One of the first questions that comes up when moving to Costa Rica is: How will I actually be covered by health insurance there? In Germany, Austria, or Switzerland, you are used to being automatically insured. But how does it work in Central America?
The good news: Costa Rica has one of the best healthcare systems in Latin America—and as an expat, you can get comprehensive coverage for surprisingly little money. In this article, you will learn how health insurance in Costa Rica works, what the state-run Caja covers, and what options you have.
The Caja: Costa Rica’s public healthcare system
The backbone of healthcare in Costa Rica is the Caja Costarricense de Seguro Social (CCSS)—known simply as “the Caja.” It was founded back in 1941 and provides universal health insurance for all citizens and legal residents of the country.
Since 2010, membership in the Caja has been mandatory for everyone with a residence permit—it is even a requirement for obtaining residency. That may sound bureaucratic at first, but it is a major advantage: the Caja covers 100% of medical costs—doctor visits, hospital stays, surgeries, and prescription medications. With no co-payments.
How much does the Caja cost for expats?
Caja costs: fair, but income-based
Monthly contributions are based on your declared income. As an expat without a local employer (e.g., as a Pensionado or Rentista), you typically register as an “asegurado voluntario” (voluntary insured person).
Key facts at a glance:
- Contribution rate: Depending on your classification, the total rate currently ranges between 11% and 15% of your declared income.Important: Since the 2022 reform, new residents generally must contribute not only to health insurance (SEM) but also to the pension system (IVM), which has almost doubled the percentage compared to the past.
- Minimum contribution for retirees: Since the minimum income required for residency as a Pensionado is USD 1,000, contributions start at around €120 to €140 per month (approx. 65,000–75,000 colones). Cheaper rates under €100 are now hardly possible due to the inclusion of pension contributions.
- Family coverage: A major plus! Your contribution covers you as well as your spouse/registered partner and dependent children—at no extra cost.
- Adjustments: The CCSS regularly adjusts rates and income thresholds to keep the system stable.
- The comparison: Even though costs have risen, the system remains attractive. While self-employed people in Germany often have to pay €500 to over €1,000 for health insurance, the Caja in Costa Rica offers full coverage (including expensive surgeries and medications) for a fraction of that cost—and for the whole family.
A quick note on budgeting: If you are planning your residency, it is best to budget conservatively with 13% of your pension/income proof to avoid unpleasant surprises in your monthly costs.
What exactly is covered?
The Caja provides comprehensive basic coverage that pleasantly surprises many expats:
- General practitioner care and specialist visits
- Lab tests and imaging (X-ray, ultrasound, MRI)
- Inpatient hospital stays and surgeries
- Prescription medications (free via the Caja pharmacy)
- Prenatal care and childbirth
- 24/7 emergency care
- Basic dental care
- Chronic conditions and follow-up care
How is care structured?
The system is divided into three levels:
1. EBAIS (primary-level clinics)
EBAIS clinics (Equipos Básicos de Atención Integral en Salud) are small community clinics located throughout the country. They are your first point of contact—similar to a family doctor in Germany. This is where you are registered, receive routine check-ups, and, if needed, are referred to specialists.
2. Regional clinics and specialist clinics
For specialist treatment, minor procedures, and specialized diagnostics.
3. National hospitals
For complex surgeries and intensive care. The major hospitals in San José (Hospital México, Hospital Calderón Guardia, Hospital San Juan de Dios) have a strong reputation and also handle complicated cases.
On January 31, 2025, the largest and most modern hospital in Central America opened in the city of Puntarenas. No joke—a new build costing 225 million US dollars, financed by the Costa Rican Social Security Fund (CCSS) and the Central American Bank for Economic Integration (CABEI).
What this hospital offers:
- 75,000 square meters across five floors in ten interconnected buildings
- 14 operating rooms, including emergency and obstetrics ORs
- 21-bed intensive care unit, including 4 isolation rooms
- The first hospital in Costa Rica with its own heliport – for rapid patient transport from remote regions
- The country’s first semi-automatic pharmacy
- An angiography suite for cardiovascular procedures – patients no longer need to travel to San José for these
- Up to 350 beds, including 32 neonatal units
- Designed to serve 350,000 to 400,000 people in the Central Pacific region and parts of Guanacaste
Honestly: Where does the Caja have weaknesses?
No system is perfect, and that also applies to the Caja. To help you plan realistically, here are the typical points of criticism:
- Waiting times: Specialist appointments and non-urgent surgeries can take weeks to months. Emergencies, however, are treated immediately.
- Overcrowding: Especially in metropolitan areas like San José, clinics are very busy.
- Comfort: Hospitals are functional, but not at the comfort level of a private clinic in Germany.
- Language barrier: In smaller clinics, staff usually speak only Spanish. Basic knowledge is helpful.
Most expats still report: for the price, the care is surprisingly good—and in acute situations, you receive fast and competent help.
Private health insurance: Is it worth it?
Many expats in Costa Rica use a two-pillar model: the Caja as mandatory basic coverage—and additional private insurance for more comfort and shorter waiting times.
Private options in Costa Rica:
- INS (Instituto Nacional de Seguros): State insurer with private supplemental plans, often cheaper than international providers.
- International health insurance: Providers such as BUPA, Allianz Care, or Cigna offer global policies that also cover Costa Rica. Cost: approx. USD 150–400/month depending on age and coverage.
- Local private clinics: Clinics such as CIMA or Clínica Bíblica in San José offer first-class care at international standards—with private rooms, English-speaking staff, and short waiting times.
Tip: For everyday needs, the Caja is completely sufficient for many expats. If you want coverage for planned procedures, dental restorations, or more comfortable hospital stays, add a private policy—often starting at just USD 80–120/month.
Our tip from personal experience:
BDAE international health insurance
Before we moved to Costa Rica, we took out insurance in Germany through BDAE (Bund der Auslands-Erwerbstätigen)—and we can recommend it to anyone planning the move. For over 25 years, BDAE has specialized in international health insurance and offers plans tailored specifically to expats and long-term expatriates.
We ourselves have been insured abroad through BDAE for the first 5 years. The big advantage: we were able to take out the policy conveniently online from Germany before departure—without a local medical exam and without a language barrier. Everything in German, with German customer service and a 24/7 assistance hotline.
BDAE offers different plans for different needs:
- Expat Global-P: For stays of up to 5 years—ideal for the transition period until Caja membership takes effect.
- Expat Infinity: No time limit—for anyone who wants to live abroad permanently. Starting at approx. €39/month.
Especially for the transition period, while residency is still being processed and you have not yet been accepted into the Caja, this kind of insurance is worth its weight in gold. And even afterward, it can make sense as a supplement to the Caja—for example, for treatment in private clinics or repatriation to Europe.
👉 Here you can find an overview of BDAE international health insurance plans
How to register with the Caja
The process in brief:
- Apply for a residence permit – Residency is required (Pensionado, Rentista, or Inversionista visa).
- Receive your Cédula de Residencia – Your ID document as a legal resident.
- Register at the nearest CCSS regional office – You will need your cédula, proof of income, and, if applicable, a marriage certificate (to co-insure your partner).
- Be assigned an EBAIS clinic – Your local clinic near your place of residence.
- Pay monthly contributions – By direct debit or directly at the CCSS.
Important: During the residency process (approx. 12–18 months), you are not yet a Caja member. For this transition period, international health insurance is recommended—ideally arranged before departure from Europe. We handled this through BDAE and had an excellent experience.
Healthcare in the Miramar region
If you live in the Miramar / Puntarenas region, you have good access to medical care:
- EBAIS clinic in Miramar: For general medicine and routine check-ups right in town.
- Hospital Monseñor Sanabria in Puntarenas: The regional hospital (approx. 20 minutes away) with an emergency department, specialists, and inpatient care.
- San José: The capital’s major hospitals and private clinics can be reached in about 1.5 hours.
For everyday needs, Miramar is therefore well served—and for specialized treatment, the infrastructure is within reach. Exactly the right balance of peace and security.
Conclusion: Health insurance in Costa Rica—more affordable and better than expected
Costa Rica’s healthcare system is one of the reasons the country has ranked among the happiest in the world for years. The Caja provides solid, affordable basic coverage that is far above what you find in many other Latin American countries. Combined with private supplemental insurance, you are better protected as an expat than you might think—and at a fraction of the costs you know from Europe.
So health insurance in Costa Rica does not have to be an obstacle to moving abroad—quite the opposite: it can be a reason to do it.
Are you considering moving to Costa Rica? Take a look at the house in Miramar → or schedule a viewing—on site or via video call.
Also read: Moving to Costa Rica – No. 4 in the World Happiness Report 2026 | Buying a house in Costa Rica – It really is that simple
