Healthcare in Costa Rica: your own policy, and the Caja on top

Costa Rica has of all destinations in the Americas the system foreigners write about most glowingly, and it is one where as a resident you compulsorily pay into it. Those two things belong together, and together they decide what your own policy is worth to you.

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 as a voluntary insured person on a reference income. 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 — exactly the amounts of your card. On that income you pay a monthly percentage for healthcare and for the pension fund, according to 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, and that is the reason 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 — CIMA in Escazú, Clínica Bíblica in San José, Hospital Metropolitano — reach international level, with doctors who have often trained in the United States and speak English. They work with Costa Rican and international insurers, and without a policy at American rates.

A Costa Rican policy — through the state insurer INS or a private insurer — is by Dutch standards affordable, but has entry limits that rise with age and 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

1. Ask the acceptance question in writing, three months before departure, with a Costa Rican and an international insurer.
2. Only cancel your Dutch policy once the acceptance is settled, and let the end date coincide with the deregistration.
3. Live in the waiting months for the DGME on that own policy — the Caja only comes with the card.
4. Go to the Caja's sucursal in the week you get the DIMEX, and keep the proofs of payment for the renewal.
5. 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.