What Happens If You Do Not Have CAJA Health Care Coverage in Costa Rica?
A part-time resident in Costa Rica shares her experience with using only private insurance and then paying the CAJA rates
“911 — What’s your emergency?”
How many times have you called the Emergency number in your home country and heard these words? Or watched your favorite television show and the police or ambulance are called? What if you called and you understood nothing the operator is saying because you do not speak the language?
These are questions you need to ask yourself when you visit either as a tourist or live part-time or full-time in a foreign country. In Costa Rica we are lucky that there are English-speaking doctors and medical personnel. We are lucky that if we have residency we pay into a system that has free health care.
In this article I will discuss the importance of this along with what happens if you do not have health care in this country.
A pandemic in the tropics
We have been coming to Costa Rica for almost 12 years now. We have owned property for almost 11. We toyed and discussed residency for years. Always justifying that we did not start the process because of having to pay into the CAJA (the Costa Rican Social Security Fund, or CCSS) system.
It took a pandemic to show us that we had chosen a path that was unwise, especially owning property. With the borders closed we could not easily leave and if we left as tourists we were not coming back for who knew how long?
Our other consideration was health care. My travel policy expired and I was unable to renew being out of the US. My husband’s Medicare Advantage plan that covers 90 days expired as well. We were uncovered for almost a year. We were lucky… nothing happened. But what if?
Consider my friend who was renting and living here. They purchased a travel insurance plan for several hundred dollars monthly. One day in town she suffered a seizure. We live in a semi-rural beach town. Luckily, we have two doctors. The doctor came and she was taken to his office about a block away.
He determined that she needed to be taken to San José, which is 4-5 hours away depending on traffic, or a 45 minute chopper ride (meaning it takes 45 minutes for them to get here). Today the cost of this ride in a medical helicopter is $10,000 payable in advance.
Once at the private hospital in San José and several days later she was released with medications. The travel insurance company refused to pay. Unlike the United States, you can’t just leave the hospital with a promise to pay. Total out of pocket over $50,000.
Younger people reading this article may be surprised by this number but continue to be uncovered as they live here with their family. Preferring to pay privately out of pocket. The issue is you are in the tropics and illness and accidents are different here. You need to have some form of insurance that the hospitals here will accept.
Even with my husband’s medicare advantage we would be required to pay cash and get reimbursed.
The “blended” insurance plan
Many people that live in Costa Rica use what they call a “blended plan”. They private pay for tests and then use the CAJA for treatment. Many of the doctors are the same doctors that work in both systems. This helps get the testing quickly and diagnosis and if surgery and further treatment are needed they will use the public CAJA system.
In March the CAJA added an additional fee to be paid by residents which has significantly increased the monthly amounts residents must pay to CAJA. According to many posting on social media, they may opt to get private insurance instead of paying into CAJA. Buyer beware!
If you opt to get a quote for private insurance, make absolutely sure you know what you are getting for that coverage. If you are younger, you may feel after a time paying these premiums that you are essentially self insured because you have not exceeded your deductible. If you are over 65 you may feel that you have no real coverage at all!
In the US we are accustomed to there being no exclusions for pre-existing conditions as there were in our country for decades. Now we do not worry about this at all. In Costa Rica you need to be worried about this. We looked into this insurance as we were here uncovered. The prices for seniors are high and any pre-existing condition is excluded.
The very reason we wanted to take the policy out was because my husband had a silent heart attack years earlier. My recollection at that time the premium would have been approximately $700 per month and we would have been paying for nothing!
We both now have our residency and pay to the CAJA. We have used it and have had our labs done and my husband is getting his medications. Five days ago he was outside talking to the electrician when he collapsed in the driveway because he got very dizzy.
We got him into the house to lay down. My head was spinning because I needed to decide what he needed and how I was going to handle this situation. We got to the doctor and today he is fine and we are awaiting blood work, etc.
All I can tell you is that I was so thankful to know that no matter what was needed I would not be faced with a $50,000 or more medical because we have CAJA.
Questions about the CAJA rates?
Today, I have just celebrated my first year helping expats learn about moving to Costa Rica to achieve their dreams at Outlier as the leader of the Outlier Experience Manager team.
If you are thinking of residency and have questions about the CAJA send me an email to email@example.com and myself or one of my team can talk to you about how your rates will be calculated so you can make an educated decision about whether the CAJA system is for you.
In the end I can tell you that we are very happy to have our residency even though we are not full-time in Costa Rica. We will never have to be in the long line at the airport ever again. A side benefit, but that alone is worth the cost of residency.