Costa Rica Expat Resource
Healthcare in Costa Rica
CAJA, Private Hospitals and What Expats Actually Pay
Last Fact-Checked & Updated: April 19, 2026.
Costa Rica runs one of the most respected healthcare systems in Latin America, but navigating it as a foreigner means understanding two parallel worlds: the public CAJA system and the private sector. This guide explains both, clearly and honestly.
How Costa Rica’s Healthcare System Works
Costa Rica abolished its military in 1948 and redirected that budget toward education and healthcare. The result, more than seven decades later, is a universal public health system that covers every legal resident — and a private sector that rivals Central American medical tourism destinations at a fraction of US or European prices.
The system operates on two parallel tracks. The public track is run by the Caja Costarricense de Seguro Social (CCSS), universally known as “CAJA.” The private track consists of independent hospitals, clinics, and specialists that operate outside CAJA and charge patients directly. As an expat resident, you will likely use both: CAJA for ongoing care and prescription coverage, private clinics for faster access and specialist appointments.
82.3
Life expectancy in years, above the US average (WHO 2023)
~30
CAJA (CCSS) Hospitals nationwide, plus 1,000+ clinics and EBAIS
60–70%
Lower cost than comparable US private care for most procedures
Costa Rica ranks above the United States in life expectancy
According to WHO data, Costa Ricans live an average of 82.3 years — longer than the US average of approximately 77 years. This is frequently cited as evidence that a well-funded universal public health system, combined with the “Pura Vida” lifestyle, produces measurably better population health outcomes than wealthier countries with fragmented systems.
CAJA: Costa Rica’s Universal Public Health System
The Caja Costarricense de Seguro Social (CCSS) is a constitutionally mandated institution that provides universal healthcare, disability coverage, maternity benefits, and retirement pensions to all legal residents of Costa Rica. Enrollment is not optional, it is required by law once you hold legal residency status.
CAJA operates a full network of services: neighborhood primary care clinics called EBAIS (Equipos Básicos de Atención Integral en Salud), regional clinics, and national specialty hospitals. In theory, a CAJA patient can access everything from a routine check-up to open-heart surgery without paying anything at the point of care.
What Does Caja Cover?
Covered by CAJA, at no direct cost
Once enrolled and current on contributions, the following are covered with no out-of-pocket charge:
Emergency care
Specialist referrals
Surgery
Maternity & prenatal
Pediatrics
Mental health
Prescriptions
Basic dental
Lab tests
X-ray & ultrasound
Cancer treatment
Where the system shows constraints
CAJA’s coverage is comprehensive, but capacity is its main challenge:This is why most expat residents use CAJA as their healthcare foundation and carry supplemental private insurance for faster specialist access.
CAJA wait times are real: plan accordingly
For a non-urgent specialist appointment through CAJA, wait times of 3 to 6 months are common in the Central Valley. For emergencies, CAJA hospitals are legally required to treat you regardless of insurance status, and they do. Many expats use CAJA for routine care and prescriptions, then pay privately for specialist consultations where speed matters.
How much does CCSS costs?
CAJA contributions are income-based. As a resident, you pay a monthly percentage of your declared income to CCSS. The approximate breakdown is as follows:
| Contribution Type | Aproximate Rate | Covers |
|---|---|---|
| Employee (worker share) | ~5.5% of salary | Health + pension |
| Employer contribution | ~26% of payroll | Employee health + pension |
| Voluntary / self-employed resident | ~13.5% of declared income | Health + dependents |
| Pensionado / Rentista resident | ~13.5% of declared monthly income | Full health coverage |
| Minimum monthly payment | Approx. $35–$80 USD/month | Full CAJA coverage |
How to Enroll in CAJA as a Resident
CAJA enrollment is mandatory once you receive your DIMEX card. The process is straightforward but requires an in-person visit and some documentation. Most expats complete enrollment within a few weeks of receiving residency approval.
Obtain your DIMEX card first
You cannot enroll in CAJA without proof of legal residency. Once DGME approves your application and issues your DIMEX card, you have both the right and the obligation to enroll. Some attorneys coordinate CAJA enrollment simultaneously with residency finalization to minimize the gap.
Gather your documents
You will need your DIMEX card, your passport, proof of address in Costa Rica (a utility bill or rental contract), and proof of income or pension amount. If you are enrolling dependents — a spouse or children — bring their documentation as well.
Visit a CCSS administrative office
Go to a full CCSS administrative office, not an EBAIS clinic. In San José, the main office is on Avenida 2. Bring your documents and be prepared to fill out an enrollment form in Spanish. Appointments can sometimes be made online at ccss.sa.cr to reduce wait times at the office.
Declare your income and set your contribution
A CCSS official will review your declared income and calculate your monthly contribution. For pensionados and rentistas, this is based on your pension or passive income amount. You will receive a payment schedule and instructions for paying monthly by bank transfer, online, or in person at a branch.
Register at your local EBAIS
After CCSS enrollment, visit the EBAIS clinic in your neighborhood to register as a patient. You will be assigned a primary care physician known as your médico de cabecera. This doctor becomes your entry point into the CCSS system, referrals to specialists, imaging orders, and most services flow through this initial registration.
The Private Sector: Hospitals and Clinics
Costa Rica’s private healthcare sector is genuinely excellent. Private hospitals in San José and the Central Valley operate to international standards, employ specialists trained in the US and Europe, and routinely serve medical tourists from North America who travel specifically for procedures. Wait times are dramatically shorter than CAJA, same-day or next-day appointments are common. Many staff speak English, and facilities are modern and well-equipped.
The tradeoff is cost, though private care in Costa Rica is still dramatically cheaper than equivalent care in the United States.
Clínica Bíblica
Founded in 1929, Clínica Bíblica is one of Costa Rica’s most established private hospitals. It is internationally accredited, has English-speaking staff throughout, and maintains a full specialist roster. Particular strengths include cardiology, oncology, maternity, and emergency care.
Hospital Clínica Católica
A Catholic-run institution with a strong reputation, particularly for maternity and oncology. La Católica’s price point is generally slightly lower than CIMA or Bíblica, making it popular with cost-conscious expats who want private care without the premium pricing of the top-tier hospitals.
Pacific Coast
Guanacaste and surrounding areas: The Pacific coast (Tamarindo, Liberia, Nosara, and surrounding areas) has a network of private clinics adequate for routine care. For serious conditions, major surgery, or complex cases, most patients travel to San José or, in some cases, fly home. If you live on the Pacific coast full-time, medical evacuation insurance is strongly recommended.
Hospital Cima
Part of the CIMA international hospital network and located in Escazú, the expat hub of the Central Valley. CIMA operates to US-standard facilities and protocols and is the hospital most commonly recommended to newly arrived expats. Particular strengths include surgery, orthopedics, neurology, and broad acceptance of international insurance plans. CIMA has an international patient coordinator specifically for English-speaking patients.
Hospital Metropolitano
A newer facility with modern equipment and competitive pricing. Growing reputation for diagnostics, laboratory services, and general practice. A good option for routine private care in San José.
Caribbean Coast
The Caribbean coast (Puerto Viejo, Limón, and surroundings) has limited private healthcare options. CAJA’s regional hospital in Limón covers emergencies, but private facilities are sparse. Medical evacuation coverage is essential for full-time residents in this region.
Medical tourism is a real phenomenon here
Thousands of Americans and Canadians travel to Costa Rica specifically for dental work, orthopedic surgery, cosmetic procedures, and LASIK, at 40 to 70 percent below US prices, performed by surgeons often trained in North America or Europe. As a resident, you have access to this same quality care year-round without the travel cost.
What Does Private Care Actually Cost?
All figures below are in USD and represent representative ranges based on publicly available information from Costa Rican private hospitals and patient reports. Actual costs vary by provider, procedure complexity, and insurance status.
General consultations and primary care:
| Service | Costa Rica | Aprox. Equivalent in USA |
|---|---|---|
| General practitioner visit | $50–$120 | $150–$300+ |
| Specialist consultation | $80–$180 | $250–$500+ |
| Emergency room visit (private) | $200–$500 | $1,000–$3,000+ |
| Comprehensive blood panel | $50–$180 | $100–$400 |
| X-ray | $30–$60 | $100–$400 |
| MRI (no contrast) | $300–$600 | $1,000–$3,000 |
| Ultrasound | $50–$120 | $200–$600 |
Procedures and surgery:
| Procedure | Costa Rica (private) | Aprox Equivalent in USA |
|---|---|---|
| Dental crown (porcelain) | $350–$600 | $1,000–$2,000 |
| Dental implant (full) | $900–$1,500 | $3,000–$5,000 |
| LASIK (both eyes) | $1,500–$2,500 | $4,000–$6,000 |
| Hip replacement | $12,000–$20,000 | $40,000–$80,000 |
| Knee replacement | $10,000–$18,000 | $35,000–$70,000 |
| Appendectomy | $3,000–$6,000 | $15,000–$35,000 |
| Cesarean section (private) | $3,500–$6,000 | $15,000–$30,000 |
Health Insurance Options for Expats
Most experienced expats carry some form of private health insurance in addition to CAJA enrollment. Here is a clear breakdown of the main options.
CAJA (CCSS)
Mandatory for all legal residents. Covers everything in the public system with no out-of-pocket costs at the point of service. The right foundation for every resident, but slow for non-urgent specialist care. Cost: approximately $35 to $200 or more per month depending on declared income.International Expat Insurance
Plans from Cigna Global, Allianz Care, AXA, BUPA International, and similar providers cover private hospitals in Costa Rica and worldwide. This is the recommended option if you travel frequently outside Costa Rica or want the maximum flexibility. Cost: approximately $150 to $600 or more per month depending on age and coverage level.Medical Evacuation Coverage
Particularly important if you live outside the Central Valley, on the Pacific coast, Caribbean coast, or in mountain communities. Covers emergency transport to a major hospital in San José or back to your home country if needed. Often bundled with expat or travel insurance plans. Cost: approximately $200 to $500 per year as a standalone policy.INS Supplemental Plans
The Instituto Nacional de Seguros (INS) is Costa Rica’s state-run insurance institution and offers supplemental health plans (Seguro de Salud INS) that top up CAJA coverage and allow access to private providers. A good-value local option for residents who want a Costa Rican supplemental plan without paying international insurance premiums. Check current plan options and pricing at ins.cr.
Local Private Insurance
Several Costa Rican private insurers offer health plans at lower premiums than international options, with coverage limited to Costa Rica. Good for full-time residents who do not travel internationally on a regular basis. Cost: approximately $80 to $250 per month depending on the plan.
Self-Pay
Some expats, particularly those in good health with substantial savings living near Central Valley hospitals, choose CAJA enrollment plus direct payment for private visits. Given how affordable private care is in Costa Rica, this works for many healthy individuals. A prudent budget for self-pay planning is $2,000 to $5,000 USD per year in addition to CAJA contributions, covering routine private visits and unexpected minor procedures.
The most common expat strategy:
Enroll in CAJA (mandatory, and genuinely valuable for serious conditions), then add either an INS supplemental plan or an international expat plan for private clinic access and faster specialist appointments. If you live outside San José, add medical evacuation coverage. Total monthly cost for a healthy person in their 50s: approximately $150 to $350 USD including CAJA contributions.
Emergency Care: What to Know Before You Need It
Every CAJA hospital has an emergency department, and by law they must treat any person presenting with a medical emergency, regardless of insurance status, residency, or ability to pay. Tourists and undocumented individuals are treated in emergencies without question.
Emergency contact numbers
911 is Costa Rica’s unified emergency number for police, ambulance, and fire. Available 24 hours a day. English-speaking operators are available but response quality may vary by time of day and location.
1128 is the Cruz Roja (Red Cross) ambulance line. The Red Cross operates ambulance services throughout Costa Rica and is often faster and better-equipped than government ambulances in some regions. This number is worth saving in your phone immediately.
Hospital CIMA’s emergency line is 2208-1000, available 24 hours with English-speaking staff.
Emergency contact numbers
In the Central Valley, San José, Heredia, Alajuela, and Cartago, you are within 20 to 30 minutes of major hospital facilities in most situations (plus traffic jams).
On the Pacific coast or Caribbean coast, you may be one to three hours from a major hospital by road. Medical evacuation insurance is strongly recommended for full-time residents in these areas, particularly for older residents or those with chronic conditions.
We are currently researching emergency services in rural areas. Updates coming soon.
Do not wait for insurance approval in a true emergency.
Go directly to the nearest hospital emergency room. CAJA hospitals are legally required to treat you. Private hospitals will treat you and sort out billing afterward. Every reputable insurer operating in Costa Rica understands that pre-authorization in a genuine emergency is not possible — your coverage can be confirmed after you are stabilized.
Fequently Asked Questions:
Can I use CAJA before I have my DIMEX card?
In general, no. Formal CCSS enrollment requires proof of legal residency in the form of your DIMEX card. However, anyone can access emergency care at any CAJA hospital regardless of status, including tourists and pending-residency applicants. Some expats in the residency application process can begin CAJA enrollment with a pending application letter from DGME — your attorney can advise on current CCSS policy, as this can change.
Do Costa Rican doctors speak English?
At major private hospitals in San José — particularly Hospital CIMA, Clínica Bíblica, and Hospital La Católica, English-speaking physicians are common, and international patient departments are set up specifically for this. At CAJA facilities and in rural areas, Spanish is the primary language of care. If you do not speak Spanish, using a private hospital or bringing a translator to CAJA appointments is strongly advisable for any complex medical discussion.
How do I get a specialist referral through CAJA?
CAJA specialist care works through referral. You first see your primary care physician, your médico de cabecera, at your registered EBAIS clinic. If the doctor determines you need a specialist, they issue a referral and you are placed on a waiting list at the regional hospital or specialty clinic. Wait times for non-urgent referrals range from a few weeks to several months depending on the specialty and region. For urgent cases, CAJA does prioritize — the long waits apply primarily to non-emergency, elective referrals.
Can I bring my existing prescriptions from the US?
You can bring a reasonable personal supply of existing medications into Costa Rica for your own use. For ongoing needs, you will need a Costa Rican prescription from a licensed local physician. Most common medications are available at Costa Rican pharmacies (farmacias), often at lower prices than in the US. Some specialty medications may not be available locally and would need to be imported. It is advisable to establish care with a local doctor early to maintain prescription continuity without gaps.
Is dental care covered by CAJA?
CAJA provides basic dental care — extractions, basic fillings, and some preventive care — through its dental clinics, but wait times are significant and the scope is limited. For restorative work, implants, cosmetic dentistry, or orthodontics, the private dental sector in Costa Rica is excellent and dramatically less expensive than in the US or Canada. Most expats use private dentists for all their dental care and consider it one of the best value aspects of living in Costa Rica.
How does CAJA handle chronic conditions and long-term medications?
CAJA handles chronic conditions well. Once you are registered in the system with a diagnosis — diabetes, hypertension, thyroid conditions, and similar — the system manages your follow-up appointments and provides medications from the CAJA formulary at no cost. The main limitation is that newer branded drugs may not be in the CAJA formulary and would need to be purchased privately. For most common chronic conditions, CAJA’s coverage is genuinely good once you are established as a patient in the system.
Should I use CAJA or a private hospital for surgery?
For non-urgent elective surgery, the private system is usually preferable for expats who can afford it — faster scheduling, English-speaking surgeons, and modern facilities at the top private hospitals. For emergencies, CAJA surgeons are highly competent — Hospital México and Hospital San Juan de Dios in San José handle complex surgeries daily. For major planned procedures, getting quotes from private hospitals and weighing the cost against your insurance coverage is worthwhile. Many expats find that paying out-of-pocket at a private hospital in Costa Rica still costs far less than the equivalent procedure in the United States.