How the public CAJA and private systems work — and what expats actually pay.
Costa Rica consistently ranks among the best healthcare systems in Latin America — frequently rated at or above the United States on key outcomes — and it's a major draw for retirees, families and digital nomads. The country runs two parallel systems, public and private, and most expats use a mix of both.
The public system (CAJA). The Caja Costarricense de Seguro Social, universally called 'la Caja,' provides comprehensive coverage: doctor visits, specialists, hospitalization, surgeries and prescription medications, with no exclusions for pre-existing conditions and no age cap. Legal residents are required to enroll.
What CAJA costs. You pay a percentage of your declared monthly income — commonly around 7–11%, which works out to roughly $60–$150/month for many retirees. Once enrolled, care is essentially free at the point of use. The main trade-offs are longer wait times for non-urgent specialists and procedures, and Spanish-first service.
The private system. Private care in Costa Rica is remarkably affordable by US standards: a specialist consultation typically runs $50–$80, and many tests and procedures cost a fraction of US prices. Wait times are short and many doctors speak English. Top private hospitals — CIMA (Escazú), Clínica Bíblica (San José) and Hospital Metropolitano — offer US-trained physicians and modern facilities, which is why Costa Rica has a thriving medical-tourism industry for dental work, cosmetic surgery and elective procedures.
Private insurance. You can buy private health insurance through Costa Rican insurers (such as INS) or international providers. Premiums vary widely with age and coverage but are generally far lower than comparable US plans; some retirees skip insurance entirely and simply pay out of pocket for private care because prices are so reasonable.
The hybrid approach most expats use. Enroll in CAJA for comprehensive, guaranteed ongoing coverage and chronic-condition management, then use private care (out of pocket or with insurance) for speed and convenience when you want a fast appointment or a specific specialist. This combination delivers excellent care at a fraction of US costs.
Practical notes: pharmacies are widespread and many medications are available without the prescriptions they'd require in the US; the public emergency number is 911; and San José's Central Valley has the densest concentration of top hospitals — one reason retirees favor towns like Escazú and Atenas.
Bottom line: whether you lean on CAJA, private care, or both, healthcare is one of the strongest reasons to move to Costa Rica — high quality, accessible, and dramatically cheaper than the US. Factor your CAJA contribution into your monthly budget and you're set.
This article is general information, not legal, tax or investment advice. Always consult a licensed professional for your situation.