Welcome to our Retire For Less In Costa Rica Newsletter
In This Issue:
- Our June 2017 Costa Rica Cost of Living
- My 2017 Healthcare Plan, by Rob Evans
- Paul and Gloria in Mexico – A First Look
- Featured Property: Easy-Care, Spacious, Furnished House in Grecia-Price Reduced to $119K
- Our Ultimate CR Healthcare Tour
Our June 2017 Cost of Living Report needs a bit of explanation. As we mentioned in our last newsletter, Paul and I traveled to Mexico on June 20th where we will be staying for an extended period. Therefore, our June Costa Rica Cost of Living report includes all of our normal fixed living expenses but only shows the variable expenses we incurred for the first 19 days of the month. Had we spent the entire month in Costa Rica, I’m sure our grocery expenses would have been about $100 more, but I don’t expect that the other categories would have increased much, if at all. Some categories were already inflated due to preparing for our trip. Let’s take a look at the breakdown.
Transportation – $113.44
Since moving into town, we find that we keep our car parked in the garage most days, mostly using it for our relocation tours and to visit friends. We only had one gasoline fill-up in June, which cost $51.36.
We also did some routine maintenance on our car in June. An oil change cost $54.47 and we paid $2.44 to replace a light bulb.
The balance of our transportation expenses went to tolls and parking.
Groceries – $111.06
This has to be our lowest grocery bill ever, even allowing for the fact that it only covered 19 days instead of 30. Knowing that we would be leaving for an extended period, I tried to use up what we had in our freezer and fridge, buying mostly fresh fruits and vegetables. We also did very little entertaining in June.
Another factor that influenced our low spending for the month was that, for the first 15 days of the month, we were very busy with our healthcare and relocation tours. Paul was gone so often on tour that he wasn’t around to eat meals at home. That meant that I didn’t cook as much. Our total of $111.06 includes both food and non-food purchases.
Meals Out – $63.27
As our departure date for our Mexico trip approached, we ate out more often instead of at home as our cupboards were bare and I was busy packing.
Healthcare – $334.11
In June, we both had dentist appointments for cleanings and I also had a filling replaced. Dental care in Costa Rica is a bargain. In fact, it’s one of the top reasons folks come for medical tourism. Our dentist is no exception. For each of our dental cleanings we paid 15,000 colones, totaling $53.29 USD. The normal cost would have been 18,000 colones each but, for some reason, she charged us less this time. My thought was that maybe she didn’t have correct change. When I went back two days later to have a cracked filling replaced, the charge was 20,000 colones ($35.52). I spent over an hour in her chair and she told me to be sure to call her the next day to let her know if I was having any pain.
In June, we also stocked up on our vitamins and supplements, both at local macrobioticas and through a VitaCost order which friends “muled down” for us from the States. I divided the total cost of the Vitacost order in half and will be showing the other half in our July expenses.
Also included in our healthcare spending was our monthly Caja payment of 27,360 colones ($48.60). We used the Caja a couple of times in June. Paul had had a colonoscopy through the Caja on May 31st, so on June 2nd, he had a follow-up visit with his gastroenterologist to discuss the results. We both refilled our prescription medications. And I went to our local EBAIS (Caja clinic) to see the doctor for some on-going IBS symptoms. He ordered some tests which I will have done when we return to Costa Rica in early August. Since all of this was done through the Caja, we had zero out of pocket expenses, over-and-above our monthly Caja payment.
Rent, Phone, & Utilities – $804.30
This category came in higher than normal since we finally bought a second propane tank. We use propane only for cooking in our San Ramón apartment. We bought one propane tank when we moved into the apartment in January. A tank usually lasts us two to three months. However, it always seems to run out when we are having guests over for a meal! And since it takes an hour or two to get a propane refill, we decided to buy a second propane tank. The cost of the second tank, full of propane, was 45,000 colones (about $80 USD). Now that we have two tanks, when one runs out, we will have the other tank in reserve. Then, all we have to do is refill the empty tank at our leisure. I say “refill,” but in actuality, we are exchanging the empty tank for a full one. Even though you “buy” the propane tank, you never actually keep the one you bought; you exchange it for another tank. That’s why it’s important to work with someone who will give you a tank of the same quality as the one you are trading in.
Our increased spending due to the propane tank purchase was somewhat balanced by the fact that we only paid our housekeeper for two cleanings in June, due to the timing of our trip.
Our electric bill continues to be right around $65/month and all other bills are in line with previous months.
Other Hardware & Household – $293.71
Most of the expense in this category was for the purchase of a Berkey Water Filter, a set of flouride filters, and a maintenance kit ($286.50 USD). Thanks to our friends Laura and Terry who muled it to Costa Rica for us! In Costa Rica, the water is drinkable just about everywhere right out of the tap. They don’t floridate the water here, but they do add chlorine. I’ve never worried about drinking the water in Costa Rica. However, since I started to bake sourdough bread, I need to have a source of filtered water. Combine that with our upcoming trip to Mexico (where you definitely can not drink the water out of the tap), we decided to buy a water filter. We chose the Berkey because of it’s great reputation, its ability to remove 99.9999999% of pathogenic bacteria and 99.999% of viruses, and its affordable price. We chose the Travel Berkey for its portability and capacity. With normal use for two people, the filters will last us four years.
Personal Care & Clothing – $41.74
You know how it is when you are getting ready to take a trip. You get your hair cut (and in my case, colored), you check your wardrobe to see if you need to buy anything new, and you make sure you have all the basics. We got a lot for our money in this category. Here’s the breakdown:
- Haircut (Paul) – $4.44
- Haircut and color (Gloria) – $17.76
- 2 pairs of sunglasses (Gloria) – $5.33
- 5 pairs of pants at Ropa Americana (Gloria) – $9.24
- 1 blouse at Ropa Americana (Gloria) – $2.49
- 1 shirt at Ropa Americana (Paul) – $2.49
We’ve written about Ropa Americana many times. In fact, it’s not just one store but many stores (depending on the size of the town) which sell gently used clothing from the U.S. at bargain prices. The day I bought the pants, I bought the first pair at the regular price of 2,800 colones (about $5), then decided to check upstairs where the real bargains were. I found a pair of jeans for 1,200 colones ( little over $2) and went to the register where the cashier told me that it was buy-one-get-one-free. I went back to the rack and found not one but three more pairs I liked. Granted, some of the clothing for sale is less “gently used” than I would want to buy, and it’s often hit or miss when I’m looking for something specific. But when I come home with lovely “new” clothes for so little money, I’m a happy camper!
Pet Care & Food – $41.57
As I write this newsletter, Paul and I are in Oaxaca, Mexico and our kitties, Tori and Laura, are back in Costa Rica. We miss them! But we know that they are in good hands. Our friends, Bill and Barbara, are staying in our apartment while we are gone and are taking wonderful care of them. The cat food Tori and Laura like can be purchased just about anywhere, but we can only buy the scoopable litter at PriceSmart. Therefore, in preparation for our being gone, we stocked up on kitty litter which now costs 9,495 colones (about $17.60) per 40 pound bag.
As usual, to help put things into perspective, here are our expenses for the previous two months. If you want more information about a particular month, just click on the graphic for that month below:
- Paul’s Monthly Tip to Live for Less in Costa Rica: Shop at Ropa Americana
- Retire for Less Goes to Mexico, Again
While surveying US healthcare over the past several years, I became increasingly concerned that the future looks rough. The number of Americans 65 and over continues to increase. Those seniors are overweight, out of shape, and have a number of pre-existing conditions like hypertension, high cholesterol, cancer, diabetes, etc.
Also, baby-boom doctors are retiring in record numbers. A growing population of unhealthy seniors coupled with increasing costs and a decreasing number of doctors may lead to Medicare bankrupting the US.
In addition, the confusion in Congress over Obamacare / Trumpcare is keeping Americans in limbo, while anti-immigrant sentiment may keep foreign doctors from filling the gaps.
Under current law, a 64-year-old woman who earns $26,500 pays $1,700 annually in premiums for coverage. Under the AHCA (TrumpCare), that would jump to either $16,100 or $13,600 depending on where that person lives. At a minimum, her premiums would increase 700 percent, eating up half her income. There are winners in the AHCA: people who are younger and healthier. You can see in the chart below that a 21-year-old who earns $68,200 would see her premiums decline from $5,100 to $1,250. For older Americans, the future does not look bright.
Furthermore, reintroduction of restrictions for pre-existing conditions is going to change things. About a quarter of American adults under 65 have pre-existing conditions that made them “declinable”—they could be denied coverage—before the ACA, according to a report by the Kaiser Family Foundation. In 2015, 6.5 million people had pre-existing conditions, which includes high blood pressure, high cholesterol, diabetes, stroke, sleep apnea to name a few common ailments that will exclude some from getting coverage or would price the premiums so high they could not afford it.
And I was under the mistaken impression that if I could make it to 65 and get on Medicare, my healthcare would be free. However, I since discovered Medicare is not free, and fewer and fewer doctors are accepting Medicare patients because of the low reimbursement rates. The chart to the right shows the 2017 total (premium, out of pocket, not covered, etc.) cost for a 65-year-old Medicare patient with health issues – $11k-$16k!!!
Of course, the powers that be won’t let Medicare impact the military budget, so I expect some draconian measure to be taken to prevent that from happening. One measure proposed in Congress is to give seniors a $5000 voucher/ tax credit or tax deduction to help buy a $20,000 private healthcare policy once Medicare is dissolved. So $20,000 – $5,000 = $15,000 out-of-pocket expense. A voucher or credit is preferable since a deduction may only be useful to high-income people after the standard deduction is increased. Medicare does not look like the panacea I had hoped and may go through serious changes because of escalating costs. In short, I do not see a solution for affordable US healthcare coming anytime soon, and it may take a total collapse to get people to work together on a solution. I would like to avoid being in the middle of the coming turmoil. So, I came up with Plan B: look for solutions outside the US.
My Basic Plan
I’ve noticed that many elderly people avoid going to the doctor because they fear finding a problem—they know too many people who have gone into the hospital for surgery and ended up in worse shape, who were prescribed medicines that made them feel worse or they will be informed about a dreaded pre-existing disease the will make them un-insurable. But simply not going to the doctor will not keep me healthy. The best way to avoid healthcare headaches is not to get sick in the first place!
Therefore, my healthcare plan includes being preventive and proactive by doing the following:
- Exercising regularly and eating a healthier diet to improve my weight, strength, and immune system.
- Eliminating and avoiding toxins (sugar, excess salt, fluorine, pesticides, pollution, mold, processed foods) to prevent disease.
- Having regular examinations, including an annual physical, visits to specialists, and recommended tests for my age to identify potential health concerns as early as possible so they can be addressed.
- Living where healthcare is affordable (can be paid out-of-pocket and/or insurance rates are reasonable).
Implementation of my plan:
- Preventive care: Actively pursue a preventive lifestyle. Use the local clinic (EBAIS) for regular check-ups and to discuss health concerns. Pay out-of-pocket for specialized preventive checkups with dermatologist, ophthalmologist, gastroenterologist, cardiologist, and lab tests.
- Reactive care: Use pharmacies for minor cuts/burns, allergies, gastric ailments, Go to ER at the local public hospital (CAJA) for more serious problems—stitches, broken bones, stroke, etc.; or if unhappy with their care, speed, or ability, transfer to a private hospital using my insurance.
Since moving to Costa Rica, my health has been my priority. Without a car, I tend to walk more, and my diet is largely plant-based with limited animal products, sugar, and salt, and no additives. The result: I have lost 70 pounds and all of my health indicators—BMI, glucose, blood pressure, prostate, cholesterol—are in the normal range.
Recap of My Healthcare History
For most of my life, my company paid for my healthcare. It was free! I had no idea what it cost or how it worked beyond knowing no matter what happened to me or my family it would be taken care of. I believe they refer to this as a “Cadillac” plan that generous companies, unions, and governments give their employees. After 2000, my company introduced cost sharing, which eventually led to my paying $6000/yr. for my family of four (which was half the actual cost as my company was paying the other half). When I retired in 2013, my company paid for a COBRA transition plan, which alerted me to the real cost of health insurance—about $13k/yr. for my wife and me. I realized healthcare costs in retirement would be unsustainable. The new ObamaCare tax subsidy of $4000 might have helped but was still not enough ($12,000 – $4,000 =$8,000).
Presently, I have merged Costa Rica’s socialized healthcare (Caja $89/m) with private (WEA, no USA, $1851/yr.) with travel insurance (US, $279/yr.) and a discount program (Medismart, $15/m) to build my healthcare portfolio. I am glad I could piece it together but sad it took so much thought to do so. I was hoping for something less complex. I am happy that the 2016 to 2017 TOTAL cost decreased by 13%.
My 2017 Plan
Lifestyle: We have been fortunate since moving to Costa Rica not to experience the frequent colds and flus we came to expect living in the US. Although I was never seriously ill in the US, those frequent minor illnesses indicated a compromised immune system.
Living in Costa Rica has been good for my health. Whether it’s less stress, the increased sunshine, fresh air, and warm weather that has made the difference, or that I have less exposure to household pesticides, chemicals, and food additives, and better access to fresh local produce, but my immune system is stronger. To build on this success and to move up to the next level of healthiness, I joined a world-class gym ($65 x 2=$130/m) and I am working out three times a week. In addition, I started Spanish lessons to address my cognitive health and to stave off dementia.
In the US, I paid little attention to preventive care. Fortunately, an annual physical is included in both INS and WEA policies as a paid benefit. Now, I pay attention to any test results headed in the wrong direction. If any test numbers are too high or are climbing, I adapt my habits to get them back on track. Now that I am “normal,” I want to be “extraordinary.” Going forward, I want to further decrease my BMI and to keep my blood pressure, cholesterol, PSA, etc. as low as possible using natural and drug-free methods.
Caja: The Caja or Caja Costarricense de Seguro Social (CCSS) is the socialized healthcare system for Costa Rica. It is mandatory for all residents to join and pay. The cost is about 10% of your declared income, so for someone seeking residency with $1000/month required minimum income, the cost is about $100/month for YOUR FAMILY. Paul and Gloria Yeatman have provided more details on the Caja and their experience using it here: How the CAJA works.
A new development this year for us was ARCR (Association of Residents of Costa Rica ARCR), an expat group, re-opened their Caja group rate with a negotiated fixed rate with the government. The result was my monthly cost dropped from $130 to $89. An additional benefit beyond the lower group rate is ARCR debits my credit card quarterly, so that is one less bill each month and no need to pay in person. I have registered at our local clinic (EBAIS) but have not yet made an appointment; I am determined to do that soon and to learn the system. I hope to use the Caja for vaccines and checkups to monitor my health instead of paying for private care. I understand that the group rate decreases by $10/m when I become a permanent resident next year.
Travel Insurance: I bought an annual travel insurance policy ($279/couple/yr.) from BUPA through Perfect Circle to cover us while traveling in the US because my WEA policy excludes care in the US. The BUPA policy is good for 30-day visits, which meets our need for an annual trip to see our kids in the States. Note: I could go on multiple 30-day trips to the US, but each has to be 30 days or less. I could buy multiple per-each-trip insurance, but the annual policy is cheaper. An unexpected development this year was my BUPA policy cost decreased from $380 to $279/yr.
WEA: During my first year using WEA, I discovered how much times have changed. With my former Cadillac plan in the US where everything was electronic, I never bothered with deductibles, pre-certifications, limits, paperwork, etc. I simply handed the receptionist my magic card and everything was miraculously completed.
Now, with private insurance and living in a foreign country, I have learned I must involve WEA in everything I do. I must get approvals/ pre-certifications all along the way. I have to have the right paperwork—invoices with the doctor’s name and signature, receipts, detailed results of consultations with diagnoses, prescriptions for treatment or follow-up tests, all hand-written. Do I sound like I’m whining? Sorry, but having a Cadillac plan where you are treated like royalty and becoming a commoner is a jolt.
However, since I bought my WEA policy through a local agent, Perfect Circle (PC), at no additional cost, PC processes all my claims for free and acts as my advocate. When I need medical care, I first contact PC to get advice and approval. Afterwards, I gather the paperwork and either drop it off at their office or PC will send a messenger to my house to pick them up. I can also take pictures and email the documents. PC handles the pre-certification and submitting the bills, which includes calling the doctor for missing information. Because interfacing with doctors and the insurance company can involve complex medical Spanish, I especially appreciate PC’s assistance. I have accessed the WEA website and have observed how PC documents my claims. I feel confident I could easily do the same if we ever moved to another country where I had to do it myself.
Another revelation this year was the realization WEA is emergency insurance, not comprehensive healthcare insurance. With my previous Cadillac policy, everything health related was covered—over-the-counter and prescription drugs, dermatologists, nutritionists, even heating pads, cold packs, and bandages—with no questions asked and no pre-certification. With WEA, the big things like a heart attack, cancer, broken bones, etc. are covered without question, but examinations, prescriptions, and preventative tests or consultations are a little more problematic. WEA would like to see a paper trail; so I couldn’t expect to simply get an allergy test out of curiosity and expect to be reimbursed—not without a doctor’s recommendation and prior approval. But really, that IS the product I wanted. I wanted a policy that stepped in when bad things happened. I prefer to manage and pay for all the preventive and self-prescribed treatments I feel I need (from vitamins to consultations with specialists). The game I am playing is to pay $900 /person /year to be covered for any emergencies (>$2500) up to $3M. This is a simple plan I can understand, can afford, and am willing to accept. I can maintain an emergency fund of $2500 to cover that deductible, and rest knowing that my policy will cover it from there.
I purchased the SELECT product.
** 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. If you can accept $1M coverage, the CARE product would probably be a great deal worth choosing. Here is the agent for Costa Rica. Perfect Circle
The ARCR 2017 Plans
It appears ARCR has worked hard to find more affordable insurance policies since last year’s huge INS cost increase. While ARCR/INS is no longer what I want, they may be right for other people. Don’t be fooled by the numbers below with commas in place of decimals. For example, $500,00 is five hundred dollars ($500.00).
For more information about these policies, contact:
Juan Carlos Calero
Customer Service Manager
ARCR – Insurance Department
For comparison: INS through ARCR is offering three healthcare options to members. I have found them too expensive and limiting for my needs. INS’s cost has escalated too fast for me and coverage is restricted to Central America. I may decide one day to move to Mexico or Europe and I want transportable coverage WEA offers.
INS is Central America
WEA is Worldwide except the USA
I have pieced together a collection of insurances to build a total healthcare portfolio that meets my needs. That collection includes Costa Rica’s public Caja, WEA for private care (not in USA), BUPA for when we travel to the US, and the Medismart discount program to get the lowest prices possible. Some costs have gone up and others down year to year, but overall, I am paying 13% less in 2017 than 2016, which is a miracle in the health insurance world. I was expecting a bigger increase since I turn 60 this year, but fortunately that did not happen. As a result of the savings, I have added some investments to get me to the next level – a gym membership (for muscle and cardio strength), a Spanish class (for cognitive health), and $100 for random tests, vitamins, and miscellaneous natural products.
- Our 2016 Costa Rica Healthcare Plan, by Rob Evans
- Our Costa Rica Healthcare Plan, by Rob and Jeni Evans
- Rob’s Medismart discount plan
- MediSmart: An Affordable Alternative to Private Health Insurance in Costa Rica
- Costa Rica’s Caja: How it Works
- The EBAIS – Where Healthcare Starts
If you’ve been reading our newsletter for a while, you know that we have been traveling to Mexico for about a month each year for the past several years. This year, we decided to try something different, spending a total of about five months in all. We are in Oaxaca, Mexico, now, where we have rented an apartment, and we are learning all the ins and outs of daily life here. This is the first time we are here as more than tourists. Living here is different from vacationing here, for sure. There is a lot to learn!
That’s not to say we aren’t enjoying the sights, the food, and the culture. Here are a just few pictures to give you an idea of why we love it here.
Property ID Number: 37778
Price (US$): $119,000
Geographic Area: Grecia and Naranjo areas
Property City: Grecia
Neighborhood: Puente de Piedra
Meters Squared Hectares: 311.98
Year Built: 2001
Construction (sq. ft.): 1500 (sq.ft.)
Full Baths: 2
This low-maintenance home is located near the Puente de Piedra de Grecia area off the main road and is close lots of services.
Completely fenced in and very private this house is much bigger than it looks. Lots of light pours in from the two well placed atriums, one that two rooms share and another in the living room. The kitchen has lots of storage space and counter space to work. There is a separate living area and dining area that both have lots of light.
The master bedroom of this low maintenance home is huge and has plenty of closet space. The master bathroom has double sinks and even more storage space.
There are two other bedrooms both with closets and a guest bathroom. The laundry room has space for a work area and a skylight so lots of natural light. There are 4 split AC units to keep temps perfect, although I doubt you will need them. All the windows have screens.
Most of the furniture like beds, sofa, tv’s, and appliances are included.
Outside are bananas and lots of tropical flowers. Located off of the main road, it quiet and safe.
Property ID Number: 37778
Click here to check out our other properties under $150,000 and read about what to do before you buy.
Our Ultimate CR Healthcare Tour
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.”
We’ve lived in Costa Rica for over eight 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.
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 for lunch 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.
- At least two private hospitals in San Jose area
- Hospital Mexico, the largest and best public hospital (they even do open heart surgeries there)
- 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!
- 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.
- Paul Gets a CAT Scan Through the Caja
- Integration 102 – Speaking Up at the Hospital
- Waiting to See the Doctor, by Jo Stuart
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Check out our newest posts on www.retireforlessincostarica.com:
- Our May 2017 Costa Rica Cost of Living
- Retire for Less Goes to Mexico, Again
- Jackson’s Care – A Cost Effective Option for Private Healthcare in Costa Rica
- In the Mailbag – Medicare and Health Insurance
- Our April 2017 Costa Rica Cost of Living
- Paul’s Money Saving Tip: Find Reasonable Housing
- In the Mailbag – Tracking Living Expenses, Grocery Expense Breakdown, and “Being Gringoed”
- Our 2016 Annual Cost of Living in Costa Rica Summary
- In the Mailbag – April 16, 2017
- Renewing Our Costa Rica Drivers Licenses: A Time-Saving Tip
- Our March 2017 Costa Rica Cost of Living
- In the Mailbag – Vonage, and Getting an Emergency U.S. Passport
- Con Mucho Gusto: The Tico Way