Retiring in Costa Rica is a dream shared by thousands of North Americans and Europeans each year. The images are seductive: lush green landscapes, volcanoes rising above misty valleys, affordable fresh food, friendly people, and a slower pace of life. One of the most frequently asked—and misunderstood—questions among future retirees is about health care, specifically Costa Rica’s public health insurance system known as the Caja Costarricense de Seguro Social, commonly called “the Caja.”
Can you buy it?
Is it affordable?
Is it good?
Is it enough for retirement years?
The honest answer is: yes, no, maybe, and it depends.
This article is written to help you understand the reality behind the Caja—not the fantasy often promoted in glossy brochures or online forums—and to help you make informed decisions as you plan your retirement in Costa Rica.
What Is the Caja?
The Caja Costarricense de Seguro Social (CCSS) is Costa Rica’s government-run public health care system. It provides basic and specialized medical care to Costa Rican citizens, legal residents, and certain categories of workers.
The Caja is funded through mandatory monthly contributions, based primarily on income. These contributions cover:
- Primary care (local clinics)
- Hospital care
- Specialist consultations
- Surgeries (when available)
- Basic medications
If you become a legal permanent resident (pensionado or rentista), enrollment in the Caja is not optional. It is required by law.
Can Retirees Buy Caja Insurance?
Yes—but only after you become a legal resident of Costa Rica.
Tourists, perpetual visa runners, and people living in Costa Rica without legal residency cannot enroll in the Caja. Once residency is approved, enrollment becomes mandatory.
Many people hear that Caja insurance is “cheap,” but this is only partly true.
How Much Does Caja Insurance Cost?
Caja premiums are based on your declared monthly income, not your age or medical history.
For retirees, income usually includes:
- Social Security
- Pensions
- Investment income
- Rental income
The contribution typically ranges between 7% and 11% of your declared income.
Examples:
- If your income is $1,000/month, your Caja payment might be around $70–$110/month
- If your income is $3,000/month, your Caja payment could be $210–$330/month
- Higher incomes = higher premiums
So while Caja can be inexpensive for lower-income retirees, it is not cheap for those with comfortable or higher retirement incomes.
And remember—you must pay it, whether you use it or not.
How the Caja Health Care System Works
Primary Care: EBAIS Clinics
Most routine medical care is handled through EBAIS clinics, small neighborhood health centers located throughout Costa Rica.
These clinics treat:
- Colds and flu
- Minor infections
- Blood pressure issues
- Diabetes monitoring
- Routine checkups
This is where the Caja works best.
However, access comes with rules:
- You must arrive very early to get in line
- Waiting times are common (often 1 hour or more)
- Appointments are limited
- Staff are overworked
Medication: A Test of Patience
If medication is prescribed, it is often not immediately available.
A common scenario looks like this:
- Morning visit to the clinic
- Prescription written
- Medication sent to a dispensary
- Patient must return later that day, often during a very narrow pickup window (for example, 2:30–3:00 PM)
If you miss that window, you may:
- Lose your medication
- Be forced to return another day
- Travel to a distant central dispensary
For retirees used to same-day pharmacy access, this can be extremely frustrating.
Specialists and Surgery: Where the System Breaks Down
This is where the real problem with the Caja lies.
Long Waiting Times
If your condition requires a specialist:
- Rheumatology
- Cardiology
- Orthopedics
- Neurology
You will be referred—but your appointment may be months away.
Waiting periods of 6 to 12 months are not uncommon.
A Real-Life Example
My adult adopted daughter lives in a suburb of Alajuela and is fully insured through the Caja.
- Minor illnesses? Handled well at the local clinic.
- Torn rotator cuff? A completely different story.
She was referred to a rheumatologist.
Her appointment: 9 months later.
Unable to live with the pain, she paid out-of-pocket to see a private specialist. The diagnosis was clear: she needed surgery.
Here’s where the system failed completely.
There was no qualified surgeon within the Caja system capable of performing the required procedure.
Result?
- No surgery through Caja
- No referral within the public system
- All care must now be paid privately
In this case, Caja insurance provided no solution.
The Reality of Specialized Care
This is a hard truth many retirees do not hear until it’s too late:
- The Caja is excellent for basic care
- The Caja is weak for specialized and advanced procedures
- Some surgeries simply do not exist within the public system
- Even when they do, waiting times can be dangerously long
For retirees with:
- Joint problems
- Heart issues
- Spine conditions
- Cancer concerns
This is a critical consideration.
Private Health Care: The Necessary Backup
Because of these limitations, many retirees choose to:
- Use the Caja for routine care
- Pay privately for specialists and surgeries
Private care in Costa Rica is:
- High quality
- Modern
- Often faster than in the U.S.
- Sometimes cheaper—but not always
Major surgeries can cost the same as in the United States, especially when performed by top-tier private hospitals.
Private Health Insurance in Costa Rica
Yes, you can buy private insurance policies in Costa Rica.
Some are good.
Some are limited.
Some exclude pre-existing conditions.
Most increase sharply with age.
Here is the problem:
Even if you buy private insurance, you must still pay the Caja.
This means:
- Two monthly premiums
- One mandatory
- One optional
Many retirees feel this is unfair, and honestly—it is difficult to argue otherwise.
Is Caja Insurance Good or Bad?
The truth is nuanced.
Caja Is Good For:
- Routine medical visits
- Basic medications
- Preventive care
- People with time and patience
- Those on limited incomes
Caja Is Not Good For:
- Urgent surgeries
- Specialized procedures
- Time-sensitive conditions
- People used to fast service
- Those with complex medical needs
The Emotional Cost of the System
Beyond money, the Caja demands something else: patience.
- Long lines
- Delays
- Bureaucracy
- Limited information
- Few explanations
Costa Ricans grow up with this system and accept it.
Foreign retirees often struggle deeply with it.
So… Truth or Fantasy?
The idea that Caja insurance is:
- Cheap
- Comprehensive
- Fast
- Perfect for retirees
👉 That is a fantasy.
The truth:
- It is mandatory
- It can be affordable or expensive
- It works well for basic care
- It often fails for serious conditions
Final Advice for Retirees
If you are planning to retire in Costa Rica:
- Understand the Caja realistically
- Budget for private medical care
- Consider private insurance carefully
- Expect delays
- Do not rely on Caja alone for serious health issues
Costa Rica offers a beautiful lifestyle, warm people, and an excellent climate—but health care is not something to romanticize.
Go in informed, prepared, and realistic.
That is the best insurance policy of all.