Dec 28 2018

Retire for Less in Costa Rica – December 28, 2018

Welcome to our Retire For Less In Costa Rica Newsletter

Paul and Gloria

In This Issue: 

 

 

Happy Holidays and Best Wishes for a Joyful New Year

from Paul & Gloria at Retire for Less in Costa Rica!

 

What’s Up With the Yeatmans? CT Scan, Cancer, and the Caja-Part 3

First off, thank you for your concern, support, kindness, and prayers when you learned of Paul’s cancer scare. It is now 4.5 months since his surgery to remove his right kidney and 6.5 months since we learned the results of the CT scan (“TAC” in Costa Rica) which showed two tumors with a 95% probability of being cancerous. A lot has happened since then. After surgery, Paul recovered slowly but has never lost his positive outlook on life. We delayed our planned trip to Mexico by a month to allow him to get strong enough for the trip. We traveled to Mexico City on September 28th, still not knowing the results of the biopsy, but determined we would take it easy and enjoy every moment of our trip. Paul wasted no time by dancing in the street to the music of a Mexican rock and roll band, though it was short and sweet.

Paul dancin' in the street our last night in Mexico City. Not bad for 8 weeks post-op, huh?

Posted by Gloria Yeatman on Friday, October 5, 2018

After spending three nights in Mexico City, we traveled to the city of Oaxaca to the bungalow that we would call home for the next two months. As many of you know, we spend part of every year in Oaxaca, during Costa Rica’s rainy season. You can see some of the pictures from our time in Oaxaca this year in our last couple of newsletters or click the links in the “Related Articles” section below. Towards the end of our trip, Paul danced in the streets again, this time in Oaxaca’s Zocolo to the tunes of a Mexican blues/rock band! 

He is at it again…dancing in the street in Oaxaca!

Posted by Gloria Yeatman on Saturday, November 24, 2018

To me, this was evidence of how far he had progressed in his recovery from surgery. He was like the Energizer Bunny, he just kept going, and going, and going…

We returned home to Costa Rica on December 1st, did a healthcare tour we’d had scheduled for December 6th and 7th, and prepared ourselves emotionally to get the results of the biopsy at Paul’s December 12th follow-up appointment with the Caja surgeon. Unfortunately, due to the public workers’ strike, the Caja had changed his appointment…until December 1, 2020. No, that’s not a typo or a mistake. His follow-up appointment was rescheduled for two years later as a result of the 2-month-long strike.

“What are we going to do now?” we wondered. Then we came up with a strategy. Thankfully, we discovered the appointment change a few days before, while using the online appointment system to make a routine appointment to renew our prescriptions for 6 more months. We decided we would just go to the appointment as if we didn’t know it had been changed. But we also prepared a written request to get a copy of Paul’s expediente (patient file) covering the time period from the initial CT scan in April up to the present. That way, if we couldn’t get in to see the doctor, we could take the results to a private doctor to review the results.

On December 12th, Paul spoke to the head of the Urology Department at San Rafael Hospital who was also one of Paul’s doctors. She informed us that, yes, that’s correct, the appointment was changed to two years from now…and there is nothing she can do about it. Next, we went upstairs to see Paul’s gastroenterologist, Dr. Moreno, who has been his doctor for over five years and who was the one who ordered the CT scan which found the tumors. He also is a wonderful doctor with a warm, helpful bedside manner. He agreed with us that the delay was unacceptable and he wrote us a referral to the Pathology Department to get a copy of the biopsy results. Thank you Dr. Moreno!

We continued on to the Pathology Department, located deep within the hospital. There we learned that the biopsy sample had been forwarded on to Hospital Mexico (a top-tier hospital in the Caja system) for analysis and that the results hadn’t come back yet. Check back in a month, we were advised.

We also put in our request for the copy of Paul’s expediente and were told that they would count the pages to be copied (which would take 8 days) and we would need to return at that time to pay for the copies at 12 colones per page. Then it would take another few days until the copies were ready to pick up.

Knowing that we couldn’t stand to be in limbo while waiting for things we couldn’t control, we decided to get a PET scan done privately for Paul. While we were still in Mexico, we researched the availability and price of this test in the U.S., Mexico, and Costa Rica. In the U.S., the PET scan would cost about $5,000 USD; in Mexico, it would cost about $1,800 USD and was primarily available in Mexico City. For either of these options, we would have the additional costs of travel and housing. We found that there is one place in Costa Rica that offers PET-CTs and they charged $2,500 USD. We decided to wait until we were back in Costa Rica to have the test done once we had received the results of the biopsy. However, since we still didn’t have the biopsy results, and didn’t know when we would, we wanted to have the test done as soon as possible.

Sample Scan Results for Illustration

We left Hospital San Rafael and drove directly to Imágenes Médicas in San Jose, located right next to Hospital Mexico. Turns out, they are the only radiology center in Central American which offers PET-CTs. We were extremely thankful that they are located just about an hour from where we live in the Central Valley and that we were able to schedule the scan for the following day, after Paul got the necessary lab tests done first thing in the morning. We asked if they gave any discounts and were told that they offered a 15% Senior Citizen discount, so the scan ended up costing us $2,125 instead of $2,500.

One of the reasons for our desire to have the test done quickly is that, prior to our trip to Mexico, Paul had a 4G ultrasound done of his abdominal area. The radiologist who administered the ultrasound had told him that she found “solids” in his liver which may be more potentially cancerous tumors instead of the benign cysts originally diagnosed. Needless to say, we were worried that the cancer had spread before they were able to remove the kidney. Two business days after having the PET/CT, we received the results in Spanish, then a few days later, we received the results translated into English (per our request) as well as the disc with the actual scans. The result? Paul now has no cancer in the areas of his kidney and liver!

Unfortunately, the scans didn’t come out completely clean. They showed “metabolic activity” in a nodule on Paul’s thyroid gland that we will have to have checked out. But, if it turns out to be cancerous, the thyroid can be removed; we have been told that people rarely die from thyroid cancer. So, we are relieved for the most part but plan on staying on top of this. Early detection is so important when it comes to cancer and other potentially deadly diseases.

Overall, how do we feel about this whole experience? On the positive side, the Caja did perform the surgery at no cost to us, saving us about $15,000 USD had we had the surgery privately in Costa Rica. He received great care while in the hospital for those 14 days; we were impressed with the cleanliness and professionalism we observed at Hospital San Rafael. Another positive is that we were able to get a copy of Paul’s patient file. And we have the financial ability to be able to pay for a PET/CT scan privately and to take all of the records to a private doctor for consultation about what’s next. On the negative side, everything has taken longer than expected: the wait for the hospital bed to become available (7 weeks), the wait for surgery once Paul was admitted to the hospital (9 days), and now, the wait for the biopsy results (4.5 months and counting) and follow-up appointment in the Caja (2+ years).

So, What’s the “Take-Away?”

Yes, Caja delays are aggravating, frustrating, and unacceptable. But, this is a good illustration of why we always say it is important for retirees in Costa Rica to have a financial reserve to cover these unexpected expenses and a “Plan B” for these unexpected delays in care. There are times when you will need to pay to see a doctor and have diagnostic tests done privately. You don’t want to rely just on the Caja. Blending the public and private healthcare that Costa Rica offers is the best way to go. If you are able to keep an option in your home country (Medicare, VA healthcare, or socialized medicine) or can afford to purchase international health insurance, that’s even better.

Related Articles:

and our Facebook page of the same name:

 

Costa Rica Caja Health Insurance Payment Scale

We recently got a question from a reader which we couldn’t answer: “If a person has a large pension and his Caja payment is based on the higher percentage (say 13%), is there a cap on the maximum they might pay each month?” We contacted Attorney Roger Petersen, the author of The Legal Guide to Costa Rica. “Bottom line,” Roger answered, “there is no cap from what I can tell.  If you are above $3,035 then it is 10.69%…Here is the last table I found from 2016:”

Roger also gave us permission to reprint his article, “Costa Rica Caja Health Insurance Payment Scale” which was originally published on his webiste, CostaRicaLaw.com, and follows here in its entirety:

What is the health insurance payment scale used by the Costa Rican Caja system to establish the monthly public health care premium?

The Costa Rica public health care system is administered by the Caja Costarricense de Seguro Social (CCSS)  known locally as the “CAJA”.   The law requires every worker in Costa Rica to be covered by the public health care system.  Employees are covered by their employer and those that are self employed must pay into the system under the independent worker coverage known as “asegurado voluntario”.

What about foreign residents in Costa Rica ?

Costa Rican law also requires foreign residents that have been approved for legal residency in Costa Rica to pay into the public health care system as part of the condition to obtain and preserve their legal residency status in the country.   As such if you are applying for legal residency in Costa Rica before you are granted the residency card you must show proof that you have registered and are current in your payments to the public health care system.   To renew your residency status you will also have to show proof that you are up to date with all health care coverage payments to the Caja. These calculations will be done using the health insurance payment scale of the Caja.

What are the amounts that must be paid ?

The type of insurance that is required for residency purposes would be the insurance called “asegurado voluntario” which means you are insuring yourself as opposed to having an employer provide the health coverage.

The amount that will be used as the basis for monthly  premium for coverage is based on a percentage of the income that you have reported when you applied for residency.   As part of the process the applicant will be required to undergo a short interview with the Caja case officer to determine amount you will be required to pay.  Each regional CAJA office has their own process to carry out the interview so much of this will depend on the particular Caja office for your location.   The place where you live will determine the regional Caja office where you must apply.  I have seen a lot of variations in procedures and methods used by local offices in the manner in which they go about establishing the income level threshold which then becomes the basis for the monthly premium.   The starting point will always be the information that you provided in your immigration application as income.

Once that income amount is established then the following sliding scale will apply to that income to determine the monthly premium payment.  Foreign residents are only required to pay into the health care portion (SEM) and not into the pension system (IVM) as such the information below relates to the health care premium payment.

The scale is set forth below in colones as provided to us by the Caja Costarricense de Seguro Social:

The following is an example of the registration form provided to a foreign residency holder, Pensionado status issued by the Caja office in  Atenas.  In that example the pension amount that was the basis for the calculation was 604,260 Colones (US$1,060) and the amount of monthly premium that was applied was 6.24% for a monthly payment of 37,706 Colones per month (approx $67 per month).

Related Articles:

 

Cooking in Costa Rica: An Expat’s Guide to Buying Groceries, Cooking, and Eating in Costa Rica

PRINT & KINDLE VERSIONS AVAILABLE!

I’m so excited to announce that my new book, Cooking in Costa Rica: An Expat’s Guide to Buying Groceries, Cooking, and Eating in Costa Rica is now available on Amazon.com! Here are a couple of my 5 star reviews:

“Outstanding. I have been looking for a book that would tell me where to buy certain items that are not available in the local Costa Rica stores and I found all of that and more. Information such as translation from English to Spanish and of course Spanish to English. This is helpful so when I am shopping I can find what I am looking for using the translation. There is a break down of measurements and substitutions that was helpful. I like the few recipes that are included, and can’t wait to try them. This is a great book with so much information to help you learn about cooking in Costa Rica. I love the layout of the book and the clear explanations, and its easy to locate what I am looking for without going through an entire book. Also the resources in the back have been super helpful. Thanks so much for the book.”

“Practical as well as scholarly, this is a must-have guide for any man or woman who commands a kitchen in Costa Rica. Wonderfully readable and quickly useable for whatever and whenever you may need to know all things culinary in Costa Rica. And if that were not enough, what an amazing tour guide for English-speaking lovers of food in a Spanish-speaking culture, where the recipes you know and have always loved can come alive in new and exciting ways. I just feel smarter having read it!”

When you move to a Spanish-speaking country, it can be daunting to stock your kitchen and cook meals when you don’t know what your ingredients are called in Spanish. And even when you know the Spanish translation, it can be a challenge at times to find what you are looking for.

You can download this practical, comprehenive guide and on-going reference tool on your smart phone or iPad so you have it with you whenever you shop. The table of contents is interactive, so you can easily click through to the meat section when you are at the butcher shop (carnicería) or to the dairy section when you are standing in front of the dairy case. Here’s what you will find inside:

    • A little bit about me, our life in Costa Rica, how and where we shop for groceries, what we spend, and some insights about grocery shopping in Costa Rica.
    • An English-to-Spanish and Spanish-to-English food dictionary, broken down into the following sections:
      • Fruits
      • Vegetables
      • Meat & Poultry
      • Fish & Seafood
      • Grains, Nuts, Seeds, & Baking Ingredients
      • Dairy & Eggs, Refrigerated & Frozen Foods
      • Beans, Canned & Prepared Foods
      • Herbs, Spices, & Seasonings
      • Condiments
      • Beverages
    • An English-to-Spanish and Spanish-to-English food dictionary in alphabetical order.
    • An English-to-Spanish and Spanish-to-English dictionary of things you find in the kitchen.
  • A Glossary of cooking terms and helpful adjectives to use when buying and cooking food, ordering in a restaurant, and reading recipes in Spanish.
  • Recipe substitutions for when you can’t find familiar ingredients here in Costa Rica.
Chipotle Beef Chili
  • Recipes which I have adapted to use with ingredients found in Costa Rica, plus some favorite recipes of other expat cooks in Costa Rica.
  • A U.S. Measure to Metric Conversion Guide for temperature, volume, weight, and length.
  • A resource section with links to expat cooking blogs, Facebook groups and pages, specialty products, and other food-related things.

Buy the print edition on Amazon.com

Buy the Kindle edition on Amazon.com

If you don’t have a Kindle, you can download the Kindle app for your iPad or computer at this link.

I hope you enjoy my book and find it useful!
Gloria

 

Our Ultimate CR Healthcare Tour

HCTOUR_030

We are proud to offer the Ultimate Healthcare Tour of Costa Rica. When asked what he liked best about our healthcare tour, one of our guests wrote, “the wide variety of places we saw, the experts that Paul arranged for us to meet and talk with, and an emphasis on all aspects of health, not just doctors and hospitals. Mental health is just as important as physical, if not more so.”

HCTOUR_008

David and Donna H. recently too our healthcare tour and had this to say on one of the expat Facebook groups: Donna and I just finished the medical tour that Paul and Gloria (Retire For Less in Costa Rica) offer. It was excellent! Two days of information and tours around hospitals and clinics as well as educational and cultural centers and even information on some of the banking. The tour is designed to introduce a new arrival to the Costa Rican system of health care that includes, not just the body but the whole person. I highly recommend this tour to anyone that is new, or relatively new in country, especially to the people that live in and around the central valley. Paul taylors the two days to the groups needs as far as their ability, including any and all physical limitations, and his own experience and contacts with the people at the various institutions makes this tour extremely personable and pleasurable. It is a really great opportunity to learn more about the health care and how you can tailor it to your own needs, and learn more about what is available to enhance your experience while living in Costa Rica.”

We’ve lived in Costa Rica for almost 10 years and have used the Caja, Costa Rica’s public healthcare system extensively, as well as the private system, when needed. We’ve learned the system and have been referred up the ladder to see specialists in the maze that is the Caja system. Gloria’s even had surgery here.

Our blend of personal insights and on-the-ground experience combines to answer your questions about whether or not Costa Rica’s healthcare system could meet your individual needs.

HCTOUR_004

But, while it is focused on healthcare, you will learn a lot more about living and retiring in Costa Rica’s Central Valley. Most of the second day of the tour takes place in the town of San Ramón where we live and use the services. And you will come to our home that day to listen to two presentations.

Our tour is designed to save you both time and money, packing a lot of information into a short period of time. Our goal is to show you the possibilities and to try to demystify Costa Rica’s healthcare system. Our tour lasts two days and 1 night and includes lodging, transportation, meals and non-alcoholic beverages.

Sample Itinerary

You’ll visit:

  • At least two private hospitals in San Jose area
  • Hospital Mexico, the largest and best public hospital (they even do open heart surgeries there)
    HospitalMexico
  • An insurance broker for a presentation on the various supplemental health insurance options, including public, private, and international plans
  • A senior living retirement community
  • CPI language school for a presentation about how learning Spanish increases your options for healthcare and some basic medical Spanish.
  • Our local hospital here in San Ramón
  • A local EBAIS (community clinic)
  • The office of our dentist in San Ramón
  • A local Seguro Social office where you would sign up for the Caja (national healthcare coverage)
  • A pharmacy
  • A local feria (farmer’s market) where you will see the abundance of fresh food available.
  • The local Cruz Roja (Red Cross) to learn about their services and programs.
  • A health food store (macrobiotica), and more!
EBAISStaff

You’ll learn:

  • If the Costa Rican healthcare system could meet your needs and put your mind to rest, once and for all, about this sensitive subject.
  • About the public system and how it works, about the private healthcare system, and how you can use a combination of both to your advantage.
  • About the EBAIS – where healthcare starts in Costa Rica.
  • Approximately how much you would pay for Caja.
  • About medical tourism in Costa Rica.
  • About home health care in Costa Rica.

Prices: $650 for a couple, $550 for a single.
Please contact us if you are interested in booking a tour. Space is limited.

Related Articles:

 

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2 comments

  1. Last year Paul was great to get us unto the bus to Los Arcos stop

    1. Thanks Mike. Happy New Year!

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