Costa Rica's public healthcare (the CAJA) is excellent and affordable — but most expat retirees pair it with private insurance for faster access and worldwide coverage. Understanding how the two work together is key to a worry-free retirement. Here is your 2026 guide to private health insurance.
Costa Rica's Two-Track System
Costa Rica runs a dual healthcare system:
1. CAJA (CCSS) — the mandatory public system for all legal residents, funded by an income-based contribution (roughly 7–11% of declared income, commonly $80–$150/month). It covers doctor visits, prescriptions, surgeries, and hospitalization with no lifetime caps and no pre-existing exclusions. 2. Private sector — modern hospitals (CIMA, Clínica Bíblica, Hospital Metropolitano) and clinics offering shorter waits, specialist choice, and English-speaking staff, at 40–70% below US prices.
As a resident you must enroll in the CAJA. Private insurance is an optional — and popular — layer on top.
Why Most Expats Add Private Insurance
The CAJA is comprehensive but can have longer wait times for non-urgent specialist care and elective procedures. Private insurance lets you:
- See specialists quickly and choose your own doctors
- Use modern private hospitals with English-speaking staff
- Get covered while traveling or back in your home country (with international plans)
Many retirees use the CAJA for prescriptions, chronic-condition management, and major emergencies, while paying privately (or via private insurance) for speed and convenience.
Your Private Options: INS vs. International
INS (Instituto Nacional de Seguros) — Costa Rica's national insurer offers private health policies to legal residents, tied to the local private hospital-and-clinic network. It is affordable and locally focused, with many plans covering costs up to around 80%. Key limitation: INS medical plans generally are not available to new applicants over age 70, which pushes many older retirees toward international insurers.
International plans (e.g., Cigna Global, and other global insurers) — Portable, comprehensive coverage that follows you worldwide, with tiered plans (often Silver/Gold/Platinum) covering office visits, prescriptions, surgery, hospitalization, diagnostics, evacuation, and optional US coverage. More expensive but ideal for those who travel or want global flexibility.
What It Costs
| Coverage type | Typical cost |
|---|---|
| CAJA (mandatory) | $80–$150/mo (income-based) |
| INS private plan | ~$70–$250/mo (age/coverage dependent) |
| International plan (individual) | ~$115+/mo (~$1,390+/year) |
| International plan (family of four) | ~$4,480+/year |
Costs rise with age and coverage level, and international plans that include US coverage cost more.
Key Considerations for Retirees
- Buy before you age out. If you want an INS plan, the age-70 cutoff for new applicants matters — arrange coverage earlier rather than later.
- Pre-existing conditions. International plans may exclude or surcharge pre-existing conditions; the CAJA does not — a big reason to enroll in the public system regardless.
- Decide on US coverage. International plans let you include or exclude the US; including it raises the premium significantly.
- The CAJA is your safety net. Even with private insurance, your CAJA enrollment provides unlimited, no-exclusion backstop coverage for life.
See our healthcare guide, CAJA enrollment guide, and healthcare costs guide for the full picture.
The Foundation: Residency and the CAJA
Access to this whole system starts with legal residency, which makes CAJA enrollment mandatory and unlocks private options like INS. Legal Residency Costa Rica handles your residency end to end so your healthcare falls into place.
Request Your Free Consultation | CAJA Enrollment Guide | Review Residency Services
Call us: +506-8385-5008 | Email: legalresidencycostarica@outlook.com | Office: Santa Ana, Costa Rica
World-class care, affordably layered. Contact us today to start your residency.
