Dec 18 2019

My 2019 Healthcare Update, by Rob Evans

To review, I retired early to Costa Rica in 2014 since healthcare costs were too high in the US. My employer had paid most of the cost, and I never realized the true cost of healthcare until I had to pay it all myself. My payment went from zero to $14,000 a year, which meant I would have to continue working at a job with benefits until 65 to survive, or better yet, I could simply retire immediately to Costa Rica. I estimate my healthcare costs in the US would be $24,000/yr in 2019 compared to the $5000 I am spending here. Note: this is for a couple in their 60s. I am not sure what we will do when we reach 65 and are eligible for Medicare, which does not cover medical care outside the US. I will report back on that in four years.

I am skeptical about the future of Medicare because of the increasing costs of drugs and medical care, scarcity of doctors, a growing population of unhealthy people joining the rolls, etc. I think it will soon come to a head in the US, and something drastic will happen to available coverage and the cost. So, I am happy to be in Costa Rica and in charge of my own medical decisions and costs.

My strategy has been to get healthy and try to avoid going to the hospital. Healthy living (fruits and vegetables, no processed or fast food, plenty of sun and exercise) in Costa Rica has helped me lose 70 pounds and brought all my metrics – blood pressure, cholesterol, blood sugar, etc. – into the normal range. We have annual physicals and see a private doctor and pharmacy for any minor problems. We pay for tests, treatment, and doctors out of pocket and have health insurance in case of major illness or accidents.

To make healthcare work for me in Costa Rica, I have assembled these products: private insurance, Caja (the socialized medicine program of Costa Rica), and a medical membership program. The first, my expat insurance from WEA, covers us worldwide minus the US. Why minus the US?  Because including the US doubles the cost since the US is so expensive. I figure with 150 countries to choose from, I am OK with that limitation. Why WEA? Because my insurance broker recommended it and it met my needs and was affordable. Also, we might like to move to another country one day and our WEA insurance will cover us whether we go to Mexico or Europe. I like the idea of not having to start over with a new insurance company each time we move to a new country. To be fair, my WEA policy includes $150 each reimbursement for any preventive care. We use the money each year for annual physicals, so the 2019 insurance cost in the list below of $3215 should be $300 less depending on how you handle your accounting.

To cover trips back to the US to visit family, I bought a travel policy that covers us for 30-day trips in the US. I can have as many 30-day trips as I want, but they need to be separate trips.  Note: travel insurance will not fix cancer. Travel insurance will only cover you if you get sick or injured, so we would need to leave the US to continue treatment after recovering. I could have purchased the travel policy trip by trip, but one annual policy vs. per trip was simpler and the difference in cost was insignificant.

Next, I pay a group rate for the Caja through ARCR (Association of Residents of Costa Rica), an expat advocacy group. In addition, ARCR also helps with seminars, banking, and residency. The Caja assigns you to a local clinic near our home where you can go for checkups and medical care. I don’t use it, but I feel confident that if I were in an accident, the Caja would take great care of me.

Finally, I joined Medismart, which is like Sam’s Club or Costco where I pay $15/month (two people) and get 10%-80% discount on medical treatment. A doctor visit is $15 at the hospital and $25 at your home. Medical costs are hard to compare, but as an example, I think my insurance company in the US paid $3000 for my colonoscopy, while I paid $600 in Costa Rica of which $150 was covered by the WEA preventive rebate and it included an endoscopy as well. I should mention that pharmacists in Costa Rica are qualified to recommend treatments for general ailments such as flu, stomach aches, cuts, burns, etc., and because you don’t need a prescription for most drugs, your first stop in many cases might be to the pharmacy where a doctor or pharmacist will discuss your symptoms and give you the treatment you need—all in one place.

In the table below you can see my overall costs went up 16% Year to Year (YtY) from 2018. Some of that is to be expected since my wife reached age 60, apparently an important marker for the insurance company, as you can see by the WEA insurance increase of 24% in 2019 and 40% the year before when I turned 60. I don’t want to be alarmed, but I am keeping my eye on the YtY increases and hope they slow down now that we have both reached the 60 mark. Plan B is to increase my deductible from $2500 per person to $5000 per person which could halve my annual premium. While that deductible seems high, I bought insurance to cover critical illness, not ordinary day-to-day care. Moving on, my travel insurance, Caja, and Medismart YtY costs did not increase significantly.

You can buy WEA insurance from their website or through a broker. There is no cost difference between the web price and broker price. I bought my policy from Perfect Circle (PC) in Escazu, Marge Esquivel. I can submit my claims to PC and they make sure I have all the documentation to help them sail through, including calling the doctor and speaking to them in Spanish to resolve issues or to get more documentation. Some people worry that expat insurance like WEA is not local to Costa Rica and therefore cannot be sued in Costa Rica if something seriously went wrong. I hope that never is an issue for me but people should be aware of that concern.  Note: I receive nothing from recommending Perfect Circle.  I just like the service they provide.

Finally, to double-check things, I found an expat health insurance company called Safety Wing using Google.  I know nothing about this company besides that it is used by many digital nomads. Their site quotes a monthly premium of $127.68 for an adult over 60. They include travel insurance back home and exclude care in the US except during a 30-day travel period. If I take that quote and convert it into an annual rate for two people, I get $3064 compared to my WEA+Travel Insurance combo of $3568. If I take out the $150 x 2=$300 rebate for preventive care, I get a new total of $3268 annual cost for two 60-year-olds, so my costs appear to be in the ballpark with this one. A consideration is that the Safety Wing policy does not cover pre-existing conditions nor cancer.  Bottom line: I think my choices are priced correctly.


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