Health insurance in Costa Rica: How to choose the right plan

Costa Rica is one of the most popular expat destinations in the Americas. Whether they're working remotely for a while or retiring there, expats love it. What's more, many are happy with the public healthcare in Costa Rica. That sometimes surprises people.

But there’s a catch. Getting residency approved can take up to 18 months. Until it comes through, you can’t access the public system at all. International health insurance is the only real option during that window.

There’s also an age issue. Local private insurers typically stop accepting new applicants between 65 and 70. If you’re arriving later in life, international cover accepts you where local private won’t.

For everyone else, the key is understanding the “layered” model of healthcare. The CCSS public system is a mandatory base. A private or international policy sits above it. Done right, it’s one of the most cost-effective healthcare setups available to retirees anywhere.

This guide covers:

• How Costa Rica’s public healthcare system works, and what it actually delivers

• Your private and international insurance options, and what each is suited for

• The layered CCSS + supplement strategy many expats use

• A profile-based cost breakdown to estimate your monthly outlay

• How to choose for your age, visa, and budget

Before we go any further: Feather sells international health insurance. We’ll tell you where it fits and where it doesn’t.

How Costa Rica’s healthcare system works

When people talk about Costa Rica health insurance, they usually mean one of three things. They’re CCSS, local private, or international cover. The CCSS – known as La Caja – is compulsory. It operates under the national health policy set by the Ministerio de Salud.

CCSS enrollment and contributions are mandatory for every legal resident. Rates run from 7% to 11% of declared income. Pensionado visa holders (retirees on Costa Rica's dedicated retirement visa) typically pay around USD 80 to 150 per month.

What does CCSS actually cover?

• Inpatient and outpatient treatment

• Prescriptions (free at CCSS pharmacies)

• Maternity care

• Chronic condition management

• Routine lab work (free at EBAIS clinics)

• Basic dental

Pre-existing conditions are covered from day one. And there’s no age limit for enrollment.

What’s the main problem with CCSS?

The system’s main weakness is wait times. Specialist wait times average over a year, according to Q Costa Rica reporting on CCSS data. Nephrology appointments range from 164 to 350 days, depending on the hospital. Cardiovascular surgery at Hospital México can mean a 640-day wait. But emergency care is immediate. So, you can see why many expats add private cover. It's to bypass the queue for specialist appointments and elective procedures.

How does the private system fit in?

There’s a practical detail that explains why the layered model works so well. Costa Rican doctors typically work morning shifts within the CCSS system. Then they run private clinics in the afternoons. The same doctor, a different queue.

One leading private option is CIMA. It's affiliated with Baylor, which is a major US hospital network. CIMA is also accredited by the US Department of Veterans Affairs. Another good option is Clínica Bíblica. Both are popular with expats who want faster access or English-speaking care.

The 18-month residency gap

New arrivals can’t enroll in CCSS until residency is approved. It's given by the Dirección General de Migración y Extranjería (DGME). Processing can take up to 18 months. During that window, CCSS cover simply isn’t available. International insurance or out-of-pocket payment are the only options.

Are you in the residency process? This is the single most important coverage decision to make before arriving. Check our guide to international health insurance for visa applicants. It covers what to arrange and when.

What are your health insurance options in Costa Rica?

Private health insurance in Costa Rica

The dominant local insurer is INS (Instituto Nacional de Seguros). It was a state monopoly until the 2008 Insurance Market Opening Law (No. 8653) opened the sector to competition. It's now regulated by the Superintendencia General de Seguros (SUGESE). For private health insurance in Costa Rica, INS remains the most widely used option. Other names include Blue Medical and various brokers.

Annual premiums typically run from USD 1,500 to 5,000, depending on age and plan. The main advantages? Access to private facilities and much shorter wait times for specialist appointments.

The limitations matter, though. INS policies cover treatment within Costa Rica only. Policies are written in Spanish. Most plans exclude pre-existing conditions. And INS won’t accept new applicants aged 70 or above. That's a big constraint for retirees arriving later in life. Most expats treat local private cover as a CCSS supplement, not a replacement.

International health insurance in Costa Rica

International cover works differently. There’s no restriction to a Costa Rican hospital network – you’re covered in Costa Rica and worldwide. Repatriation is included as standard. Documentation is in English, and so is the claims process. That matters more than people expect when something goes wrong.

Feather’s international health insurance in Costa Rica accepts new applicants up to age 75. That's higher than local private insurers typically allow. Pre-existing conditions are assessed individually at application, so you get a clear answer upfront, rather than an automatic exclusion. Plans start from EUR 85 per month.

Who is international cover for?

• Digital nomads and frequent travellers who need portability

• Expats over 70, where local private cover is unavailable

• Anyone in the 18-month residency gap before CCSS kicks in.

• Anyone who wants repatriation coverage in case they need complex treatment back home

Digital nomads on the Estancia visa are legally required to hold health insurance with at least USD 50,000 in coverage for their full stay. Travel insurance doesn't qualify – it has to be a long-term policy. The right international health insurance plan, such as Feather's, will satisfy this requirement.

Here’s one point some providers don’t always make clear. CCSS enrollment is a legal obligation once you have residency. International cover sits alongside it, not instead of it.

For more on how these plans work, see our guide to how international health insurance works.

The CCSS + supplement strategy

This is the approach most expat retirees actually use. Once you have residency, CCSS contributions are compulsory. Think of it as a healthcare tax that comes with real benefits attached.

CCSS covers a lot for a pensionado in reasonable health, including:

• Prescriptions (free at CCSS pharmacies)

• routine lab work (free at local EBAIS clinics)

• Chronic condition management

• hospitalisation and emergency care

The supplement handles the things CCSS does poorly. That means:

• Specialist appointments on your schedule

• Elective procedures without a months-long wait

• Repatriation (with international cover)

Which works best depends on your age and priorities. Local private suits those under 65 to 70 who are staying in Costa Rica. When does international make more sense? If you’re older, travel frequently, or want coverage that follows you.

What does it cost in practice?

Take a retired couple using this model, for example. They can often have comprehensive coverage for less than USD 300 to 400 per month combined. That figure includes CCSS contributions for both.

Here's an alternative many expats use. CCSS for prescriptions and lab work, plus out-of-pocket payment for specialist visits. Private specialists in the Central Valley typically charge USD 60 to 120. For someone in good health, this can work out cheaper than a full private policy.

Comparing your options

All figures are approximate and reflect indicative market rates as of Q1 2026. International figures based on Feather pricing. CCSS contributions are government-mandated rates, not insurance premiums.

Costa Rica health insurance for expats: how to choose

Choosing health insurance in Costa Rica for expats depends on your profile. Here’s a breakdown by situation.

CCSS contributions reflect indicative pensionado rates. Private and international figures are indicative market rates as of Q1 2026. International figures based on Feather pricing.

Which setup suits you?

US or Canadian retiree, healthy, budget-focused. CCSS alone may be sufficient for day-to-day care. Add a private supplement if specialist wait times become a practical problem.

Retiree with pre-existing conditions. CCSS covers them. Local private cover typically doesn’t. International cover may cover them too, subject to a health assessment at the point of application. It’s also worth considering if repatriation matters to you. Especially for complex treatment back in your home country. See our guide to international health insurance for seniors.

Digital nomad or remote worker. International cover is the right choice for portability. Bear in mind that CCSS contributions become mandatory once residency is approved. See our guide to international health insurance for digital nomads.

Over 65, new to Costa Rica. CCSS as the base, international as the supplement. Local private cover is often unavailable at this age. Feather accepts new applicants up to 75.

Retiree couple on a tight budget. Are you in reasonable health? Consider CCSS plus out-of-pocket specialist visits (USD 60 to 120 per consultation). That may be the most cost-effective approach.

What are the out-of-pocket costs?

Out-of-pocket costs at private facilities for context: a GP visit costs USD 40 to 70. A specialist costs USD 60 to 120. A hospital stay costs USD 300 to 800 per day. Emergency surgery can reach USD 5,000 to 25,000.

Related guides

Moving with your family? Our guide to international health insurance for families covers everything you need.

Heading to Costa Rica to study? Take a look at our guide to international health insurance for students.

Freelancing? Our guide to international health insurance for freelancers has you covered.

Time to get covered

Still waiting on residency? International health insurance covers the gap. Already settled? It covers what CCSS and local private plans don’t. And it travels with you.

Get a quote

Feather’s international health insurance starts from €56 per month. Apply online – most people get their certificate immediately.