In a previous article written in 2015, after we first arrived in Costa Rica, I detailed our healthcare plan as follows. (NOTE: click on the link to read the full first article.)
- Care Flow: pharmacy, public doctor, public hospital, and private hospital.
- Preventive: Change to preventive lifestyle. Use local clinic (EBAIS) for regular checkups and to discuss health concerns. Pay out-of-pocket for specialized preventive checkups from dermatologists, ophthalmologists, gastroenterologists, and cardiologists and lab tests. Note: these are available through the CAJA, but I want to speed up the process and get on top of my health care now.
Reactive: Go to a pharmacy for minor cuts and burns, allergies, headaches, diarrhea, stomachaches and other minor ailments. If the problem exceeds the pharmacy’s ability (stitches, broken bones, internal bleeding, stroke, etc.), go to the ER at the local public hospital (CAJA). If unhappy with their care, ability or speed, transfer to a private hospital (INS).
- Budget: Transition from $18K ($13k policy + $5k deductible, US Cadillac plan) to $4K (CAJA + INS) and eventually to $1.2K (CAJA only—would require better Spanish skills and better understanding of the system).
INS does not offer continuation of insurance from another company, but they may consider covering some pre-existing conditions (at a higher premium). Their travel insurance with this policy provides $10,000 coverage outside of Central America.
This policy had a fixed deductible of $300/year/person in 2015. Once you reached the deductible, claims would be paid applying a co-pay: 10% for in-network providers, 20% out of network.
Our 2016 Plan
Since that time, I have fine-tuned my plan with some cost-cutting changes to decrease my costs and get better coverage. The journey started at the beginning of 2016 when INS increased our private healthcare premium from $3000/year/couple to $5000/year/couple. ARCR was caught off guard, as was I. ARCR increased the deductible from $300 to $500 to help mitigate the cost increase, but I was not happy. I heard the increase was due either to increasing costs for the pool of older, sick gringos ARCR attracts or due to years of mismanagement that finally caught up with INS, neither of which instilled confidence for my future with INS.
My ideal plan:
- is worldwide.
- will not drop me because I reach a certain age.
- is easy to pay, understand and use
- kicks in when bad things happen.
Otherwise, I forget about it and hope I never have to use it. I prefer not to complicate my life understanding with co-pays, low deductibles or other charges than make knowing the true cost difficult. I want a policy that is simple to understand and pay—where someone steps in and helps me in a crisis.
The INS plan:
- was increasingly expensive for the value at $5000/yr/couple.
- was limited to Central America.
- had a steep rate increase with age, and
- included ARCR charges to file claims ($10?).
I don’t know if we’ll spend the rest of our lives in Costa Rica. If we ever moved to Mexico or Europe, we would have to re-apply for new coverage with the risk of adding pre-existing conditions that would not be covered each time.
So, I started to look at expat policies which would be transportable, no matter where we moved. I have been following the Mexico expat forum, and their expat group had a group policy from Best Doctors, which appeared to be a low cost, great value with good reviews. I wrote to Best Doctors about getting a policy in Costa Rica and they referred me to their local broker, Perfect Circle, to apply. The application was a simple questionnaire, which inquired about any pre-existing conditions to be excluded. There was no physical like INS. The quote I received was higher than I wanted ($3500/yr./couple) so the broker suggested I consider WEA. I found a blog by a Nicaragua expat with needs similar to mine: an affordable, transportable, catastrophic healthcare plan and his research led him to WEA.
When WEA’s quote came back higher than I had hoped, the broker suggested I exclude care in the US and—wham!—the cost dropped nearly in half ($1800/yr./couple) [58 year olds]. At first, I wondered if the quote was for just me or per month! Knowing how out of control US healthcare costs are, I should not have been shocked.
So, here is the summary:
- Worldwide coverage though not intended for a world-wide expat
- Mainly Costa Rica with some of Central America and 10k travelers insurance
- Worldwide except the US, so 195 choices
You do not have to be a legal resident to qualify for WEA expat insurance, though it helps speed things along. You do need a foreign address to establish you live outside the US. I think there are some tests required if you are 65 or older and you can apply until age 74. If you have an active policy with WEA before 74, you can keep it as long as you pay the premiums. Note, some conditions are excluded for 180 days unless you can prove coverage under a previous insurance policy. I chose the “SELECT” option below.
** Ignore the 100%/80% above. The 80% only applies if you choose to include US coverage and seek help in the US. Otherwise, coverage is 100% down the line in the other 195 countries.
So at this point, I am elated, having gone (in round numbers):
- from $13,000/yr., US mainly (+$5,000 deductible)
- to $5000/year, Costa Rica only (+$500 deductible)
- to $1800/yr., worldwide (minus US) coverage (+$2500 deductible).
I like to use the simulation that something serious happened and see what the costs would be. I the US, I would pay $13,000 premium plus $5,000 deductible or $18,000 before getting help and than only 80% cost sharing. With my WEA policy, if something serious happened, it would be $1,800 plus $2,500 or $4,300 with 100% coverage. Another consideration is the insurance company is only going to pay “customary and usual” expense off some standard charging sheet the insurance companies have. I think I have a better change of coming in under those standard rates in outside the US than inside the US which could be an additional hidden cost to my previous US policy I would have never seen coming.
I could have gone to WEA’s website directly, but I liked working with my local broker to answer my questions, explain the policy and help me with service. Note: there is no discount for bypassing the broker by buying the policy directly off the website so no reason not to use them. Perfect Circle has an office near my home in San Jose; they will collect, evaluate, and submit my claims for free; and they will be my advocate if something comes up. They also have offices in Nicaragua, Mexico, etc., but on-line is also an option.
Plugging the US Hole
So now I had affordable, easy-to-use coverage in 195 of 196 countries. Still, my lack of US coverage bugged me because we travel to the US occasionally, so Perfect Circle recommended BUPA travel insurance for $370 ($185 per person) per year. The policy will cover 100% of everything at every doctor and hospital world-wide, though I only need it in the US to plug US travel. Understand: this is not cancer care but emergency care. The policy would allow us to be stabilized enough to travel home to Costa Rica or another country for follow-up work using the WEA policy. They also offer a policy for each trip to the US, but the low cost and convenience of an annual payment suited our needs. Finally, this US travel policy requires the policyholders to be in the US less than 30 days for each trip.
If you want to save money, you should evaluate the trip-by-trip policy. As per my WEA comment above, you get the same rate whether you use Perfect Circle or buy it directly on the BUPA website. Again, I like placing one call to one company (Perfect Circle) to be my first point of contact.
So Where Does That Leave Me?
As much as I would prefer to have one company and one policy, this is as close as I could get to meeting my needs:
$3,400/year/couple or $283/month/couple is a significant savings over the $1200/month in the U.S.
If my pension or Social Security goes bankrupt, I have some cost levers I can use:
- WEA – I can increase the deductible from $2500 to $5000. The deductible can go up without problem but requires a new application to decrease.
- BUPA – travel less frequently to the US and buy per-trip coverage.
- CAJA – drop all other coverage and rely solely on CAJA, but this will require me to be more patient with socialized medicine and to improve my Spanish.
Pièce de Résistance
Recently, there have been a number of articles about a medical discount program called MediSmart out of Hospital Metropolitano, which offers medical procedures discounted by 20-80% after you join and pay a monthly subscription of $15/month/couple. An aside – they also cover your pet for an additional charge! I wrote about my MediSmart experiences at this link.
Also, Paul and Gloria wrote about the MediSmart program at this link.
While MediSmart is not healthcare insurance, it is an important part of my healthcare plan. To stay healthy, one needs to regularly see specialists for tests and to seek advice. The MediSmart discount plan provides a variety of doctors and services in one place. Note: I will use WEA insurance if I get a serious illness or injury, while MediSmart is my program to help me avoid serious illness in the first place.
Final cost for the package of plans that works for my family: $283 insurance + $15 discount plan, or rounded off to $300/month compared to $1200/month in the US with much lower deductibles than my US plan.
Should you like to contact Perfect Circle to check on plans for your situation, here is the contact info.
- Our Costa Rica Healthcare Plan, by Rob and Jeni Evans
- MediSmart: An Affordable Alternative to Private Health Insurance in Costa Rica