriates and their standards.
Likewise, the costs of the private sector and the waiting times in the public sector encourage subscribing to private health insurance. By opting for expatriate insurance, you benefit from a wide choice of healthcare providers, reimbursement levels tailored to your needs (including optical, dental, alternative medicine, private room, etc.), as well as the peace of mind of knowing that you're covered, whether in Costa Rica or your home country, if you prefer to maintain certain medical habits.
With an expatriate health insurance contract you choose security, and particularly with French expatriate contracts following the legislation specific to French insurance; for example, your rate cannot be individually adjusted based on your healthcare consumption. You benefit from 100% direct coverage of your hospitalization costs, as well as options such as teleconsultation or medical evacuation and repatriation. Additionally, your expatriate insurance offers you international emergency health coverage for your occasional personal or professional trips.
Lastly, while travel insurance isn't mandatory for tourists staying less than 90 days in Costa Rica, given the high healthcare costs in case of hospitalization, it's strongly recommended to subscribe to international health insurance.
Expatriate insurance for Costa Rica can be taken out at any time. International insurance offers are flexible, allowing you to select only the options that fit your needs. The guarantees offered are similar to those you are familiar with, thus eliminating uncertainties related to local operations.
However, it is important to note that the enrollment procedures for expatriate guarantees are generally more complex than for a regular insurance company. Therefore, it is recommended to subscribe at least 30 days before your departure.
When taking out expatriate insurance, you will be asked to complete a health questionnaire. Depending on your medical history, exchanges with the medical service may be necessary, which may result in additional processing time for your membership application. Indeed, you may be required to provide additional medical documents (preferably keep these medical records handy) or have a questionnaire completed by a doctor who follows you for a specific condition.
On our website, you have the possibility to make online simulations to obtain quotes and compare guarantees. This helps you form an opinion and choose the insurance that best suits you.
Once you have done your research and have a clearer idea of what you are looking for, our advisors will be available to refine the proposals, help you finalize your choice, and guide you through the entire membership process. They will be there to answer your questions and guide you through all the necessary steps.
Finally, your advisor can verify that the chosen formula is accepted/recognized by the administration.
If you contribute to CCSS, you benefit from free coverage for all types of care in the public sector. However, if you prefer to be covered in the private sector and have the freedom to choose your doctors and places of care, it is recommended to opt for an expatriate plan that covers hospitalization and basic medical expenses. Additionally, if you do not have access to universal health coverage, taking out health insurance is mandatory, whether it be temporary travel coverage or long-term expatriate coverage.
Hospitalization and repatriation assistance is the minimum recommended coverage in Costa Rica. This ensures good hospitalization coverage in the private sector for CCSS beneficiaries, in addition to basic care provided in the public sector. This option is also valid and highly recommended for expatriates who do not yet have access to CCSS health insurance, as hospitalization represents a significant financial risk in the country.
If your budget allows and you have regular medical needs, consider a formula that also reimburses outpatient medical expenses, especially if access to the public sector is difficult, limited, or unavailable. You can also select a plan with optical and dental coverage if justified; although deemed accessible, the majority of these costs remain your responsibility. Furthermore, the growth of medical tourism in Costa Rica in recent years may influence prices and cause them to rise.
Lastly, for non-resident expectant mothers, remember to subscribe to maternity coverage in advance, considering the maternity waiting periods of 9 to 12 months for this guarantee. It is important to know that no insurer covers pregnancies already in progress, including CFE. Additionally, health expenses related to childbirth complications or neonatal care for the newborn can be very expensive.
Given the country's geography, medical evacuation is essential in Costa Rica, despite the quality of local healthcare. Repatriation assistance guarantees transportation to the most suitable hospital for your situation, especially if you reside in a more rural area outside of San José or the tourist beaches.
Repatriation assistance also offers "comfort" services particularly useful in times of hardship. This may include covering the travel expenses of a loved one who would come to your bedside, organizing childcare or transferring your children, as well as providing access to medical advice and consultations, and more.
It's worth noting that in the event of a medical emergency, neither your embassy nor your consulate is responsible for organizing or covering the costs of medical repatriation. If you prefer not to foot the bill alone (which can amount to tens of thousands of euros), hospitalization with repatriation assistance is the minimum recommended for any traveler or expatriate in Costa Rica.
Furthermore, expatriate insurance policies also offer optional civil liability coverage. In Costa Rica, this can be useful in a society heavily influenced by the United States. It's always good to have legal support when needed.
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