Healthcare in Costa Rica: your own policy, and the Caja on top
No CAK route, so an own policy is what you carry from the first day. But unlike in Panama or Mexico something comes on top: as soon as you're a resident, the migration law requires an uninterrupted affiliation to the Caja, the state system, against a percentage of a reference income of at least the amount of your card. Two premiums side by side, and an order that prevents a gap.
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Written and checked by Auke on , against the sources at the bottom. Is something no longer right? Report it below and I'll fix it.
In Costa Rica you arrange your healthcare with your own policy, and as soon as you are a resident you also pay compulsorily into the Caja, the state system.
Costa Rica has of all destinations in the Americas the system foreigners write about most glowingly. As a resident you compulsorily pay into it. Those two things belong together. Together they decide what your own policy is worth to you.
| The Caja | Your own policy | |
|---|---|---|
| Compulsory? | yes, from the grant and without interruption until renewal | no, but without a policy the wait for the DGME is uninsured |
| From when | as soon as the resolution of approval has been notified, even before the card | before your Dutch insurance stops |
| What it costs | a percentage of a reference income of at least 1,000 dollars (pensionado) or 2,500 dollars (rentista) a month | premium per insurer, rising with age |
| What you get | EBAIS, clinics and state hospitals, no deductible, with waiting lists | private clinics, pace, and cover for visits to the Netherlands |
No CAK
Costa Rica isn't on the list of treaty countries of the scheme for living abroad. There is no CAK form, no treaty contribution and no right to care at the expense of the Netherlands. Your Dutch basic insurance ends on the day of deregistration, and what applies after that is the policy you have taken out.
That is the reason healthcare with Costa Rica sits in phase 3 of the journey, before deregistering. The acceptance question at an insurer has to be asked before the age limit. And the policy has to run on the day the Dutch one stops.
The Caja: no choice but a condition
Article 80 of the migration law says it without detours: a temporary resident has to be insured with the Caja Costarricense de Seguro Social without interruption from the grant of the residence, and shows that at every renewal of the card. Whoever lets the affiliation lapse gets no renewal.
You enrol at the sucursal in your place of residence, the Caja's local office. You become a voluntary insured person on a reference income: the income your premium is calculated on. That is already possible with the resolution of approval (the decision of the DGME, the immigration service) and your passport, before you have the card. That is what the Caja's guidelines say. And article 32 of the regulation requires the application "as soon as the resolution has been notified", meaning as soon as the decision has officially been served on you.
The Caja's guidelines say what the floor is:
- for a pensionado the equivalent in colones of 1,000 dollars a month;
- for a rentista 2,500 dollars.
Those are exactly the amounts of your card. On that income you pay a monthly percentage for healthcare and for the pension fund. That goes by the scale for voluntary insured persons, which rises with the income and is adjusted every year. Count roughly with ten percent of the reference income a month, and have the sucursal work out the exact amount.
The partner is co-insured as a family member on your affiliation; children too. Whoever goes to work in Costa Rica enters the system through the employer or as self-employed, with a different percentage.
What the Caja is
The public system is nationwide and layered:
- the EBAIS, the neighbourhood clinic for primary care;
- above that the regional clinics;
- and the state hospitals in San José and the provincial capitals.
No deductible, no co-payment at the desk, prescription medicines included. It is the system that gives Costa Rica its life expectancy.
What it isn't is fast. For a specialist or a planned procedure the waiting lists are long. That is why almost every Dutch person keeps their own policy alongside: the Caja as a safety net and for the chronic, the own policy for pace and for the private clinics.
The own policy
The private hospitals in the Central Valley reach international level: CIMA in Escazú, Clínica Bíblica in San José and Hospital Metropolitano. Their doctors have often trained in the United States and speak English. The hospitals work with Costa Rican and international insurers, and without a policy at American rates.
A Costa Rican policy you take out with the state insurer INS or a private insurer. It is by Dutch standards affordable, but has entry limits that rise with age. And it excludes existing conditions the first years.
An international policy is wider in age and cover, also for the visits to the Netherlands, and correspondingly more expensive. For whoever leaves above seventy that is usually the only private door.
The order
- Ask the acceptance question in writing, three months before departure, with a Costa Rican and an international insurer.
- Only cancel your Dutch policy once the acceptance is settled, and let the end date coincide with the deregistration.
- Live in the waiting months for the DGME on that own policy. The Caja only comes with the approval.
- Go to the Caja's sucursal in the week the resolution is notified, with the resolution and your passport, and keep the proofs of payment for the renewal.
- Find a GP at the EBAIS and a doctor at the private clinic in the same week, before you need one.
Two premiums side by side is the price of this system. A gap between two systems is the most expensive mistake, and with Costa Rica the gap is double: the waiting months without Caja, and the age limit of the own policy you can't turn back.
In Vertrekklaar this is phase 1 of 5 of the journey, step 1.2: the same steps, but for your situation — in your order, tickable, and with the deadlines watched. See the whole journey to Costa Rica or go straight to step 1.2 in the open plan.
What this rests on
The facts in this article come from these official pages. Rules change. When in doubt, go by the source, not this article.
- NederlandWereldwijd — the treaty country list, Costa Rica isn't on it — nederlandwereldwijd.nl
- Ley 8764, Title VI — article 80, the Caja affiliation as a condition for the residence — dhr.go.cr
- CCSS — the guidelines for voluntary insurance, self-employed and migrants, with the reference income of pensionados and rentistas and the document you affiliate with — pgrweb.go.cr
- Reglamento de Extranjería (decree 37112-G), article 32 — affiliation with the Caja as soon as the resolution has been notified — pgrweb.go.cr
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