Welcome to our Retire For Less In Costa Rica Newsletter
In This Issue:
- Our September 2016 Costa Rica Cost of Living
- Our 2016 Costa Rica Healthcare Plan, by Rob Evans
- In the Mailbag: Bringing Pets, Getting Residency, and INS Insurance
- Featured Property-Jaco Beach: Modern New 3BR House 8 Blocks to Ocean $145,000
- Our Ultimate CR Healthcare Tour
We knew that September was going to be an expensive month for us. It always is. It’s the month when we take our car to RITEVE for the annual inspection and when we renew our car insurance for 6 months. But this September, we also had some other big expenses in the area of healthcare and telephone. Here are the highlights of our September 2016 spending:
Groceries – $304.67
Our grocery expenses came in lower than average, despite a visit to PriceSmart. Here’s what we bought and a breakdown of what everything cost:
I’m sure it would have cost less in the States, but I feel like we got a lot for our money. The blueberries, nuts, olive oils and vinegar will last us a couple of months at least.
Transportation – $539.32
As I mentioned above, we we took our car to RITEVE, Costa Rica’s mandatory annual inspection. The RITEVE inspection itself isn’t expensive — less than $20. But, of course, since we want our car to pass the very detailed inspection, we have our mechanic go over the car and fix anything that needs fixing. In the weeks before the inspection, we had our mechanic replace eight bushings & a tension bar in order to fix a bad squeak.
Then off we confidently went to RIVETE. We were shocked that our car failed the inspection. Turns out the idleing was too fast (though it had been fine earlier in the day) and our back brakes needed to be replaced (even though we had them replaced just the year before). Neither Paul nor our mechanic even suspected that the brakes were low, so finding out during the inspection turned out to be a blessing. Paul went back to our mechanic to have both things fixed, then returned to RITEVE on the last day of the month. (They actually give you 30 days to have the repairs made and to do the follow-up inspection, but we wanted to have it done before leaving for Mexico.)
Here’s a breakdown of what we spent:
- Replace eight bushings & a tension bar – $146.75
- RITEVE (1st inspection) – $18.22
- RITEVE (2nd inspection) – $9.11
- Replace rear brakes and adjust idling – $66.42
- Brake fluid – $9.54
September was also time to renew our car insurance. The insurance payment is easy. Every 6 months, we go to the INS office and pay our premium. We have found them to be courteous and helpful, though it definitely helps to speak some Spanish. We have liability coverage, emergency road service, and coverage on anyone in our car or driving our car. We dropped collision coverage several years ago due to the high deductible and the fact that it only covers 60% after the deductible. This time around, our payment increased by about $20 since we took the advice of the INS agent and increased our liability coverage. Total cost for 6 months: $170.09.
Healthcare – $416.06
If you’ve been reading our recent newsletters, you know we joined MediSmart, a membership discount plan on services at Hospital Metropolitano in San Jose. You can read all about it here.
We used the plan for the first time in September. Both of us went to see a dermatologist. The MediSmart office not only made the appointments for us, they confirmed it by email with the doctor’s name, photo, and location of her office. Then they sent reminders to us, even calling us the day before.
Our appointments were on the same day and Doctor Maria spent about an hour with each one of us. She did a thorough examination of our bodies, from our scalps down to the spaces between our toes. She was wonderful and even spoke some English. She took photos of one bump on Paul and one on me, in order to compare them, to see if they grow over the next 6 months or so.
Since we were enrolled in MediSmart, we got a 60% discount off of the regular cost. We only spent 18,000 colones each (about $33). We were thrilled with the price but even more pleased about our time with Dr. Maria.
On the same day, I (Gloria) also had an appointment with the holistic doctor I am seeing for some digestion issues. We were with her for over an hour. The charge for the visit was 35,000 colones (about $64).
The other item of note was our first purchase of essential oils. This is one area of natural healthcare we are just learning about and are finding it to be expensive. We buy doTerra essential oils, which I can order online and have sent to our post office box here in San Ramon. The cost of this first order was $84.34. We are going to give them a try to see whether or not they will be as helpful to us as they seem to be for some folks.
Other than these items, our healthcare expenses, like usual, included our monthly Caja payment, one prescription medication, vitamins and other supplements.
Rent/Phone/Utilities – $1,172.58
The last category we will dig into is rent, phone, and utilities. Rent and utilities actually stayed constant with other months, though electricity is running a bit higher (about $65) since we’re deep into the rainy season. We run our ceiling fans more to keep the air circulating and prevent mildew, and also use the drier instead of hanging our clothes on the line to dry.
But the two items which cost more than normal in September were phone and housekeeping. Here’s why.
First off, Paul’s birthday was September 19th. I won’t tell you how old he is, but it was a significant one! So, for his birthday, we got him a new smartphone. He wanted a Samsung 5 but we found that they are no longer available here, at least in San Ramon. So we looked at other models and settled on Huawei P8 which was the closest comparable phone within our budget.
We have learned to buy our phones in Costa Rica instead of (less expensively) in the States and having someone bring them down to us. The reason is that phones purchased in the U.S. are not covered by warranty in Costa Rica. Paul’s first smartphone, which we purchased here in CR, stopped working about a month after purchase and, when they couldn’t repair it, the store gave Paul a brand new phone. So, for us, buying a phone with a warranty really makes sense.
The Huawei has a different look and feel than his old Samsung Grand Prime, so there’s a bit of a learning curve. But he will be a pro soon. And I inherited his old phone since my old smartphone just hasn’t been as smart since it fell into a toilet at the airport six months ago.
The cost of Paul’s phone was 172,000 colones, plus an extra 10,000 colones to buy him a case and me a new case for his old phone. Total cost in dollars: $334.00.
The other item of note in this category is housekeeping. You might remember that we have a lady clean our house every week for four hours on Wednesdays. She does a great job and it makes life so much easier for us. There are three other couples who use her services and we take turns paying her Caja (national health plan), which covers her as well as her two children. September was our month to pay, so our housekeeping total increased by $39 as a result of this expense.
That’s it for September. 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:
- Our 2015 Annual Cost of Living in Costa Rica Summary
- Our 2014 Annual Cost of Living in Costa Rica Summary
- Our 2013 Cost of Living Summary
- Our 2012 Cost of Living Summary
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. In the US, I would pay $13,000 premium plus $5,000 deductible or $18,000 before getting help and then 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
We always get lots of responses and questions from readers, both newsletter subscribers and on facebook. Here are a few notes we received in our mailbag.
In one of our previous “In the Mailbag” columns, Vikki R. asked for advice about renting a van and driving their 10 dogs and themselves to Costa Rica from the States, crossing all the borders along the way. Here is a response from one of our readers who has actually done it.
Mike W. writes:
One of your readers asked about transporting dogs to Costa Rica. We traveled by car with our 2 dogs when we moved here almost 4 years ago (wow! – does time ever fly!). Both dogs were big. One was around 95 lbs. and the other 60 lbs.
On the whole, I would say that the trip was doable, although I don’t think I would try it again. The dogs had all their vaccinations (I seem to recall that there was a Costa Rica website that listed the requirements). The vet certifications in the US or Canada were no particular problem, and were sufficient in all countries except Honduras. We made multiple certified copies of the certifications before we left Canada.
Every border crossing was a challenge. The process always took between 2 and 3 hours, I think mostly because of the car, not the dogs. The border agents seemed more concerned about whether you were planning on selling the car in the country without paying import duty, than they were about bringing animals into the country. Expect to pay (on average) $100 at every crossing. We kept a supply of $20 bills in the glove compartment. Luckily, most ATMs in Latin America dispense US dollars.
As we approached every border, a bunch of “helpers” would appear out of nowhere. We picked one, and he led us through the process on both sides of the border. Every border was hot and unshaded, so keeping the air conditioning going for the dogs was essential. The process wasn’t particularly stressful; just time (and $20 bill) consuming.
Honduras was the most difficult. We got stopped by a policeman who made a nice living checking if the car had all the required safety equipment (more $20 bills), and the customs required some special vaccination for the animals. However, for a fee, the special vaccination became unnecessary. That was often the case. There was a fee for a veterinarian to examine the animals, and another fee for the vet to NOT examine the animals. Since typically the vet lived in a distant town and it would take many hours for him to arrive, you can figure out which option we chose!
Another issue was that many highways throughout Latin America have “sleeping policemen” stretched across the road to slow down traffic. One of our dogs got freaked out by the discomfort of bumping over these obstacles, and since then has been nervous about riding in the car.
And finally, you need to be aware that Guatemala, El Salvador and Honduras don’t have car insurance available for vehicles transiting the country. So you will be a “rich” gringo travelling without any insurance should there be a problem. You buy insurance for Mexico; government insurance is part of the fee when entering Nicaragua and Costa Rica.
Thanks Mike, for the reality check!
Our article, Questions and Answers: Getting Residency in Costa Rica and Joining the Caja, lead to lots of comments on facebook.
Attorney Rick P. wrote:
Two comments on the Residency requirements update: 1. INS will not provide Medical Insurance coverage prior to a party becoming a legal Resident of Costa Rica, either Temporary, or Permanent; and 2. Renewing your Tourist Visa by leaving the Country every 90 days and re-entering is not a guaranty of the grant by Costa Rica Immigration Officials of a new Tourist Visa. The grant of the Visa is discretionary on the part of Immigration, with no practical recourse to the Tourist if denied.
The current policy of INS on issuing Medical Insurance coverage to foreigners without Costa Rica Residency is as follows:
INS will issue Medical Insurance to foreigners without Residency subject to the following:
1. An Application for Residency must be in progress at Immigration.
2. The Applicant must have had Medical Insurance previously (U.S., Canada, etc.) and submit the current three years of claims records, or submit a letter from the insurer that no claims were made.
3. Submit three most current years of medical records, annual physicals, etc.
4. Pre-existing medical conditions are excluded from coverage.”
Thanks, Rick, for the helpful info. Paul’s immediate response to this was, “Wow Rick, most of us would not even qualify, plus it’s so expensive. There are better options.”
Danny G. did NOT have a good experience with getting residency here:
Got my residency after 4 years, 12 thieving lawyers and $25,000 later. Thanks Costa Rica you’re the best!”
We always recommend you get multiple recommendations for any attorney or residency expert you consider using. Click here for our recommendation of the service we used.
Danny G’s experience is by no means typical. Sheryl W. wrote:
Mine was quick and easy. 6 months start to finish. Great lawyer who walked me through the whole process. I just had to get the correct documents and hand them over. He’s still a friend today! They are out there but try to get a good recommendation as I did.
- Read all of our In the Mailbag columns at this link.
Total Rooms: 7
# Bedrooms: 3
# Bathrooms: 2
Total SqM: 95
Description: Own a brand new modern home close to the ocean and all the amenities of Jaco Beach at a price that is right. This 3-bedroom floor plan is 1,100 square feet with a spacious kitchen and living area. Included in the price are granite counter tops, all cabinetry, sinks and closets and the homes are pre-equipped for TV, internet and telephone. The house does not come furnished and the photos are of the model.
This gated community features 23 home sites, barbecue area, children’s playground and parking.
- Air Conditioning
- Near/On Beach
- Security – Surveillance
- Near Public Transportation
- Near Highway
- Outdoor Swimming Pool
Listing ID #900131013-120
Click here to check out our other properties under $150,000 and read about what to do before you buy.
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 seven 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
Facebook, Twitter, & YouTube
Check out our newest posts on www.retireforlessincostarica.com:
- Costa Rica Weather–July 2016 Observations, Facts, & Tidbits
- Costa Rica Weather–August 2016 Observations, Facts, & Tidbits
- Costa Rica Weather Report: 2016 Monthly Temps & Rainfall
- Gardening in Costa Rica With Steve – Growing Garlic
- Our August 2016 Costa Rica Cost of Living
- Getting Married (Again) in Costa Rica
- Our 12-Day Road Trip to Costa Rica’s Southern Zone: San Isidro de El General
- Our 12-Day Road Trip to Costa Rica’s Southern Zone: Drake Bay, Osa Peninsula
- Our 12-Day Road Trip to Costa Rica’s Southern Zone: San Vito
- Our 12-Day Road Trip to Costa Rica’s Southern Zone: Uvita & Quepos
- Our 2015 Annual Cost of Living in Costa Rica Summary