Expat Health Insurance in Costa Rica: CAJA, INS and Private Top-Up Cover in 2026

Written by Steffan Grund · Insurance specialist (Versicherungsfachmann BWV) · Updated October 27, 2026Facts checked: October 27, 2026

Key facts: health insurance in Costa Rica for expats in 2026

Sources: GOV.UK Living in Costa Rica (27 February 2026), General Law on Migration and Foreigners No. 8764, CCSS internal audit as reported by Teletica (17 July 2026), SUGESE, Medicare, Care Expat World terms.

What are your health insurance options as an expat in Costa Rica?

As a resident you always have the CAJA, and on top of it you can add a local policy from the INS or another SUGESE-registered insurer, a long-term international plan, or (for Americans from 65) Medicare for care back in the US. This is the main difference from countries such as Mexico, where the public scheme is optional: in Costa Rica the CAJA is the base layer, and everything else is a choice you make on top. The table shows the four layers for someone aged 50 to 64.

Paying private doctors yourself is a fifth route rather than a layer: you can pay a private specialist for a quick appointment while still paying the CAJA. That works for small bills, but a hospital stay or an air evacuation (USD 20,000–200,000 according to the US State Department) is a different scale. Our general guide to expat health insurance explains the terms used here, and our Costa Rica guides cover retiring in Costa Rica, the Costa Rica retirement visa and the cost of living in Costa Rica.

Is the CAJA mandatory for expats, and how do you join?

Yes: GOV.UK states that temporary and permanent residents must register with the national health insurance system, and Costa Rica's migration law ties residence to it. The CCSS (Caja Costarricense de Seguro Social) runs public healthcare and is financed by contributions from everyone insured, including foreign retirees.

What the migration law says

There has been an attempt to change this. A Costa Rican law firm reported in April 2024 that a bill to exempt them from CCSS contributions, by amending Articles 7 and 80, was unanimously rejected. So plan on paying the CAJA for as long as you hold residence.

How you join. Immigration services commonly report that you register with the CCSS after your residence is approved and before your DIMEX identity card is issued; GOV.UK says to collect the DIMEX within 90 days of approval. Foreign retirees without Costa Rican work income may be registered as voluntary insured (asegurado voluntario), the CCSS category for people with no salaried or self-employed activity but able to contribute. Ask the CCSS which documents it needs; it sets your contribution from the income you declare. Our Costa Rica retirement visa guide sets out the full residency steps.

Staying in good standing. The contribution is monthly. Costa Rican press has reported residents in arrears with the CCSS facing problems when they renew their DIMEX. Set up a standing payment, keep the receipts and check your status before each renewal; a private policy, however generous, does not cure CCSS arrears.

What does the CAJA give you, and what doesn't it?

The CAJA gives insured residents access to the full public network, from local clinics to national hospitals, but it does not give fast planned care, choice of doctor or cover outside Costa Rica. Costa Rica scores 84 on the WHO's universal health coverage service index (2023), above Mexico (79) and Panama (82) and below the UK and the US (88) in our healthcare comparison. Its weak point is waiting time for anything that is not urgent.

How long are CAJA waiting lists?

The figures below are from an internal CCSS audit, as reported by the Costa Rican broadcaster Teletica on 17 July 2026, with a cut-off in March 2026. Other press reports in 2026 gave slightly different averages, so treat them as an order of magnitude, not a promise for your hospital.

For a 58-year-old the practical meaning is simple: a hip, knee, cataract or hernia problem that is not an emergency can take more than a year to reach the operating table through the CAJA. That is the gap a private top-up fills. Our comparison of healthcare systems by country sets Costa Rica's public system beside 29 others.

How does INS or local private health insurance work in Costa Rica?

Local private health insurance pays for private doctors and hospitals in Costa Rica above a deductible, and it is sold by the state-owned Instituto Nacional de Seguros (INS) and by private insurers authorised by SUGESE. Every policy sold legally in Costa Rica must come from an authorised insurer, and SUGESE keeps a public register of authorised policies ("Pólizas Registradas") where the registered conditions can be read. SUGESE also publishes warnings about people and companies selling insurance without authorisation, and its Defensoría de asegurados handles complaints.

We looked for the entry and renewal ages of the INS individual health product and could not confirm them from an official INS or SUGESE page; group policies we saw had their own age rules, which do not apply to individuals. The terms you need are in the registered policy conditions, under entry age, renewal and limits by age. Ask for them in writing before you buy.

A local policy priced in colones or dollars avoids euro currency risk if your income is in dollars, and a SUGESE-authorised broker in Costa Rica can arrange it. Whichever you choose, it sits on top of your CAJA membership; no Costa Rican private policy removes the CCSS obligation.

When does an international top-up make sense in Costa Rica?

An international top-up makes sense when you want private hospitals without the CAJA waits, cover that travels with you across a wide zone, and a contract that does not end at an age limit once you are in. Costa Rica sits in Care Expat World's Zone 1, the cheapest zone, which covers the whole world except the USA, China and Singapore.

• Speed: a private surgeon in San José or Escazú instead of a CAJA list averaging 441 days for surgery.
• Choice: your own doctor and hospital, a single or double room, the chief physician.
• Travel: cover across Zone 1, for example on trips to Panama, Colombia or Europe; trips into the USA, China or Singapore are covered for emergencies only, for up to 42 days per trip (never for US citizens, whose home country is the USA).
• Moving on: if you move on to another country in your zone, the plan goes with you (it ends if you return home for good); the CAJA does not.
• No end date: once accepted, the contract has no maximum term and the insurer waives ordinary cancellation.

What it does not do matters just as much. It does not replace the CAJA, it is not a residency document, and we make no claim that DGME or the CCSS accept it in place of CCSS enrolment. It does not cover US citizens in the USA or UK citizens in the UK, because home-country cover is limited to EU and Schengen citizens. And it is underwritten: a health interview by video call reviews your records from the last five years, and the insurer can add a surcharge, exclude a condition or decline. For the benefit-by-benefit detail, see the Care Expat World overview.

Does Medicare cover you in Costa Rica?

No: Medicare does not pay for care in Costa Rica, apart from narrow exceptions listed in its fact sheet on coverage outside the United States, none of which fits someone living in Guanacaste or the Central Valley. Americans who live in Costa Rica therefore pay the CAJA like everyone else and decide separately what to keep in the US.

Keeping Part B is a personal decision. If you drop it and sign up later, Medicare adds 10% to the premium for each 12-month period you could have had it and did not. Our guide to health insurance for Americans living abroad works through the Part B decision and the options before 65 in detail.

What do CAJA and a private top-up cost together?

Your total is the CAJA contribution the CCSS sets from your declared income plus the top-up premium; a long-term international top-up for Costa Rica costs from €140 a month at 50–54 up to several hundred euros a month at 60–64, depending on level and deductible. We show no CAJA figure because we could not confirm an official 2026 rate, and private guides quote percentages that disagree with each other. Use the calculator above with the amount the CCSS gives you.

International premiums are Care Expat World Zone 1 from our price registry; yearly figures are our calculation (12 × monthly). We do not convert euros to dollars or colones at a fixed rate; use the calculator with today's rate.

Three cost drivers are easy to miss. The deductible: with a €3,600 deductible you pay the first €3,600 of bills each calendar year yourself, so your worst case is the premiums plus that sum. The age bands: Care Expat World moves you into the next band from 1 January of the year you reach it. And the currency: euro premiums cost more dollars when the euro strengthens, while your CAJA contribution is in colones. For how premiums rise across all ages, see what international health insurance costs; for rent, food and utilities, see our Costa Rica cost of living guide.

Can British expats use the NHS or an S1 in Costa Rica?

No: GOV.UK states that Costa Rica has no reciprocal health agreement with the UK, so there is no NHS cover and the S1 does not apply. British residents register with the CCSS like every other resident and, as GOV.UK advises, arrange appropriate health insurance. A Care Expat World plan does not cover a UK citizen during visits to the UK, because home-country cover is limited to EU and Schengen home countries. If you split your year between Costa Rica and the UK, check what NHS care you can use on visits under current UK rules before you leave, and remember that Costa Rica can cancel temporary residence after more than two consecutive years abroad.

What should you look for in a Costa Rica health insurance top-up?

Look first at whether the top-up accepts you at your age and health, how long it lasts and where it pays; the price comes after those three. The CAJA column is there for comparison, because you will hold it in any case.

Two further checks are worth the time. Ask how a private hospital stay is paid: up front by you or guaranteed by the insurer. And read the cancer limit: Care Expat World caps cancer treatment at €50,000 in Basic and €100,000 in Comfort, which our plan details page sets out with every other benefit.

How do health insurance claims work in Costa Rica?

With the CAJA there is no claim: you are treated in CCSS units as an insured person; with a private or international top-up you usually pay the private provider and claim the money back.

• Before a planned private hospital stay: call the insurer's 24/7 emergency line and ask how payment can be arranged. We make no direct-billing claim for Care Expat World; private hospitals may ask for a deposit, so keep a card with room for it.
• Get an itemised invoice: your name, date, diagnosis, each treatment and price, and the provider's name and address. Ask for the electronic invoice (factura electrónica) the provider issues.
• Send the claim with prescriptions or referrals and keep the originals until it is settled.
• Currency: Care Expat World converts colón or dollar invoices into euros under its terms and pays in euros.
• Deductible: claims count against your deductible until it is used up for the calendar year.
• Disputes: complaints about a Costa Rican insurer go to SUGESE's Defensoría de asegurados; for Care Expat World, follow the complaints route in its terms.

Buyer's checklist: health cover for Costa Rica

• I will register with the CCSS once residence is approved, before the DIMEX card
• I have the CCSS's own figure for my monthly CAJA contribution
• I have set up a standing CAJA payment and keep receipts for every renewal
• I understand any private policy is a top-up and does not replace the CAJA
• I have checked any local insurer and policy in the SUGESE register
• I have read the entry age, renewal clause and age limits of any local policy
• I know my age in the year cover would start (calendar year minus year of birth)
• I have listed my diagnoses and medicines from the last 5 years for the health interview
• I know Medicare and the NHS do not pay in Costa Rica, and I have a plan for visits home
• I have compared worst-case yearly costs: CAJA plus premiums plus deductible
• If I am under 65, I will apply for long-term cover before the year I turn 65

Worked example: a 58-year-old American in Atenas and a 62-year-old Briton in Grecia

Linda, 58, from Ohio, moves to Atenas as a pensionado on a company pension of USD 1,600 a month. After approval she registers with the CCSS as a voluntary insured person and the CCSS sets her monthly contribution from the pension she declared; she enters that figure in the calculator above. She wants a private orthopaedic surgeon if her knee gets worse, rather than a CAJA surgery list averaging 441 days, so she adds Care Expat World Comfort with a €1,200 deductible: €505 a month at 55–59, €6,060 a year, and a worst case of €7,260 including the full deductible, on top of her CAJA. She discloses her knee in the health interview. Because she is a US citizen, the plan does not cover her in the USA, so she keeps separate US cover for visits home until Medicare starts at 65.

Peter, 62, from Norwich, lives in Grecia on rentista residency. He has no NHS or S1 cover in Costa Rica and pays the CAJA set by the CCSS on his declared income. He is healthy and has savings, so he takes Basic with a €3,600 deductible as his top-up: €325 a month at 60–64, €3,900 a year, worst case €7,500. Comfort with the same deductible would be €495 a month and add dental care. He uses his local CCSS clinic for routine care and the private plan for anything that would otherwise wait. When he visits his son in Manchester, the plan does not cover him in the UK.

What if you are already 65 or older?

At 65 or over the CAJA remains your mandatory base, and your top-up options narrow to local policies that still accept your age, Medicare for care back in the US, and paying private bills yourself. Already 65 or older in the year cover would start? This plan is closed to you; we are preparing a comparison of plans without an entry-age limit.

If you are 63 or 64 now, the deadline is close: the entry age is counted as calendar year minus year of birth, so you are treated as 65 from 1 January of the year of your 65th birthday.

How does Costa Rica compare with other expat destinations?

Costa Rica is in Zone 1 like every other country covered on this site, so the international top-up costs the same at the same age; what differs is the public layer underneath. Costa Rica makes it compulsory, Mexico makes it optional, and Panama sets no insurance rule for its pensionado visa. Compare our guides to expat health insurance in Panama, Colombia, Mexico, Portugal and Vietnam.

The plans below are a top-up to your CAJA membership, never a substitute for it. They add private hospitals, choice of doctor and cover across Zone 1, and they stay with you if you move on to another country in your zone (cover ends when you return home for good). Your CCSS contribution continues alongside them.

Costa Rica is in Zone 1 (worldwide except the USA, China and Singapore). Care Expat World is private long-term cover that you hold next to your compulsory CCSS (CAJA) membership; it does not replace it and is not a residency document. Trips into a higher zone are covered for medical emergencies only, for up to 42 days per trip. Your home country is never part of the zone, and the terms give home-country cover only to EU or Schengen citizens, so Americans are not covered in the USA and Britons are not covered in the UK. Already 65 or older in the year cover would start? This plan is closed to you; we are preparing a comparison of plans without an entry-age limit. Full benefits are in the plan details.

Plan your move to Costa Rica

Each of our Costa Rica guides covers one part of the move:

• Costa Rica retirement visa guide: requirements, documents and the application steps.
• Retiring in Costa Rica: the lifestyle decision, places to live and trade-offs.
• Cost of living in Costa Rica: monthly budgets, rent and everyday prices.
• Healthcare in Costa Rica for expats: how the public and private systems work for foreigners.
• Moving to Costa Rica: the step-by-step plan for the move itself.

Before you apply, check the age limits on international health insurance, how insurers treat pre-existing conditions, and the options for covering a partner or family. Who qualifies for cover on visits home is explained in international health insurance with home-country cover.

Where these facts come from

• GOV.UK: Living in Costa Rica (updated 27 February 2026)
• General Law on Migration and Foreigners No. 8764 (Ley General de Migración y Extranjería), Articles 7, 31, 78, 80, 86 and 129, read in the full text hosted by a Costa Rican law firm, 27 October 2026
• CCSS internal audit of waiting lists (cut-off March 2026), as reported by Teletica on 17 July 2026
• SUGESE (Superintendencia General de Seguros): register of authorised policies, warnings and Defensoría de asegurados, read 27 October 2026
• Costa Rica Law (law firm): report on the rejected bill to exempt pensionados, rentistas and investors from CCSS contributions, 24 April 2024
• Medicare: fact sheet on coverage outside the United States; Medicare costs and late-enrolment penalties (2026); US State Department: medicine and health abroad
• World Health Organization: universal health coverage service coverage index (2023)
• Banco Central de Costa Rica (BCCR): Monex exchange rate, early October 2026, as reported by Costa Rican press
• Care Concept / Barmenia: Care Expat World terms (VB-KV 2026_05), product information and premium table, read 27 October 2026

We found no official 2026 CCSS contribution rate for voluntary insured residents, no official entry or renewal age for the INS individual health product and no official CCSS waiting-time publication (the figures above come from an internal audit as reported by the press); where that matters, the text says so. The CCSS sets your contribution and DGME decides on residency.