Costa Rica Healthcare for Expats: Caja & Private

Guides · Costa Rica

How the Caja Works for Residents

Costa Rica healthcare runs on two tracks, public and private. The Caja Costarricense de Seguro Social, known simply as the Caja, owns and runs the public hospitals and clinics.

Its front door is an EBAIS, short for Equipo Básico de Atención Integral en Salud. The Caja assigns you to one by your home address, not by choice.

An EBAIS is a team rather than a building. The Caja defines it as a general doctor, an auxiliary nurse, a primary-care technical assistant and a network assistant.

The Caja counted 105 áreas de salud and 1,080 EBAIS at 31 December 2021, in its inventory of health establishments. The same count lists 29 hospitals, from peripheral units up to national specialist centres.

If you move cantón or barrio, update your registration at your new área de salud. Otherwise your file and your appointments stay where you used to live.

Joining the Caja, and What You Pay

Cover is not something you can decline in favour of private insurance. Articles 78 and 80 of the immigration law, Ley 8764, require continuous Caja affiliation.

The proof is checked when a residency card comes up for renewal. That law was published on 1 September 2009 and took effect six months later, on 1 March 2010.

Salaried workers are insured through an employer. Everyone else joins in their own right, and that is the route for residents without a local employer.

From January 2026 a salaried worker has 10.83 percent deducted from pay. That splits into 5.50 percent for health, 4.33 percent for pensions and 1.00 percent for the Banco Popular.

The employer adds 26.83 percent, of which 9.25 percent is health. With a state share of 0.25 percent, health cover alone costs 15 percent of the salary.

Residents without an employer pay on a separate Caja scale. The Caja sets a reference income for them, applies a percentage to it and bills every month.

Colón figures here convert at a rate of 451.86 to the US dollar. That is the Banco Central de Costa Rica reference selling rate on 23 September 2026.

From the January 2026 billing cycle that assessed income has a floor. For health it is ₡346,789 a month (about US$767), and for pensions ₡324,590 (about US$718).

Decree 45303-MTSS set both figures, published in La Gaceta of 5 December 2025. The percentage charged on top of that income rises across five bands.

The Caja health-insurance scale for contributors outside the payroll system, document E-GF-USIN-030, in force from January 2025.

The pension scale runs in parallel, from 4.00 percent in the lowest band to 8.26 percent in the highest. Its lowest band ends a little earlier than the health one.

The contributor’s pension share rose by 0.16 of a percentage point on 1 January 2026, and holds until 31 December 2028. Health and pension together therefore run from about 7.05 to 19.11 percent.

Ignore the single flat rate quoted on relocation sites. That figure is the salaried payroll deduction, which rose from 10.67 to 10.83 percent in January 2026.

The Waiting Lists, in Numbers

The Colegio de Médicos y Cirujanos, the national medical association, compiled Caja figures to 31 July 2026. They show 391,314 people waiting for a specialist appointment, at an average of 565 days.

The surgical list held 211,650 cases at an average wait of 452 days. Diario Extra published the same two averages on 23 September 2026.

Both lists have grown since February 2023. The specialist list then stood at 233,044 cases and the surgical list at 174,815.

The bottleneck is staff rather than operating theatres. Marvin Palma, the Caja’s interim medical manager, put the hospital shortfall at more than 900 specialists on 6 August 2026.

There is movement the other way as well. The Caja said on 5 August 2026 that it had resolved 56,678 surgical cases between January and July.

That cut its historic backlog by 26.9 percent, from 195,700 cases to 142,987. Mónica Taylor, the Caja’s executive president, says the strategy puts the oldest cases first.

Emergencies are not queued at all. The waiting lists cover non-urgent appointments and elective surgery, and an emergency is treated when you arrive.

Private Hospitals and Membership Plans

The private sector is the other half of Costa Rica healthcare. Hospital CIMA, Hospital Clínica Bíblica and Hospital Metropolitano are the country’s main private hospital groups.

The big groups do not publish general tariffs and quote on request. The practical entry point is a membership plan, which is a discount card rather than insurance.

Hospital Clínica Bíblica sells its Mi Vida plan from ₡9,900 a month (about US$22) for one person. A group or family affiliation costs from ₡8,500 (about US$19) each.

The plan carries an annual check-up and two emergency consultations with no doctor’s fee. It also discounts laboratory work, imaging, pharmacy, surgery and hospital stays.

The hospital sells it for its San José, Santa Ana and Aleste sites. CIMA Prime, sold by Sana Sana in alliance with Hospital CIMA, costs US$16 a month with tax included.

That works out at US$192 a year. It prices a specialist consultation from ₡25,000 (about US$55) and other health professionals from ₡16,000 (about US$35).

CIMA Prime also takes 40 percent off laboratory work and imaging, and 20 percent off hospital stays and surgery. Hospital Metropolitano lists ten hospital sites and five medical centres.

Those run from Escazú and Lindora to Quepos, Liberia and San Carlos. Private prices are not regulated, so confirm the cost with the hospital before treatment.

What Foreign Residents Get Wrong

The commonest mistake is treating Caja enrolment as optional once residency is approved. Ley 8764 makes continuous affiliation a condition of renewing the card.

The second is budgeting from a single flat percentage found online. The Caja sets the reference income itself, and the scale is progressive across five bands.

The third is assuming private cover replaces the Caja. It does not, and a hospital membership plan is not insurance at all.

Costa Rica healthcare rules are published by the Caja at ccss.sa.cr, mostly in Spanish. Residency questions go to the Dirección General de Migración y Extranjería, the immigration authority, at migracion.go.cr.

Sources: Caja Costarricense de Seguro Social contribution scale E-GF-USIN-030 and its inventory of health establishments; decree 45303-MTSS, La Gaceta, 5 December 2025; Ley 8764; Colegio de Médicos y Cirujanos; Diario Extra; Infobae; Teletica; Banco Central de Costa Rica reference rate via the Ministerio de Hacienda; Hospital Clínica Bíblica; Sana Sana; Hospital Metropolitano.

More: Costa Rica news in English, every day from The Rio Times.

Frequently Asked Questions

Is Costa Rica healthcare free for residents?

No. Treatment, hospitalisation and medication carry nothing to pay at the point of care, but compulsory monthly contributions fund the system.

How much does the Caja cost a foreign resident?

It is a percentage of an income the Caja assesses, not a flat fee. The 2026 scale runs from about 7.05 to 19.11 percent, above a floor of ₡346,789 a month (about US$767).

Can I use private insurance instead of the Caja?

No. Articles 78 and 80 of Ley 8764 require continuous Caja affiliation until a residency card is renewed. Private cover is an addition, not a substitute.

How long is the wait for a public specialist?

Caja data to 31 July 2026 gives an average of 565 days for a specialist appointment and 452 days for surgery. Emergencies are treated when you arrive.

What do private hospital plans cost?

The big groups quote on request. Hospital Clínica Bíblica sells its Mi Vida plan from ₡9,900 a month (about US$22), and CIMA Prime costs US$16 a month.

This article was produced by The Rio Times’ automated newsroom system. How we use AI · Report an error · Editorial responsibility: Matthias Camenzind, Editor-in-Chief