One of the first questions American retirees ask us is simple: "Will my Medicare work in Costa Rica?" The short answer is no — but that is far less alarming than it sounds. Costa Rica offers excellent, affordable healthcare that most expats find easier to navigate than the US system. Here is exactly how it works.
The Hard Truth: Medicare Stops at the Border
Medicare — including Part A (hospital), Part B (medical), and most Advantage plans — only pays for care delivered inside the United States and its territories. A doctor or hospital in San José will not bill Medicare, and Medicare will not reimburse you for care received in Costa Rica. There are only a handful of narrow exceptions (certain emergencies near the US-Canada or US-Mexico border), and none of them apply to Costa Rica.
This surprises many people, but in practice it rarely becomes a problem — because Costa Rica's own system is genuinely good and genuinely cheap.
Your Two Pillars: CAJA + Private Insurance
Legal residents of Costa Rica get access to two layers of care that, together, replace what Medicare did back home.
CAJA (public system). The Caja Costarricense de Seguro Social is Costa Rica's universal public healthcare system. Enrollment is mandatory for all residents. You pay a monthly premium of roughly 7–11% of your declared income — for most retirees that lands between $70 and $150 per month per household. In return you get doctor visits, specialists, hospitalization, surgeries, and prescription medications with no deductibles and no exclusions for pre-existing conditions.
Private insurance and pay-out-of-pocket care. Because CAJA can involve wait times for non-urgent specialist care, many expats also carry private insurance (roughly $80–$200/month depending on age and coverage) or simply pay cash at private hospitals. Private care in Costa Rica costs 40–70% less than comparable US care, so an office visit might run $60–$90 and many procedures are a fraction of US prices.
| Coverage | Monthly cost (typical) | What it covers |
|---|---|---|
| CAJA (public) | $70–$150/household | Everything, no exclusions, wait times possible |
| Private insurance | $80–$200/person | Faster private-hospital access |
| Cash at private hospital | Pay per visit | Immediate care, US-quality facilities |
Read our full CAJA enrollment guide and our private health insurance guide for the details.
Should You Keep Medicare Part B?
This is a personal financial decision, but here is the framework we see retirees use:
- If you plan to return to the US regularly or eventually move back: Many keep paying Part B (about $185–$206/month in 2026 depending on income) to avoid the late-enrollment penalty, which permanently raises your premium by 10% for each 12-month period you could have had Part B but did not.
- If you are committed to never using US healthcare again: Some retirees drop Part B to save the premium, accepting the penalty risk if they ever change their mind.
- Part A is usually premium-free if you or your spouse paid Medicare taxes for 40 quarters, so most people simply keep it — there is little reason to drop free coverage.
We are not financial or Medicare advisors, so talk to a licensed advisor before dropping any coverage. But do the math: if you are paying $200/month for Part B you will never use, that is $2,400 a year that could fund private insurance in Costa Rica several times over.
What About Emergencies and Medical Evacuation?
For serious emergencies, Costa Rica's private hospitals (CIMA, Clínica Bíblica, Hospital Metropolitano) are modern and staffed by many US-trained, English-speaking doctors. Some retirees add a medical evacuation policy (often $300–$600/year) that would fly them to the US or a regional hospital if something catastrophic happened. It is optional, but popular among those who want extra peace of mind.
How This Fits Your Residency
Enrolling in CAJA is not just a healthcare choice — it is a legal requirement of residency. Once your residency is approved, CAJA registration is one of the final steps, and our team walks you through it along with your DIMEX card. See how residency works and our healthcare guide for expats.
The Bottom Line
Medicare will not follow you to Costa Rica — but you will likely spend far less on better-organized care than you did in the US. Between CAJA and affordable private options, most retirees tell us healthcare is one of the reasons they are glad they made the move.
Request Your Free Consultation | CAJA Enrollment Guide | Residency Services
Call us: +506-8385-5008 | Email: legalresidencycostarica@outlook.com | Office: Santa Ana, Costa Rica
Ready to plan your move with healthcare sorted? Contact our team today.
