Written by
John Spencer
John Spencer is the founder of Compare Expat Plans, focusing on clear, neutral information to help people find health coverage abroad.
Last updated: January 29, 2026
Quick Summary: Health Insurance in Nicaragua
- No insurance required for visas—but private coverage is essential given limited public healthcare.
- Hospital Metropolitano Vivian Pellas (Managua) is the only hospital meeting international standards.
- Extremely affordable—private GP visits $20-40, hospital stays $100-300/day, insurance $50-100/month.
- Popular retirement destination—Pensionado visa requires only $600/month pension income.
- Miami evacuation (2.5 hours) essential for serious conditions—Managua can't handle complex cases.
Do You Need Private Health Insurance in Nicaragua?
Nicaragua doesn't require health insurance for visas. However, private insurance is strongly recommended—the public system (MINSA) is severely underfunded and not suitable for expats. Most expats rely entirely on private hospitals in Managua and international insurance for anything serious. The Pensionado (retirement) visa doesn't require insurance but you'll want it.
You likely need private insurance if:
- All expats—public healthcare is inadequate; private insurance is your only realistic option
- Retirees—popular destination but medical needs increase with age
- Anyone outside Managua—Granada, León, San Juan del Sur have very limited healthcare
- Beach/rural dwellers—evacuation to Managua may be needed for basic emergencies
- US retirees—Medicare doesn't work abroad; you need replacement coverage
Public vs Private Healthcare in Nicaragua
Public Healthcare
MINSA (Ministerio de Salud) / INSS (Social Security)
- Access: Nicaraguan citizens; INSS for formal employees
- Cost: Free (MINSA) or payroll deduction (INSS ~6.25%)
Nicaragua's public healthcare is severely underfunded—among the poorest in Latin America. MINSA hospitals lack equipment, medications, and specialists. INSS (social security) hospitals are slightly better but still basic. Expats should not rely on public healthcare except for absolute emergencies. Managua has the best public facilities; rural areas have only basic clinics. English is rarely spoken in public facilities.
Private Healthcare
International or Local Private
- Access: Open to anyone
- Cost: $50-100/month (international plans); $30-60/month (local plans)
Hospital Metropolitano Vivian Pellas in Managua is the country's only truly international-standard hospital—modern equipment, trained specialists, some English. Hospital Bautista is a reasonable backup. Outside Managua: Hospital Privado de Masaya, but quality drops significantly. Private costs are very low by international standards—GP visit $20-40, specialist $40-80, surgery $2,000-8,000 for procedures costing $20,000-50,000 in the US. For serious conditions, plan on Miami evacuation.
Plan Options to Compare
Here are the most popular insurance options for expats in Nicaragua. Each has trade-offs depending on your situation.
Cigna Global
Best for: Medical evacuation to Costa Rica or Miami—critical given limited local specialist care
Not ideal for: Budget retirees—Nicaragua's low costs mean high premiums may not pencil out
Allianz Care
Best for: SJDS/Granada beach expats wanting regional hospital network access in Costa Rica
Not ideal for: Managua residents with direct access to Vivian Pellas hospital
BUPA Global
Best for: Pre-existing conditions with guaranteed evacuation to Miami for complex care
Not ideal for: Healthy retirees—local costs are so low that premium coverage rarely pays off
IMG Global
Best for: Budget coverage with evacuation for digital nomads on Nicaragua's tourist visa
Not ideal for: Long-term expats—limited provider network in-country
Comparison Table: Top Expat Health Plans for Nicaragua
Compare the leading options side by side. Click "Details" to learn more about each provider.
| Provider | Best For | Coverage Style | Includes U.S.? | Notable Limits | Learn More |
|---|---|---|---|---|---|
| Cigna Global | Medical evacuation to Costa | International comprehensive | Higher cost than local options | Details → | |
| Allianz Care | SJDS/Granada beach expats wanting | International comprehensive | Deductibles apply to savings | Details → | |
| BUPA Global | Pre-existing conditions with guaranteed | International premium | Premium pricing | Details → | |
| IMG Global | Budget coverage with evacuation | International standard | 12-month pre-existing exclusion | Details → |
Common Watch-outs for Nicaragua
Keep these points in mind when choosing coverage:
- Vivian Pellas is your lifeline: This is the only hospital in Nicaragua meeting international standards. If you live in Granada, San Juan del Sur, or León, you're 45-90 minutes from quality care. If you live on the Caribbean coast (Corn Islands, Bluefields), evacuation to Managua requires a flight.
- Political instability: Nicaragua has experienced political tensions and protests since 2018. Some international insurers have temporarily restricted coverage or added exclusions. Verify your insurer's current stance on Nicaragua before purchasing.
- Miami evacuation reality: For complex cardiac surgery, serious trauma, advanced cancer, or specialized care, you'll evacuate to Miami (2.5 hours by air). Ensure your plan covers medical evacuation with a reputable provider (not just reimbursement).
- CA-4 visa limitations: Nicaragua is part of the CA-4 agreement (with Guatemala, El Salvador, Honduras). You get 90 days shared across all four countries—not 90 days per country. For longer stays, you'll need residency.
- Limited specialist availability: Even Vivian Pellas doesn't have every specialist on staff. Some specialists fly in from Costa Rica or the US for scheduled procedures. Urgent specialty care may require evacuation.
Frequently Asked Questions
Is Nicaragua's Pensionado visa good for retirees?
Nicaragua's Pensionado (retiree) visa is one of the easiest and cheapest in the Americas. Requirements: Proof of $600/month pension or social security income, criminal background check, basic application. Benefits: Tax exemption on foreign income, one-time duty-free import of household goods and vehicle, permanent residency status. No health insurance required for the visa—but you absolutely need private coverage. Many US retirees find Nicaragua affordable on Social Security alone.
How does Hospital Vivian Pellas compare to US hospitals?
Hospital Metropolitano Vivian Pellas is a modern, JCI-aspirant facility in Managua with good equipment and trained doctors (many US/European-trained). It handles: general surgery, cardiology, orthopedics, obstetrics, oncology basics, emergency care. Quality is comparable to a good US regional hospital. Limitations: Not a teaching hospital, limited subspecialties, some advanced procedures require referral abroad. For routine care and emergencies, it's excellent. For complex cases (transplants, rare cancers, specialized pediatrics), you'll evacuate.
What healthcare exists in San Juan del Sur and Granada?
These popular expat towns have basic private clinics for minor issues—GP visits, simple injuries, common illnesses. Anything serious means driving to Managua (Granada: 45 min, San Juan del Sur: 2 hours). Both towns have pharmacies with many medications available without prescription. For beach communities, some expats arrange standing relationships with Managua doctors for telemedicine consultations. Bottom line: minor issues handled locally, anything significant = Managua or Miami.
How affordable is healthcare in Nicaragua really?
Very affordable. Examples at Vivian Pellas: GP consultation $25-40, specialist $50-80, blood panel $30-50, ultrasound $40-60, MRI $200-350, ER visit $50-100 (plus treatments), cesarean delivery $2,500-4,000, knee replacement $8,000-12,000. Local clinics outside Managua charge 30-50% less. Prescriptions are extremely cheap—$5-20 for most common medications. Nicaragua is one of the cheapest places in the Americas for quality private healthcare.
Should I get international or local health insurance in Nicaragua?
International insurance is recommended. Reasons: 1) Covers evacuation to Miami for serious conditions—local plans usually don't, 2) Provides coverage when traveling (important given CA-4 limitations), 3) More reliable claims payment, 4) Better customer service in English. Local insurers (INISER, ASSA) are cheap but have limitations. Best approach: International plan with evacuation coverage (Cigna, IMG, Allianz) for major issues, pay cash for minor private care (it's so cheap that going through insurance isn't worth it).
Related: Comparisons and Next Steps
Disclaimer: This guide is for informational purposes only. Healthcare policies, insurance requirements, and visa rules change. We are not insurance brokers, immigration consultants, or licensed advisors. Verify all information with official sources and insurance providers before making decisions.