Costa Rica Healthcare for Expats: CAJA, Private Hospitals and Insurance

The short answer: three ways to pay for care

An expat resident in Costa Rica typically combines up to three things:

1. CAJA, the public system run by the Caja Costarricense de Seguro Social (CCSS). Mandatory for residents, paid monthly as a share of declared income.
2. Private hospitals and doctors, paid out of pocket, for faster appointments or a preferred specialist.
3. Private health insurance, from INS or a private insurer, to cover those private bills.

Only the first is required. The table below compares them.

CAJA: how the public system works for residents

CAJA is not optional for a resident. Three rules make it part of the immigration process:

• Before the card. Enrollment must be in place before Migración releases your DIMEX (Reglamento 37112-GOB, arts. 183 and 184).
• At every renewal. Temporary residents must show CCSS enrollment without interruption from approval (Ley 8764 art. 80; Reglamento arts. 227 and 228).
• As a permanent resident too. Continuous enrollment is shown at each renewal of permanent residency.

You join as a voluntary or independent contributor and pay a percentage of the income you declared to Migración. In 2026 that is about $100 a month on a $1,000 pension and about $344 at the $2,500 rentista minimum. A spouse can usually be carried as a family beneficiary. The bands, edge effects, family rules and the income figure CAJA offices apply are in our CAJA guide for residents; we do not repeat them here.

What CAJA covers. Primary care, specialists, surgery, hospitalization, maternity and prescription medication, with pre-existing conditions covered from enrollment. The trade-off is waiting time for non-urgent specialist appointments and elective procedures.

Inside the CCSS network

For enrolled residents, local CCSS clinics provide primary care and referrals. Above the clinics, the CCSS directory lists its hospitals in tiers:

Which hospital you are referred to depends on where you live and what you need; our guide to the best places to live in Costa Rica shows the road distance from nine common areas to their nearest CCSS hospital.

Private hospitals

Costa Rica also has private hospitals, open to anyone who pays or holds accepted insurance. Three hospital groups with sites in the areas where North Americans often live, described from their own websites:

• Hospital CIMA San José, on the Próspero Fernández highway in Escazú. CIMA states it has earned the Joint Commission International (JCI) Gold Seal for the sixth consecutive time.
• Hospital Clínica Bíblica, with its main hospital in San José and sites in Santa Ana, Aleste and Liberia; the Liberia site lists 24-hour emergency service. Clínica Bíblica lists JCI accreditation among its credentials.
• Hospital Metropolitano, with hospitals in San José and Lindora (Santa Ana) and branches in Quepos, Huacas (Guanacaste), Liberia, Ciudad Quesada and Cariari (Heredia), plus medical centres in Escazú, Alajuela, Heredia and Cartago.

Private consultations in San José and Escazú typically run about $60 to $120 out of pocket, per our relocation guide. Hospital procedures are priced case by case; ask for a written estimate, and ask whether the hospital bills your insurer directly.

Private health insurance: INS and the regulated market

Instituto Nacional de Seguros (INS). The Instituto Nacional de Seguros (INS) was founded by Law 12 of 30 October 1924. It sells health products under the Grupo INS name. Its INS Medical policy comes in three forms, per INS:

INS also lists other health products, including cancer and complex-diagnosis policies. Eligibility, age limits and exclusions are in the policy conditions, which INS publishes for download; read them before you apply.

The open market. Law 8653, the Ley Reguladora del Mercado de Seguros of 1 July 2008 (published 7 August 2008), set up Costa Rica's regulated insurance market. Among its stated objects are creating conditions for effective competition among insurers and strengthening INS so it can compete in an open market (art. 1). Only entities authorized by the Superintendencia General de Seguros (SUGESE) may carry on insurance business (art. 2), and consumers have freedom of choice among insurers and intermediaries (art. 4). The same law excludes the CCSS's mandatory social security schemes from its scope (art. 2), which is why CAJA is not an "insurance product" you can swap for another.

SUGESE publishes the register of active authorized insurers. Before buying from any company or agent, check that it appears there.

What private cover costs. Anuario Latam Seguros, a Costa Rican insurance publication, put individual health premiums at roughly ₡30,000 to more than ₡200,000 a month, which it gives as about $60 to $400, in January 2026, and noted that premiums rise progressively with age. El Financiero, reviewing private health policies in 2026, pointed out the variables that drive price and value: coverage territory (Costa Rica only, Central America, the Americas or worldwide), deductibles and co-payments, the provider network, waiting periods, and pre-existing condition clauses, under which individual policies may exclude conditions, add surcharges or be declined.

Practical sequence. Get private quotes, and read the pre-existing condition terms, before you cancel U.S. or Canadian coverage. If a private insurer declines or excludes a condition, CAJA still covers it once you are enrolled.

Medicare does not follow you to Costa Rica

For Americans, this point shapes the whole plan. According to medicare.gov:

• Medicare usually does not cover health care while you travel outside the U.S., and in most cases you pay all the costs yourself.
• The exceptions are narrow: certain situations where a foreign hospital is closer than the nearest U.S. hospital that can treat you, and medically necessary care on a cruise ship in, or within six hours of, a U.S. port.
• Medigap policies may cover emergency care during travel outside the U.S.

Living in Costa Rica is not a Medicare exception. Whether to keep paying Medicare premiums while living abroad is a personal decision; review Medicare's enrollment rules or take advice before dropping any part of your coverage. Canadians should check their own province's rules on how long they can be absent before losing provincial coverage.

Digital nomads: private insurance instead of CAJA

The digital nomad stay permit under Law 10008 is not residency and carries no CAJA obligation. Instead, at the card stage, you present a medical insurance policy covering the entire authorized stay with at least $50,000 of medical coverage in Costa Rica, from a SUGESE-registered insurer or a valid international policy, and each family member needs their own. That is also why a remote worker who later changes to rentista residency moves from private-only cover to mandatory CAJA.

Putting it together

A realistic set-up for a retired resident couple looks like this:

• CAJA for both, usually through one contribution with the spouse as a beneficiary, which satisfies Migración and covers pre-existing conditions.
• A decision on private cover: an INS or private policy, or a budget to pay private consultations directly.
• A plan for the U.S. or Canadian side: what happens to Medicare, Medigap or provincial coverage while you are away.
• A home within reach of care. The road distance to a regional or national hospital varies from a few kilometres in the Central Valley to more than 90 near Lake Arenal.

The full monthly picture, CAJA and insurance included, is in the cost of living in Costa Rica. The one-time residency costs are in how much Costa Rica residency costs, and the four paths are set out in the requirements guide.

Meridian includes CAJA enrollment in its flat $3,750 program fee, alongside document preparation, representation by licensed Costa Rican attorneys, every office visit and DIMEX pickup, with an approved-or-you-don't-pay guarantee. Start with the assessment to see which residency category, and which CAJA band, your income leads to.

Sources and legal basis

1. Reglamento de Extranjería, Decreto Ejecutivo 37112-GOB, arts. 183–184 (CAJA before the DIMEX), 227–228 (renewal and uninterrupted CCSS enrollment). Official text, TSE.
2. Ley General de Migración y Extranjería, Ley 8764, art. 80 (continuous CCSS enrollment). Official text, Poder Judicial.
3. CAJA 2026 contribution bands and family beneficiaries: see CAJA for residents for the CCSS scale and the Reglamento del Seguro de Salud.
4. CCSS, Hospitales: hospital tiers and descriptions. Retrieved 14 September 2026.
5. Ley Reguladora del Mercado de Seguros, Ley 8653 of 1 July 2008, Alcance 30 to La Gaceta 152, 7 August 2008, arts. 1, 2 and 4. Text published by Grupo INS.
6. Instituto Nacional de Seguros, Somos Grupo INS (Law 12 of 1924) and INS Medical (ins-cr.com redirects to grupoins.com). Retrieved 14 September 2026.
7. SUGESE, Aseguradoras (public register of authorized insurers).
8. Medicare, Travel outside the U.S. Retrieved 14 September 2026.
9. Hospital CIMA, Accreditations and Contact; Hospital Clínica Bíblica, Accreditations; Hospital Metropolitano, Our locations. Retrieved 14 September 2026.
10. Premium ranges: Anuario Latam Seguros, 23 January 2026. Policy variables and pre-existing conditions: El Financiero, 2026.
11. Law 10008 (digital nomad stay permit, $50,000 insurance): see the digital nomad guide for sources.