Written by
John Spencer
John Spencer is the founder of Compare Expat Plans, where he focuses on helping people compare health plans for life abroad. He emphasizes clear information, neutral analysis, and practical decision support.
Overview
Costa Rica is famous for its "Pura Vida" lifestyle and has one of the best healthcare systems in Latin America. The World Health Organization ranks Costa Rica 36th globally—above the United States. The country offers universal healthcare through its public system, which all legal residents must join.
What makes Costa Rica unique is that CAJA (public health insurance) enrollment is mandatory for all residents. You cannot receive your residency card without it. Most expats pay into CAJA and also carry private insurance for faster access to care.
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Costa Rica's Healthcare System
Costa Rica has both public and private healthcare options, and both are considered high quality by Latin American standards.
Public Healthcare (CAJA/CCSS)
The Caja Costarricense de Seguro Social (CCSS), commonly called "La Caja," has provided universal healthcare since 1941. It covers all citizens and legal residents.
- Network of public hospitals, clinics, and EBAIS (community health centers)
- Treatment costs fully covered when deemed medically necessary
- Medications free if on the official drug list
- Includes preventive care, specialists, surgeries, and hospitalization
Limitations of CAJA
- Long wait times for specialists and elective procedures
- Assigned to specific clinic based on where you live
- Limited English-speaking staff
- Some newer medications not available
Private Healthcare
Private hospitals in San José and other major areas offer excellent care with shorter wait times and English-speaking staff. Popular private hospitals include CIMA, Clínica Bíblica, and Hospital La Católica.
Many expats use a hybrid approach: CAJA for routine care and prescriptions, private insurance for anything urgent or complex.
CAJA Public Insurance (Mandatory)
Since 2010, enrollment in CAJA has been mandatory for all legal residents. This is not optional—you cannot receive your residency card (cédula) without joining.
Who Must Enroll
- All temporary residents (Pensionado, Rentista, Inversionista)
- All permanent residents
- Work permit holders (employer contribution)
CAJA Costs
Contributions are based on your declared income, typically 7-11% of monthly income. Minimum contribution bases:
- Pensionado visa: Based on $1,000/month minimum income = ~$75-110/month
- Rentista visa: Based on $2,500/month minimum income = ~$175-275/month
As of 2025, retirement (Pensionado) and investor visa holders must also pay into IVM (disability, old age, and death insurance) in addition to health coverage.
Enrollment Process
- Receive your residency "resolution" (approval document)
- Register at your nearest CCSS regional office with proof of residency
- Register at your local EBAIS clinic
- Begin monthly payments
- Receive your residency card (cédula)
Important: You must continue paying CAJA to renew your residency. If you stop payments, you won't be able to renew your resident card.
Visa & Residency Requirements
Costa Rica offers several residency paths, each with different income requirements but the same CAJA obligation.
Pensionado (Retiree) Visa
- Income requirement: $1,000/month lifetime pension
- Health insurance: Must enroll in CAJA upon approval
- Popular with US Social Security recipients
Rentista Visa
- Income requirement: $2,500/month stable income for 2+ years, or $60,000 deposit
- Health insurance: Must show private coverage for application, then enroll in CAJA
- Good for remote workers with consistent income
Inversionista (Investor) Visa
- Investment requirement: $150,000+ in Costa Rican business or real estate
- Health insurance: Must enroll in CAJA upon approval
While Waiting for Residency
Residency processing can take 12-18 months. During this time, you cannot access CAJA. You need private health insurance to cover you until your residency is approved.
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Recommended Plans
Here are the most popular insurance options for expats in Costa Rica. Remember: CAJA is mandatory for residents, but most expats also carry private insurance.
| Provider | Type | Best For | From |
|---|---|---|---|
| CAJA (Public) | Public | Required for residents | ~$75/mo |
| INS | Local Private | Legal residents under 70 | $60/mo |
| IMG Global | International | Budget international | $100/mo |
| Allianz Care | International | High-deductible savings | $150/mo |
| Cigna Global | International | US coverage option | $220/mo |
| BUPA Global | International | Mental health / pre-existing | $230/mo |
Local Private Insurance
INS (Instituto Nacional de Seguros) is Costa Rica's government-owned private insurance company. They offer policies for legal residents with access to private doctors, hospitals, and labs. Important limitation: INS is not available for expats over age 70.
International Plans
Bupa Global is a top choice for expats in Costa Rica. They offer an extensive medical network, multiple plan levels (Major Medical through Elite), and coverage for children at no additional cost on some plans. Elite plans include medical evacuation and routine maternity care.
Cigna Global offers comprehensive coverage with $1 million+ limits for cancer and major illnesses. Higher premiums ($320-650/month) but excellent global network and 24/7 customer support. Silver, Gold, and Platinum tiers available.
IMG Global is a more budget-friendly international option, starting around $115/month without US coverage. Good catastrophic coverage for expats who want protection against major medical events.
Money-Saving Tip
Excluding US coverage from your international plan can reduce premiums by 30-50%. If you won't need care in the United States, this is an easy way to save significantly.
Expected Costs
Healthcare costs in Costa Rica are generally much lower than in the US, but insurance costs vary widely based on coverage level and provider.
CAJA Contributions (Mandatory)
- Pensionado: ~$75-110/month (based on $1,000 income)
- Rentista: ~$175-275/month (based on $2,500 income)
- Higher earners: 7-11% of declared income
Private Insurance
- Local private (INS): $60-150/month
- International basic: $115-200/month
- International comprehensive: $300-650/month
Out-of-Pocket Costs
Private healthcare in Costa Rica is affordable compared to the US:
- Doctor visit: $50-80 USD
- Specialist visit: $75-150 USD
- Dental cleaning: $40-60 USD
- MRI scan: $200-400 USD
Common Questions
Do I have to pay for CAJA even if I have private insurance?
Yes. CAJA enrollment is mandatory for all legal residents regardless of other coverage. You cannot receive or renew your residency card without paying into CAJA. Most expats pay both CAJA and private insurance.
Can I use only private insurance and skip CAJA?
No. Since 2010, CAJA enrollment has been legally required for all residents. This is not optional—it's a condition of your residency status.
What about the Rentista visa application—do I need private insurance?
Yes, for the initial Rentista application you must show proof of private health insurance. Travel insurance is not accepted. After your residency is approved, you then enroll in CAJA as well.
Can I get INS insurance if I'm over 70?
No. INS (the local private insurer) does not accept new applicants over age 70. Older expats typically rely on CAJA plus international private insurance from providers like Bupa or Cigna that accept older applicants.
How long does residency processing take?
Currently 12-18 months. During this time you cannot access CAJA, so you need private coverage. Plan to maintain private insurance for at least the first two years.
Is CAJA good enough, or do I need private insurance too?
CAJA provides solid coverage, but wait times can be long for non-emergency care. Most expats keep private insurance for faster access to specialists, English-speaking staff, and coverage at private hospitals. Think of CAJA as your safety net and private insurance for convenience.
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Disclaimer: This guide is for informational purposes only. CAJA contribution rates, residency requirements, and insurance regulations change periodically. We are not immigration consultants or insurance brokers. Verify all information with Costa Rican immigration authorities (DGME), CCSS, and insurance providers before making decisions.
