by Rob and Jeni Evans
Admit it. In spite of the beautiful beaches and the tropical weather, affordable health care is a huge factor in why people retire to Costa Rica. Although I qualified for a pension at age 55, I found I had to continue working just to pay for my health insurance. While I was still working, the Cadillac plan for a couple, age 55+, cost $13K per year, of which I had to pay $6K (with my company paying the other $7K). Furthermore, the insurance company would only reimburse 80% of expenses (up to $5M) AFTER I met a $5K deductible. My retirement severance package included my company paying the entire premium ($13K/yr) for three years, after which I could continue paying the $13K myself. With the deductible, I would pay a total of $18K ($13K premium + $5K deductible) before receiving any benefit.
There was no way after retiring I could afford that price, so I needed to formulate a plan. Below is the three-step health plan I developed to retire in CR. Note: I do not claim this plan is the best plan, nor even that it will succeed; but it is my initial plan that I will go with until it needs revision.
- Improve health by reducing stress and by improving sleep, exercise and eating habits.
- Join the CAJA (public) and INS (private) and make use of them.
- Seek out specialists for preventative testing and advice.
The corollary of the first step is “don’t get sick.” In addition to losing a few pounds and exercising to stay fit, I wanted to eliminate toxins and processed foods from my diet, make sure I was getting enough hours of REM sleep, and monitor my health through more regular check-ups. While these healthy habits seem obvious to me now, I was all too entrenched in the US car-centric lifestyle where being busy and stressed out is celebrated, pills are the answer to every ailment, and processed foods support the on-the-go family with excessive toxins, fat, salt, and calories. It takes planning, commitment, and will power to implement a healthy lifestyle. Although it is possible in Costa Rica to continue bad habits formed in the US, moving to another country provided a unique opportunity for a complete change in the way I live.
Once we established our residency, we were able to continue with step two and join CAJA, the public healthcare system available to residents and citizens. The CAJA has no restrictions on pre-existing diseases and no age limit. The monthly CAJA premium people quote is wide ranging, but it is supposed to be 9-13% of your declared income. So, 10% of the $1000 required for pensionado status is $100/month with no deductible, no age limit and no maximum. Clearly, this is a huge savings compared to my company’s plan. But I have heard that many expats don’t bother to use the CAJA—perhaps because they are unfamiliar with how it works, they have heard bad reviews, or they struggle with Spanish. Since this is essentially a 10% tax on my income, I want to learn how and when to use it.
We will use CAJA for regular checkups / minor ailments and the public hospital for emergencies until we understand CAJA and gain faith in it. Until I learn enough Spanish and get over my US instant-gratification attitude, using CAJA will probably present a bit of a challenge at first. However, retirement provides me with the time to learn, so I can adapt to the process.
Although I might not need it, I am uncomfortable not having private insurance at this point, so I signed up for INS, the government health insurance monopoly which only works with private hospitals. INS excludes pre-existing diseases and ends at age 70. So, I can only use CAJA at public hospitals and INS at private hospitals. Private hospitals include top rated Clínica Bíblica and CIMA, both of which handle a lot of medical tourism. INS requires a physical in San Jose which they schedule for free. INS costs $3K per year (for a 55 year-old couple through ARCR) with a $300 deductible, and INS pays 90% after the deductible is met with a $200K limit. I know some people freak out over a $200K limit vs. the US $5M limit, but I understand that $200K goes a long way in Costa Rica. There are other benefits with INS, such as yearly eye exams, physicals, $10K travel insurance, death benefits, etc., that I still need to investigate.
My third step, to make better use of preventive care, means more than simply getting in better shape. Typically, because of the cost in the US, many of us fail to have regular diagnostic tests such as mammograms, colonoscopies, or dermatological exams and only seek medical attention when symptoms occur.
Also, since doctors are under tight time constraints, we rarely have a good long talk with them about our health and habits. Another concern is the questionable relationship doctors in the US have with pharmaceutical companies and their free samples and the push to try this or that chemical solution instead of leading with good general health practices.
I have heard from friends here that Costa Rica’s doctors spend more time talking with their patients and rely less on pills and antibiotics. Indeed, when you go to the pharmacy, the pharmacist will ask how many pills you need, rather than hand you a bottle of 500 pills. Because medical tests and specialists cost less here, I can consult with the appropriate professionals to understand, prevent, and avoid many ailments before they become problematic.
In Costa Rica, my first point of contact for medical needs often will be the pharmacy. Pharmacies in Costa Rica provide most drugs without prescription and have a doctor on staff to treat minor ailments like stomach aches, burns, rashes, headaches, diarrhea, etc. If my need is greater, I will go to the CAJA doctor (public), ER (public) or private doctor/ hospital depending on what I need and how fast I need it. The overall plan is not as simple and straightforward as I wanted, but I am convinced it is better quality care for less money than I would have had in the US after my employer’s plan ran out.
So in summary, our Costa Rica healthcare plan:
- Care Flow: pharmacy, public doctor, public hospital, and private hospital.
- Preventive: I will change my lifestyle to prevent getting sick. I will initially go to the local clinic (EBAIS) for regular checkups and to discuss my health concerns. I will pay out-of-pocket for specialized preventive checkups from dermatologists, ophthalmologists, gastroenterologists, and cardiologists. Note: these are available from through the CAJA (takes time and referral), but I want to speed up the process and get on top of my health care now.
- Reactive: I will go to the pharmacy initially for minor cuts and burns, allergies, headaches, diarrhea, stomach aches and other minor ailments. If the problem exceeds the pharmacy’s ability (stitches, broken bones, internal bleeding, stroke, etc.), I will go to the ER at the local public hospital (CAJA). If I am not happy with their care, ability or speed, I will transfer to a private hospital (INS).
As I learn more Spanish and better understand the healthcare system, I hope to eventually drop INS and rely entirely on the CAJA. So, I will move from $18K (US Cadillac plan) to $4K (CAJA + INS) to $1.2K (CAJA only). There are more complications ahead when I turn 65 and have to make Medicare decisions, and when I turn 70 and lose INS, but that is still several years away.
- The Best Way to Live for Less in Costa Rica (or Anywhere), by Rob Evans
- It’s All Costa Rica! by Jeni Giles Evans
- What Does It Cost You NOT to Move to Costa Rica? by Rob Evans