How does healthcare work in Costa Rica, and what travel insurance, health insurance or expat insurance do you need?

How does the healthcare system work in Costa Rica?

What is the quality of healthcare in Costa Rica?

• The World Health Organization (WHO) regularly ranks Costa Rica high on the list of countries with the highest life expectancy.
• The Costa Rican government has one of the lowest expenditures on health care per capita. Not because they can't spend money on it, but because it is not always necessary. On the other hand, Costa Rica invests heavily in prevention and health monitoring.
• Costa Rica's health care system also scores high in global rankings: the country is regularly above the USA and is often 'the best system' in all of Latin America.
• Health care in Costa Rica is often relatively (much) cheaper than what we are used to in Europe or the United States.
• Many doctors in Costa Rica receive their training (entirely or partly) in the USA, Canada or Europe.

How does the public healthcare system work in Costa Rica?

• The Caja Costarricense de Seguro Social ('Costa Rican Social Security Fund') determines a lot of policy regarding public health care in Costa Rica. In addition, they also make policy for, among other things, the pension system. The public health care system is called 'Caja' for short.
• About 90% of all permanent residents in Costa Rica are covered by the public health care system. Non-residents must be affiliated with one of the 'official resident programs': the 'Pensionado', 'Rentista', or 'Inversionista' programs (always check up-to-date status).
• Everyone who participates in 'Caja' will have to deal with EBAIS: Equipos Básicos de Atención Integral en Salud ('Comprehensive Basic Health Care Team'). A local or regional EBAIS location, or someone from the EBAIS team who comes to your home, is often your first point of contact for health problems.
• If you are a permanent legal resident of Costa Rica as an expat, you are also required to become a member of Caja/EBAIS. Please note that the application process can take up to 18 months. Once you have been admitted to the system, you register with the nearest regional government health office. After various checks and additional paperwork, they connect you to a local (EBAIS) clinic, where you register as a patient. 'Caja'/EBAIS includes several dozen hospitals and over 200 clinics.
• If you work as an expat/resident in Costa Rica, you will take out a "poliza de riesgo del trabajo" - via your local employer: an insurance policy that serves to supplement the public system and focuses on health risks during work.
• If you are self-employed in Costa Rica, or retired, there is an 'independent worker coverage plan' called 'asegurado voluntario'. Through this plan you can still participate in Caja.
• Please note that the 'Caja coverage' is quite basic.
• The costs of (public) healthcare - doctor, hospital, prescriptions - are generally lower in Costa Rica than in the USA and many European countries. For example, doctors often charge no more than less than 100 USD per consultation, even for home visits. For a consultation with a specialist, you can expect to pay a little more. Standard examinations such as tests such as an ultrasound cost around 100 USD. Always check up-to-date costs before you make a final commitment and always agree costs in advance with your international health insurer, especially for potentially substantial costs.

How does the private healthcare system work in Costa Rica?

• The vast majority of people in Costa Rica use the public healthcare program. Only about 10-15% of Costa Ricans opt for private healthcare.
• Reasons to choose private healthcare in Costa Rica include the shorter waiting lists and the freedom of choice in doctors and clinics. You can often also choose - in consultation - to only have the examination performed at a private clinic (often shorter waiting list) and to go to a cheaper 'Caja doctor' for the results.
• Private healthcare in Costa Rica is provided by the government insurer 'INS' (Instituto de Seguro Nacional). This includes dental care, eye care and annual check-ups, as well as specific medication, surgery and care from beauticians.
• In some situations it is possible for expats to use INS. Most expats in Costa Rica choose an international health insurer for several reasons. Costa Rica has only allowed international health insurers to be active on the market since 2009.
• The four largest private hospitals in Costa Rica are all located in or in the immediate vicinity of San Jose. 'CIMA' in San Jose is the best known and most extensive in terms of care and facilities. In the places on the coast that are more popular with expats, you will find smaller, but often good, private clinics.
• Many doctors from Costa Rica choose to work in private healthcare (as well). In the mornings, they work for Caja/EBAIS, in the afternoons they run a private clinic. That is precisely why the Costa Rican government is increasingly bringing in doctors and nurses from countries outside Costa Rica, including Cuba.
• Costa Rica is a popular destination for medical tourism (including from the USA), due to the pleasant living conditions, relatively low costs of (private) healthcare, a large number of bilingual staff and good medical facilities. Many foreigners also go to Costa Rica for cosmetic surgery, because of the lower costs and good facilities.

How is the general practitioner arranged in Costa Rica?

• Healthcare in Costa Rica has a strong emphasis on prevention and health and is usually personally focused.
• In Costa Rica, you will find so-called health teams, of around 5 health workers, of whom at least one is a doctor. There are over 1,000 'teams', which monitor the health of 3,500-4,000 residents per team. If you participate in the Caja system, you will be linked to a local EBAIS clinic and/or a health worker from the EBAIS home team.
• From childhood on, a 'health ambassador' from that team comes to the people's homes. That person knows the people and follows them in their development. The health ambassador gives advice, provides vaccinations, does periodic check-ups and provides medication.
• A specific point of attention is the registration and (having) improvement of sources with 'stagnant water' in and around the house / in the community. Of course, that is a source for mosquitoes, with their accompanying diseases. Extra attention is also paid to possible too basic living conditions, teenage pregnancies and even to the health and vaccination of pets, so that they do not become a source of disease for Costa Ricans.
• Throughout Costa Rica, the emphasis is not on 'repair' once people are sick, but on prevention.
• If you are insured through the private health care system, or through an international health insurance, you often have more freedom of choice in doctor or practitioner. Always check with your expat insurance (except for emergency aid) in advance which private hospitals have agreements with them, so that you can be sure that the care provided by a specialist/hospital will also be reimbursed.

How is the dentist arranged in Costa Rica?

• The 'public health care' (Caja) in Costa Rica also includes basic dental care. However, treatments performed by an orthodontist, for example, are excluded from this.
• In general, there are good dentists ('dentistas') in the larger and medium-sized cities in Costa Rica, who follow international standards, and for a very reasonable price.
• Do thorough research into which practice you choose, in consultation with your international dental insurance. If you are unsure about a certain procedure, ask for a second opinion or a price indication from another provider.
• Because Costa Rica has a lot of 'medical tourism', especially around dental care, you will find dentists in many places who speak very good English and work with international materials and standards.
• Compared to the USA and Europe, treatments with a dentist in Costa Rica are really much cheaper.

How is pregnancy care arranged in Costa Rica?

• If you are pregnant in Costa Rica, you often have 'priority' under the Caja system: you hardly have to deal with waiting lists for specialist care, for example.
• However, it is a 'take it or leave it' system; if you want to have influence on which doctor you see and when, you have to opt for private care.
• The birth of a baby in Costa Rica normally takes place in a public or private hospital.
• Many expats find public care around pregnancy and childbirth somewhat 'impersonal'; you see different doctors and you go through standard procedures where you have little influence on what happens. For example, a '20-week ultrasound' is often not part of public care. 
• A caesarean section is only performed if it is really necessary from a medical point of view. There are also relatively few single rooms and visiting hours for 'the partner' are limited.
• Private care offers more freedom of choice and more options to organize the process of childbirth as you wish. For example: multiple people from your environment at the birth, a birth in water, more choice regarding pain relief etc.
• All babies born in Costa Rica are residents of Costa Rica at birth. Babies are given their own registration number, 'cédula', which they keep their whole life.
• Because after birth you have a direct relationship with someone who is a resident of Costa Rica (your baby), it is much easier to obtain permanent residence status for yourself and your immediate family.
• Newborns are normally automatically covered by the CAJA system for one year. This covers all routine care, any emergency consultations, diagnostic tests and various other expenses. Of course, double-check this before you incur any costs!
• If your baby is born, register them at a 'Civil Registry office'. With the birth certificate from the hospital or clinic, the completed forms from the registration office, proof of identification from both parents and payment of the registration fee, you will receive an official birth certificate. You will need this for access to healthcare for the baby and -later- for education.
• If you are traveling through Costa Rica with a newborn baby, you must have a 'permiso de salida' from your doctor. This shows that your baby is healthy to travel.

How is the pharmacy in Costa Rica arranged?

• If you want to replenish your travel pharmacy en route, many types of medicines are available at pharmacies (farmacias) in Costa Rica. Many medicines, such as the birth control pill (preventing pregnancy), medication for high cholesterol or migraine medication, are available without a prescription in Costa Rica.
• The pharmacy employee is often the first point of contact for basic health problems in Costa Rica. In case of doubt, the doctor-pharmacist on duty is called in. He or she can refer you to a hospital or clinic if necessary.

How safe or unsafe is a trip or stay in Costa Rica?

What should you pay attention to in terms of safety in Costa Rica?

• Costa Rica is in principle a relatively safe country in Central America. Certainly compared to some neighbouring countries in the region.
• However, drug gangs are also active in Costa Rica and robberies and muggings take place.
• Crime in Costa Rica ranges from relatively harmless (such as pickpockets) to violent robberies and sometimes even rape and murder.
• If you live in Costa Rica for a longer period of time and travel with your own car, be alert if you get a flat tire. Criminals disguise themselves as 'helpful passers-by', in order to then rob you.
• For example, if you visit a restaurant or supermarket, do not leave any belongings in your car. A burglary can easily happen.
• The various bus stations in San José are notorious, especially after sunset.
• As everywhere, it is also not wise in Costa Rica to go to busy tourist places with large amounts of money or adorned with jewellery. Not even on the beach. Pickpockets are active in busy places. 
• If you are staying in Costa Rica for a longer period of time, there is a chance that you will encounter earthquakes or tropical storms. The period from June to November in particular is known as storm and hurricane season in Costa Rica. Be prepared and inquire which authorities you should contact for up-to-date information in English if something like this occurs.
• If you are living in Costa Rica for a longer period of time, you will sooner or later have to deal with demonstrations, as a result of political or economic issues. A strike can have consequences for transport, fuel supply and other government services. And beware: even peaceful demonstrations can end in violence.
• On the Caribbean coast and the Pacific coast in Costa Rica, dangerous currents occur ("rip currents"): very strong currents in the sea. Always check with local Costa Ricans where you can and cannot swim.
• LGBTIQ+ people are generally welcome in Costa Rica.

What should you look out for in terms of diseases in Costa Rica?

• Costa Rica is experienced by many as a country with a high quality of life: climate, beaches, nature, friendly people, low cost of living.
• However: tropical diseases are present in parts of the country. Checking vaccinations before you leave is highly recommended. Also consider hepatitis B for a longer stay.
• Always drink bottled water in Costa Rica, which is cheap and available everywhere.
• In the Limón region, be extra careful with mosquito bites; malaria occurs regularly. In principle only in this province, but always check the most up-to-date status before departure.
• Hospitals and doctors often want you to pay cash in advance for a consultation or treatment. Private hospitals also usually ask for an advance payment, or proof that you are well insured. Always coordinate this with your (international) health insurer.
• Check well before departure for which medicines you need a declaration to be allowed to take a dose to Costa Rica. Always take the original packaging with you and think about arranging a medication declaration in time. For each medicine you use, write down the international name of the active substance and try to find out before you leave whether your medicine is also available in Costa Rica, where and how.

What should you pay attention to when it comes to traffic in Costa Rica?

• Do not travel by road after sunset, especially in remote areas. Avoid car and bus rides in the evening and at night.
• Also be on your guard during the day: that is when robberies occur.
• Stay on the main roads as much as possible.
• During the hurricane season, you should take into account roadblocks due to landslides and mudslides. In Costa Rica, there are relatively few options for diversions; so expect (considerable) delays and make sure you have enough water and food.
• Traffic rules in Costa Rica are at most a 'guideline' for how to move in traffic. Many people do not adhere to them and sometimes behave quite aggressively. Therefore, drive 'defensively' and do not get involved in discussions.

What work and travel insurance policies are suitable for short and long stays in Costa Rica?

• Is the trip to Costa Rica and your return sufficiently covered? Are you sufficiently covered before, during and after your activities? Which insurance best suits your trip and your activity? Read more about insurances for abroad on JoHoinsurances.org.

What emigration and expat insurance can you take out for Costa Rica if you are going to live there for a while?

• It is not a legal requirement for expats to have health insurance, but it is highly recommended. In some circumstances, you may be eligible for the local 'Caja' health system. Even then, it is recommended to take out additional insurance through an international health insurance policy.
• Some areas in Costa Rica are considered dangerous. Depending on current events, these areas may be outside the coverage area of ​​your insurance company. Make sure you are up to date with information regarding the coverage areas of your specific health insurance.
• Read more about insurances for abroad on Expatinsurances.org.