Healthcare is one of the most compelling reasons to choose Costa Rica — and one of the areas where most Americans are most pleasantly surprised after the move. The country offers a genuine, functioning universal public system, world-class private hospitals, affordable dental care, and a range of insurance options that together cost a fraction of what equivalent coverage runs in the U.S.
But navigating it requires understanding how the different layers fit together. This guide covers everything: the public CAJA system, private hospitals, local insurance, discount medical plans, international insurance, dental care, pharmacies, and what we recommend for most expats.
How Good Is Healthcare in Costa Rica?
The WHO ranked Costa Rica 36th on “Overall Health System Performance” — one rank above the United States at 37th. Live and Invest Overseas Facilities such as Hospital CIMA, Clínica Bíblica, and Hospital La Católica in San José are renowned for their high-quality care, advanced medical technology, and excellent patient outcomes.
Many doctors and specialists in Costa Rica have received training in Europe, the United States, or Canada, and a significant number speak English fluently — especially in private clinics and hospitals. Coldwellbankersamara
A specialist doctor visit that might cost $200–$400 in the U.S. with insurance typically runs $50–$100 at a private clinic in Costa Rica. Complex procedures like knee replacements, MRIs, and cancer treatment are available at private hospitals at a fraction of U.S. prices — which is why Costa Rica has also become a significant medical tourism destination.
The main limitation is geography: the best hospitals and most specialists are concentrated in the Central Valley, particularly around San José, Escazú, and Santa Ana. If you live in a remote coastal or rural area, you’ll have access to primary care locally, but anything requiring specialists or advanced diagnostics typically means a drive to the capital.
The Three Types of Medical Facilities
Understanding where to go for what is important from day one.
Hospitals operate 24/7 and offer the full range of services you’d expect in the U.S. — surgery, emergency care, specialist consultations, advanced diagnostics, and intensive care. Both the public and private systems have hospitals. The flagship private hospitals (CIMA, Clínica Bíblica, La Católica) are in or near San José.
Clinics typically operate from 7 AM to 9 or 10 PM and handle most outpatient needs: GP visits, specialist consultations, minor procedures, lab work, imaging.
EBAIS (Equipos Básicos de Atención Integral en Salud) are community-based primary care centers present in virtually every neighborhood and small town throughout Costa Rica. They’re the entry point for the public CAJA system — good for routine care, minor illness, referrals, and preventive services.
The CAJA: Costa Rica’s Public Healthcare System
The backbone of Costa Rican healthcare is the Caja Costarricense de Seguro Social (CCSS), universally known as “the CAJA.” This universal healthcare system covers all Costa Rican residents at over 30 hospitals and 250+ clinics at no cost beyond their monthly income contributions. Pre-existing conditions and nearly all medical services are covered.
Enrollment is mandatory for all residents. Once you receive your residency approval, registering with the CAJA is a required step in completing your residency — you will not receive your cédula (residency card) until you’ve enrolled and paid initial fees.
What CAJA covers: Primary care, specialist referrals, emergency care, hospitalization, surgery, preventive care (blood panels, colonoscopies, annual checkups), prescription medications, and maternity care. Coverage is comprehensive, and all costs are covered for those enrolled — patients do not pay anything for their appointments.
What CAJA costs: Monthly premiums are income-based, typically ranging from 7–11% of declared income, which for many expats translates to $50–$200 per month depending on declared income levels. Permanent residents can pay as little as $45/month per family, making it one of the most affordable healthcare options in the world.
The tradeoff: The CAJA’s primary limitation is wait times. While emergency care is generally prompt and routine primary care is accessible, wait times for specialist appointments and elective procedures can stretch to months — or in some cases, longer. Potential difficulties finding English-speaking medical staff and limited selection of practitioners are also drawbacks. For Americans accustomed to on-demand specialist access and a primary care physician who knows them personally, the CAJA system can feel impersonal and bureaucratic.
The smart workaround most expats use: Many Costa Rican doctors work in the mornings for CAJA and have their own private clinic office hours in the afternoons and evenings. If diagnostic testing in the public system has too long a wait, expats use private facilities and have the results forwarded. Private doctors will write prescriptions for CAJA pharmacies so patients can pick up medications at no cost. This hybrid approach — CAJA for coverage and emergencies, private sector for speed and specialist access — is how the majority of expats navigate healthcare in Costa Rica.
Private Healthcare in Costa Rica
Costa Rica’s private healthcare sector is excellent, and for many Americans it will feel familiar and reassuring. It’s difficult to find an expat who doesn’t think Costa Rica’s private hospitals are as good as those back home.
The major private hospitals:
Hospital CIMA (Escazú, near San José) is the flagship of the private system and the most popular hospital among American expats. With nearly 200 doctors in dozens of specialties, CIMA became the favorite hospital of American expats soon after it opened in 2000. CIMA is owned by the International Hospital Corporation of Dallas, Texas, and is affiliated with Baylor University Medical Center. It offers JCI accreditation, the international gold standard for hospital quality, and essentially operates like a modern U.S. private hospital — English-speaking staff, short wait times, and full specialist coverage.
Hospital Clínica Bíblica (San José) is the second major private hospital, with a strong reputation among expats and a bilingual health navigator program to help patients who face language barriers. It is also JCI accredited. A new partnership between Clínica Bíblica and Hospital San Rafael Arcángel in Liberia now extends their “Mi Vida” benefits program to the Guanacaste region, offering discounts and preventive services to coastal residents.
Hospital La Católica (San José) rounds out the top-tier private hospitals, with a similarly strong reputation for quality and patient experience.
Out-of-pocket costs at private facilities: The average cost of a doctor’s visit ranges from $60–$75, while specialist care visits are closer to $100. Many diagnostic tests — ultrasounds, x-rays, blood work — are under $100. A knee replacement surgery might cost around $12,000 at a private hospital in Costa Rica, compared to over $50,000 in the U.S.
One important note: most private facilities in Costa Rica require payment upfront, in cash or by card. Come prepared.
INS: Local Private Insurance
INS (Instituto Nacional de Seguros) is the government’s private insurance arm, and it’s the most common private insurance option for expats who spend most or all of their time in Costa Rica. INS plans are accepted at most private clinics and hospitals throughout the country, and they give you the ability to choose your own doctors and use private facilities without the wait times of the CAJA.
Basic INS plans cost roughly $60–$100 per month, standard plans run $120–$180 per month, and comprehensive plans that include dental and maternity coverage start at around $200–$250 or more. INS is generally the most cost-effective option if Costa Rica is your primary base and you don’t need coverage outside the country. One important limitation: INS is not available to applicants after age 75. If you’re approaching or past that threshold, prioritize other options.
Discount Medical Plans: MediSmart and Similar Programs
Discount plans occupy a unique and genuinely useful middle ground in Costa Rica’s healthcare ecosystem — and many expats swear by them.
A discount plan is like a hospital membership card: you pay an annual membership fee and get a discount when visiting that particular hospital and other medical clinics in their network. MediSmart, provided by Hospital Metropolitano, is the best-known example. It gives you 40%–80% off literally every medical service provided by Hospital Metropolitano and their affiliates — doctors’ visits, tests, surgeries, procedures, medications, and more.
MediSmart is NOT health insurance — it is a discount plan. There are no exclusions for age or pre-existing conditions, which makes it particularly valuable for older expats or those with health conditions that make private insurance expensive or unavailable. MediSmart covers more than 45 medical fields and 500+ medical services. It also includes an optional OncoSmart add-on for cancer prevention, early diagnosis, and treatment, and you can add a dog or cat to the plan for just $2/month for veterinary discounts.
The practical limitation: discount plans can be limited to residents, since enrollment sometimes requires a Costa Rican bank account for direct debit payment.They also only apply within the network — they don’t cover you outside Costa Rica, and they don’t replace true insurance for major catastrophic events.
Most expats use MediSmart as a complement to CAJA rather than a replacement for full private insurance — it’s an affordable way to reduce out-of-pocket costs for the private services that CAJA covers slowly or not at all.
International Health Insurance
If you travel frequently, split time between Costa Rica and other countries, or want the security of being covered anywhere in the world including the U.S., an international health insurance plan is worth serious consideration.
Major international providers popular among Costa Rica expats include Cigna Global, Allianz International, IMG (International Medical Group), and GeoBlue. Flights range from roughly $115–$475 per month for non-U.S. coverage. Adding U.S. coverage to an international plan significantly increases premiums — often doubling them — so this is only worthwhile if you spend substantial time stateside each year. For shorter U.S. trips, travel insurance is a more cost-effective alternative.
Key advantages of international plans: global network access, direct billing at major private hospitals, medical evacuation coverage (especially important in Costa Rica given remote locations and adventure activities), and portability if you later move to another country.
A note on medical evacuation: Medical evacuation coverage is essential given Costa Rica’s adventure tourism opportunities and remote locations. If you live or spend time in a rural coastal or mountain area far from major hospitals, make sure your plan includes emergency evacuation to a higher-level facility — including back to the U.S. if necessary.
Retired military: TRICARE Overseas covers doctors, hospitals, and clinics in San José, Costa Rica — though you should always verify with the facility before making appointments.
Dental Care in Costa Rica
Dental care is one of the clearest financial wins for expats in Costa Rica. Costa Rica has earned a strong international reputation as a dental tourism destination. Private dental clinics throughout the country, particularly in the Central Valley, offer modern facilities and highly trained dentists, many of whom have completed specialist training in the United States or Europe.
The public CAJA system only covers emergency dental procedures — such as extractions following accidents or severe infections. Routine cleanings, fillings, and cosmetic work fall entirely outside public coverage, so most expats use the private sector for dental care.
What does private dental care cost? A routine cleaning runs about $50–$100. A single dental implant with a porcelain crown ranges from $800–$1,600, representing savings of up to 75% compared to equivalent U.S. procedures. Full-mouth restorations such as All-on-4 cost $8,500–$12,750 per arch. Many expats schedule major dental work strategically — handling years’ worth of procedures in one or two visits at a fraction of what it would cost at home.
Pharmacies and Medications
Pharmacies in Costa Rica are abundant and typically well-stocked. Many medications that require a prescription elsewhere — like antibiotics or blood pressure meds — are available over-the-counter after a brief consult with a pharmacist. Brand-name drugs are often imported, but local generics are also available and affordable. A month’s supply of basic medication is typically much less expensive than in North America, or can be covered entirely through CAJA for enrolled residents.
For CAJA-enrolled residents, prescriptions written by any doctor — including private physicians — can be filled at CAJA pharmacies at no cost. This is one of the most practical advantages of maintaining CAJA enrollment even if you primarily use private care.
Healthcare Access by Region
Where you live in Costa Rica significantly affects your day-to-day healthcare experience.
Central Valley (San José, Escazú, Santa Ana, Heredia) is the undisputed hub of Costa Rican healthcare. Hospital CIMA, Clínica Bíblica, and La Católica are all here, along with the highest density of English-speaking specialists, dental clinics, and private facilities. For expats who prioritize healthcare access above other lifestyle factors, the Central Valley is the right choice.
Guanacaste and the North Pacific coast have seen significant healthcare improvement in recent years. Liberia now has solid private facilities, and the Clínica Bíblica partnership with Hospital San Rafael Arcángel extends premium private care to the region. For most routine needs, Guanacaste is well-served. For complex specialist care, expect to travel to San José.
The Southern Zone (Uvita, Dominical, Ojochal) has improving infrastructure but remains the most limited of the popular expat regions for healthcare access. Primary care is available locally; anything beyond that requires significant travel. Expats in this region should prioritize good health insurance and have a clear plan for emergency situations.
Remote and rural areas generally have EBAIS primary care available nearby, with referrals to regional hospitals for anything more serious. If you have ongoing health conditions requiring specialist oversight, proximity to the Central Valley is an important factor in choosing where to live.
Travel Insurance: For Visitors and Pre-Residency Arrivals
Before you have residency, you have no access to the CAJA and must cover your own medical costs. This is especially important during the 10–18 months your residency application is being processed. Most pre-residency expats carry a private international plan or robust travel insurance during this window.
The Digital Nomad Visa explicitly requires proof of health insurance covering at least $50,000 in medical expenses per applicant as part of the application. Travel insurance should be treated as non-negotiable for anyone in Costa Rica without residency — private care is affordable by U.S. standards, but an emergency hospitalization or surgery without coverage can still generate significant costs.
Our Healthcare Coverage Recommendations
Healthcare planning is not one-size-fits-all — it depends on your residency status, age, health history, travel habits, and budget. That said, here’s how we generally think about it:
For new residents: During the gap between arriving and completing CAJA enrollment, carry private travel or international insurance to cover any medical expenses.
For permanent residents primarily in Costa Rica: CAJA enrollment (mandatory) combined with INS for private access is the most practical and cost-effective combination. Add MediSmart for an affordable way to reduce out-of-pocket costs at private facilities. Consider whether you need U.S. coverage based on how often you travel home.
For temporary residents who travel frequently: An international plan from Cigna Global, Allianz, or IMG — with U.S. coverage excluded unless you spend meaningful time there — gives you global flexibility and private access in Costa Rica without paying the U.S. premium.
For expats over 70 or with significant pre-existing conditions: INS has an age cap of 75, and some international plans become expensive or restrictive with age or pre-existing conditions. CAJA (which covers all conditions) plus MediSmart (no age or condition exclusions) can be an effective and affordable combination. Discuss medical evacuation coverage specifically.
For everyone: Regardless of your insurance setup, we strongly recommend building a relationship with a private concierge physician in your area. This person becomes your navigator — someone who knows you personally, can be reached directly, and can guide you through the local healthcare system when something happens. In Costa Rica’s relationship-oriented culture, this kind of connection is both accessible and genuinely valuable.
In an Emergency
Dial 911 for police, fire, and ambulance. You can also dial 128 directly to reach the Cruz Roja (Costa Rican Red Cross) for ambulance services. Emergency care is available at all public hospitals regardless of insurance status.