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Healthcare in Costa Rica —
and the Medicare gap.
Costa Rica's healthcare system is consistently rated above the U.S. on outcomes per dollar. The catch: U.S. Medicare doesn't cross the border. Here's the full picture — public Caja, private hospitals, MediSmart, INS Salud, and what each costs.
The big picture for Americans
Costa Rica runs a hybrid system: a universal public system (Caja Costarricense de Seguro Social, "the Caja") that all residents are required to participate in, plus a robust private hospital and clinic network that operates in parallel. Most American expats use both — Caja for the catastrophic-coverage backstop and routine generic care, private for fast appointments and elective procedures.
Costs across the board run 50–70% below U.S. equivalents. A primary-care visit at a private clinic is typically $50–$120. A complete blood panel runs $40–$80 cash. An MRI runs $400–$700. A hip replacement at Hospital CIMA — same prosthetics and same surgical standards as a U.S. tier-2 hospital — runs $15,000–$22,000 all-in, about a quarter of the U.S. price.
The three-layer stack most Americans build
The vast majority of our retiree clients end up running this combination: Caja as the universal-coverage floor, MediSmart or INS Salud for fast private access, and a thin medevac/travel layer for catastrophic events. Here it is visualized:
Caja — public universal coverage
Mandatory once residency approved. EBAIS clinics, specialists, hospitalization, surgery, oncology, all prescription medications on the LOM list. Pre-existing conditions covered. Long queues for non-emergency.
Private — fast access layer
MediSmart membership, INS Salud insurance, or international expat policy. Private hospitals (CIMA, Bíblica, La Católica, Metropolitano). Routine + specialist + elective in days, not months.
Medevac — catastrophic transport
Global Rescue, MedjetAssist, or international policy with medevac rider. Air-ambulance back to the U.S. for major procedures runs $30K–$70K out of pocket without coverage.
Caja — the public system
The Caja Costarricense de Seguro Social provides universal healthcare to all Costa Rican residents. It is mandatory: as soon as your residency is approved, you must enroll and start contributing. Failure to enroll is a status-revocation risk on residency renewal.
What it covers: primary care at the local EBAIS, specialist referrals, hospitalization at any of 30+ Caja hospitals, all prescription medications on the official list, emergency care, surgery, oncology, dialysis, organ transplant — all with no co-pay. Pre-existing conditions covered.
Cost: contribution is calculated on declared monthly income, on a sliding scale roughly 7–11%. Most U.S. retirees on Pensionado pay $80–$220/month for the couple. Higher earners cap around $400–$500.
The weakness: speed. Long wait times for non-emergency specialist appointments and elective procedures — sometimes 6–12 months for an MRI, 3–6 months for a non-urgent specialist consult. This is the gap private medicine fills.
The Medicare problem
U.S. Medicare does NOT cover services in Costa Rica. Medicare Parts A and B both stop at the U.S. border. Some Medicare Advantage plans include limited international emergency coverage, but routine care, specialist appointments, prescriptions, and surgeries in Costa Rica are entirely out of pocket from Medicare's perspective.
Implications for retirees who relocate to Costa Rica:
- You'll pay for healthcare in Costa Rica through Caja + private (combined ~$200–$500/month)
- If you keep paying U.S. Medicare Part B premiums (~$175/month in 2026), it only matters for trips back to the U.S.
- If you stop Part B and later want to re-enroll, there's a permanent late-enrollment penalty (10% per 12-month delay, for life)
- Most of our retiree clients keep Part A (free if you have 40 quarters of work history), drop or pause Part B, and rely on Caja + private in CR
Private layer — which one fits
Three options on the private layer. Each has a different sweet spot:
MediSmart Membership
Costa Rica primary-care network
- Unlimited GP visits
- Basic specialist visits
- Basic labs + imaging
- No hospitalization included
- Member-discounted cash for procedures
INS Salud
CR state insurer's private plan
- Hospitalization + surgery covered
- Specialist + imaging
- Usable at CIMA, Bíblica, La Católica
- 1–2yr waiting on pre-existing
- Age cap ~70 for new enrollment
International Expat
Cigna · Bupa · GeoBlue · IMG
- Comprehensive coverage
- U.S. coverage often available
- Medevac included on premium tiers
- HNW + pre-Medicare bridge
- Higher premium but full peace of mind
Which mix do most Americans use?
| Profile | Typical setup | Approx monthly |
|---|---|---|
| Retiree on Pensionado, 65+ | Caja + cash-pay private + dropped Part B | $150–$300 |
| Retiree 65+, wants U.S. fallback | Caja + retained Part B + medevac policy | $300–$500 |
| Pre-Medicare relocator, 50–64 | INS Salud OR Cigna Global + Caja | $300–$700 |
| Working-age expat, 30–50 | MediSmart + Caja + catastrophic-only intl | $150–$300 |
| HNW family with kids | Bupa Global / Cigna Platinum + Caja | $1,000–$2,000 |
| Vacation home, 4–8 weeks/year only | Keep U.S. insurance + travel insurance for trips | $0 incremental in CR |
Costa Rica's healthcare system handles routine, complex, and emergency care well, at a fraction of U.S. cost. The two real decisions for relocating Americans are: what to do about Medicare Part B, and which private layer to put on top of Caja. We can introduce you to an insurance broker who specializes in U.S. expats in Costa Rica.
The American Buyer\'s Guide to Costa Rica
Plain-English playbook covering residency, FBAR, healthcare, owner-financing, regions, and the closing process. Every number sourced. Read it in 15 minutes.
- 4 residency paths compared
- $10K FBAR + $50K FATCA thresholds
- Owner-financed deal math (3 examples)
- 8 Pacific regions ranked
- Closing process week-by-week
- Costa Rica vs Mexico
30 min — healthcare-broker referral for U.S. expats
Tell us your age, family situation, and any pre-existing conditions you want to keep covered. We will connect you to the broker whose practice fits.
Luxury Real Estate in Santa Teresa, Mal País & Playa Hermosa
Discover beachfront homes, ocean-view villas, buildable land, boutique hotels, and high-upside investment opportunities across Costa Rica’s most desirable coastal markets. Real Estate Grupo helps buyers, investors, and developers find standout properties in Santa Teresa, Mal País, Playa Hermosa.
