Healthcare — CAJA, private, and NHS.

The healthcare question matters more for British buyers — the NHS is woven into UK identity. Good news: CR runs one of Latin America's strongest public systems (CAJA) and private healthcare costs roughly 15-25% of US prices at JCI-accredited hospitals.

CAJA — the public system

Mandatory enrolment for all residents (Inversionista/Pensionado/Rentista). 90-day window after DIMEX issuance.

What CAJA covers

• Primary care via EBAIS clinics — GP visits, no co-pay
• Public hospital — inpatient, surgery, emergency — no co-pay
• Prescription medications via CAJA pharmacy
• Basic dental — limited, most expats use private dental
• Mental health, physiotherapy, preventive care

Monthly CAJA cost

Income-based, not service-based:

• Pensionado — based on declared pension, ~$50-100/mo
• Rentista — based on $2,500 declared, ~$100-150/mo
• Inversionista — based on declared personal income, ~$150-200/mo

Roughly £40-£160/month. Significantly cheaper than UK private health insurance for comparable coverage.

Private — INS and international

• INS Salud — CR state insurer with supplemental policies. £65-£200/mo by age + coverage.
• BUPA International / Cigna Global / Allianz Care — international policies covering UK + worldwide. £240-£640/mo, useful for split UK/CR residents.

Private hospitals

• CIMA San José — JCI-accredited (same as major UK hospitals). Many doctors UK/US/EU-trained. English widely spoken. 15-25% of UK private pricing.
• Hospital Clínica Bíblica — JCI-accredited, established. Strong internal medicine, general surgery, orthopaedics.
• Hospital Metropolitano — smaller network with Pacific-coast branch in Cobano (relevant for Santa Teresa / Mal País residents).

NHS — what happens to your access

If you stay UK-resident (<183 days outside)

NHS access continues. National Insurance contributions may continue if under State Pension age. Works for British buyers who split between UK and CR.

If you become CR-resident (>183 days)

You lose "ordinarily resident" status for NHS. Future NHS treatment in UK becomes chargeable (no reciprocal agreement with CR currently). Travel insurance with worldwide UK cover becomes essential.

Reclaiming NHS later

Move back to UK = NHS access immediate. No 6-month waiting period (unlike some other systems).