How Does Healthcare Work for Expats in Costa Rica?
Costa Rica has a two-tier healthcare system: CAJA (the universal public system) and a strong private sector. Expats with legal residency must enroll in CAJA at 7–11% of declared income, which covers everything from doctor visits to surgery with no copays. Most expats also carry private insurance ($200–$800/month per couple) for faster access and English-speaking providers. The quality of care is genuinely high.
The Concern Everyone Has
If there's one worry I hear more than any other from families considering Costa Rica, it's healthcare. And I understand why. You've spent decades within a system you know. Starting over feels unsettling.
So let me answer directly: Will you get good healthcare in Costa Rica? Yes. With proper planning, absolutely yes.
Costa Rica consistently ranks among the top healthcare systems in Latin America. According to the World Health Organization, Costa Rica's life expectancy is approximately 80 years, higher than the United States and among the highest in the Americas. The country's infant mortality rate, per the World Bank, is comparable to many OECD nations. But the system works differently than what you're used to. Understanding the structure is the key to using it well.
"The CAJA gap is the part nobody plans for. You arrive, apply for residency, and then wait 10 to 24 months before CAJA coverage kicks in. That entire window needs to be covered by private insurance, and most people don't budget for it." Brennan Vitali, CFP®, Vitality Wealth Planning
The Public System: CAJA
Costa Rica's universal public healthcare system, the Caja Costarricense de Seguro Social (CAJA), is the backbone of healthcare in the country.
Important: CAJA is only available to approved temporary residents and above. The residency process takes 10–24 months. If you're pre-residency, you'll need private insurance as your sole coverage.
How CAJA works:
- All legal residents are required to enroll
- Monthly contributions are based on declared income (typically 7–11%)
- Pensionado visa ($1,000/month income): approximately $65/month
- Rentista visa ($2,500/month income): approximately $200/month
- Covers doctor visits, specialist referrals, hospitalization, surgery, prescriptions, and lab work. No copay, no deductible.
- Coverage extends to dependents
- Proof of CAJA enrollment is required for your cedula (DIMEX) issuance and renewal
Strengths: Comprehensive coverage, remarkably low cost, included prescription medications, strong preventive care through community-based EBAIS clinics.
Limitations: Wait times for non-emergency specialist visits can be weeks to months. Facility quality varies. You don't choose your doctor. The system operates primarily in Spanish.
The Private System
Costa Rica has an excellent private healthcare sector, and this is where most expats spend the majority of their healthcare time.
Top private hospitals:
| Hospital | Location | Notes |
|---|---|---|
| CIMA Hospital | Escazu (San Jose metro) | Most popular among expats, English-speaking staff, internationally accredited |
| Clinica Biblica | Downtown San Jose | One of Central America's oldest and most respected, dedicated international patient department |
| Hospital Metropolitano | San Jose | Modern equipment, wide specialty range |
Regional private clinics in Guanacaste, the Central Pacific, and other expat areas handle routine and urgent care.
What private care costs:
| Service | Costa Rica | United States |
|---|---|---|
| General doctor visit | $50–$100 | $150–$300 |
| Specialist consultation | $80–$200 | $250–$500 |
| MRI scan | $300–$500 | $1,500–$3,000 |
| Surgical procedures | 40–70% less | N/A |
| Full-body annual checkup | ~$500 | $1,500–$3,000 |
| Knee replacement | $12,000–$15,000 | $30,000–$60,000 |
Many doctors trained in the United States or Europe. Equipment is modern. Facilities are clean and well-maintained. According to the Medical Tourism Association, Costa Rica is one of the top medical tourism destinations in the Americas, with an estimated 70,000+ medical tourists visiting annually (PROMED Costa Rica), a testament to the quality of private care available.
Insurance Options for Expats
Option 1: Private Insurance Only (Pre-Residency)
Before residency approval, private insurance is your only option. Two paths:
INS (Costa Rica's national insurer):
- Basic plans: $60–$100/month per person
- Standard plans: $120–$180/month per person
- Comprehensive plans: $200–$250+/month per person
- Not available for expats over age 75
International plans (Cigna Global, Aetna International, Allianz Care):
- Basic: $100–$300/month per person
- Comprehensive: $300–$700/month per person
- Premium/no-deductible: up to $1,000/month per person
- Include medical evacuation and worldwide coverage
Option 2: CAJA + Private Insurance (Post-Residency)
The most common approach for expats with resources. CAJA is mandatory for all residents. Adding private insurance gives you faster access, hospital choice, and English-speaking providers.
Option 3: Self-Insure + Catastrophic Coverage
Some families with significant assets pay out-of-pocket for routine care at private facilities while maintaining a catastrophic or international plan for major events. Given Costa Rica's low private-care costs, this can make financial sense.
Healthcare Budget by Tier
| Tier | Monthly Cost (Couple) | Coverage |
|---|---|---|
| Comfortable | ~$350 | Basic private plan (pre-residency) |
| Enhanced | ~$500 | Comprehensive private + CAJA |
| Premium | ~$800 | Top-tier international plan, no deductible |
Specialized Care: An Honest Assessment
Costa Rica's healthcare handles the vast majority of medical needs excellently, including routine care, chronic disease management, orthopedics, cardiology, oncology, and general surgery.
For ultra-specialized care, certain rare cancers, cutting-edge experimental treatments, highly specialized pediatric procedures, you may need to travel to Houston, Miami, or Mexico City. This is a planning consideration, not a dealbreaker. An international insurance plan with medical evacuation coverage addresses this.
The Bottom Line
Healthcare in Costa Rica is not a reason to hesitate. Most expats I work with tell me it was their biggest worry before the move and one of their biggest pleasant surprises after.
According to Fidelity's 2025 Retiree Health Care Cost Estimate, the average US couple retiring at age 65 will need approximately $345,000 for healthcare throughout retirement. Per the Peterson-KFF Health System Tracker, US healthcare spending per capita exceeds $14,775 annually (Peterson-KFF, 2024 data), more than double the average of other high-income nations.
With the right combination of CAJA enrollment, private insurance, and knowledge of the system, you will be well covered, often better and for less money than in the US. Healthcare costs are a major reason many families find retiring in Costa Rica compares favorably to the US.
FAQ
Can expats use the public healthcare system in Costa Rica?
Yes, but only after obtaining legal residency, which takes 10–24 months. All residents are required to enroll in CAJA and pay monthly contributions of 7–11% of declared income. Pre-residency, you must rely on private insurance. Setting up healthcare should be one of the first things on your first 90 days checklist.
How much does health insurance cost in Costa Rica for expats?
Private insurance through INS (Costa Rica's national insurer) runs $60–$250/month per person. International plans from providers like Cigna Global or Aetna International range from $100–$1,000/month depending on age, coverage level, and deductible. Most couples budget $350–$800/month total for healthcare. See our full cost of living breakdown for how this fits into your monthly budget.
Is healthcare quality good in Costa Rica?
Yes. Top private hospitals like CIMA and Clinica Biblica offer modern facilities, internationally trained doctors, and care quality comparable to good US hospitals. Many procedures cost 40–70% less than equivalent US procedures. Costa Rica ranks among the highest in Latin America for health outcomes.
Do I need private insurance if I have CAJA?
CAJA covers everything, but wait times for non-emergency specialist care can be significant. Most expats with resources carry private insurance alongside CAJA for faster access, choice of doctor, English-speaking staff, and access to the best private hospitals.
What happens if I need specialized care not available in Costa Rica?
For ultra-specialized treatments, the most common destinations are Houston, Miami, and Mexico City. An international insurance plan with medical evacuation coverage ensures you can access the best care worldwide when needed. This applies to a small percentage of medical situations.
Brennan Vitali is a CFP® and cross-border financial planner whose family splits time between the US and Costa Rica. Healthcare planning is part of every family's relocation strategy. Take the Readiness Quiz or book a discovery call.