Welcome to our RetireForLessInCostaRica.com Newsletter
In This Issue:
- Our March 2015 Costa Rica Cost of Living Expenses
- How Much Insurance Coverage Does the Annual Marchamo Include?
- Snapshots of Life in Costa Rica – Semana Santa
- More Great Caja Experiences: Learn the System, by Norman Siegel
- The EBAIS – Where Healthcare Starts
- Our Ultimate Healthcare Tour of Costa Rica
We did a better job at meeting our budget in March, coming in at $2,065.78, even though we had some big expenses. Here’s the scoop:
Groceries – $512.57
Since we were having guests stay with us in March, we took one of our always-expensive trips to PriceMart and stocked up to the tune of about $150. We bought the usual stuff — a block of feta cheese in brine and a large wedge of Parmesan, big bags of chocolate chips and walnuts for baking, olive oil, a big container of Italian seasoning, and Fresh Step kitty litter (which we can only find there) — and a few things we don’t normally buy, like a loaf of chiabatta bread to have with homemade chicken salad for dinner that night and a 3-pack of my favorite wine. Hopefully it will be a while before our next trip to PriceMart!
Transportation – $342.75
Other than the normal gas, tolls, & parking, we had two other car-related expenses:
- Car Insurance for 6 months: $150.43 (79,726 colones)
- Replace hydraulics system for clutch: $47.17 (25,000 colones)
In a strange way, those two items are related. First off, let’s talk about the car insurance. The only mandatory car insurance comes with your car’s annual Marchamo (see our article below about the compulsory insurance included in the Marchamo), but we elect to purchase additional coverage through INS. When we first moved to Costa Rica, we spent about $600 per year on extra liability, collision, theft, and emergency road service. In time, due to the deductibles involved, the low cost of body work, and a very sensitive car alarm, we reduced our optional coverage to just liability and emergency road service (Coverage Items “A,” “C,” & “G”). Luckily, we’ve never had to file a claim for an accident, but we have used the emergency road service several times, most recently last month.
We were coming home from another great beach day, still in our swim suits, when Paul had to pull the car over because his clutch pedal wouldn’t come back up. Luckily, we were in Esparza, right on the main highway and directly in front of a gas station, restaurant, and mini-mart. We couldn’t reach our mechanic who was closed for the day. We were especially concerned because we had just had the clutch replaced in February. Since Paul couldn’t get the car into gear, we called INS emergency road service. What made it easier was that they had an English-speaking customer service rep. Within the hour, a tow truck (grúa platforma in Spanish) arrived and took us back to San Ramón. Towing was free as the trip was less than 30 miles. The rep also told us to call back the next day if we needed the car towed to our mechanic’s. What great service!
The next morning, our mechanic was able to get the car to his shop where he had to replace the hydraulics system that works with the clutch. Total cost for parts and labor was 25,000 colones (about $47).
Rent/Phone/Utilities – $779.42
Since both our water bill and the cost of propane (for cooking and hot water) have decreased, we thought it was a good opportunity to show you the breakdown of expenses in this category. It’s pretty self-explanatory.
Other Household Expenses – $66.04
The house we rent was outfitted with used appliances and, to my knowledge, there are no such things as home warranties available here. Luckily, service on appliances is affordable.
We were having problems again with our refrigerator keeping things cold and the freezer not freezing completely so we called our local kitchen appliance repair guy. He spent about an hour at our house and, after we removed everything from the freezer and much from the fridge, he diagnosed the problem and replaced the timer. Total cost: 35,000 colones (about $66).
It took another hour of my time to clean the fridge and freezer, tossing anything that had gone bad, and to replace everything else. All in all, not a bad deal.
Clothing and Personal Care – $79.72
In March, it was Paul’s turn to go shopping, not something he easily does for himself. Part of the problem is that, since he’s a tall guy, it’s hard to find his size, especially in shoes. But one of the local store owners was keeping an eye out for shoes in his size and called him over one afternoon when we were visiting the Central Market in San Ramón. We left that day with a pair of gray shoes that fit Paul perfectly, for only 13,950 colones (about $27). Oddly, they didn’t come with shoe laces so we picked up a pair in another store for $400 colones (about 75 cents). About a week later, when we had about an hour to kill, we stopped by Ropa Americana so Paul could try on some shirts. He bought two nice shirts (a Lands End button-down and a good quality blue pull-over) for 2,200 colones each (a total of about $8.30). Both looked great after laundering (though without ironing — we live in a self-proclaimed “no iron zone!”)
Also in this category is my trip to the salon. My sister was visiting and we decided to have a girl’s afternoon of pampering. I had my hair cut and colored and also got a pedicure for a total cost of 21,000 colones (less than $40). It was a nice way to spend the day together!
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: Save on Car Repairs
- Our 2013 Cost of Living Summary
- Our 2012 Cost of Living Summary
The Marchamo is Costa Rica’s mandatory annual vehicle registration and it includes, among other things, compulsory car insurance. It is payable as of November 15th every year and must be paid before the end of December.
According to the INS website:
All vehicle owners should have the Compulsory Insurance for Motor Vehicles (SOA), which aims to assure people that are injured in an accident involving such means of transport.
This insurance is charged annually and is a prerequisite for the registration certificate of the vehicle.
Thus, the Compulsory Motor Vehicle Insurance covers the injury and death of people (pedestrians and occupants), victims of a traffic accident, whether or not the subjective responsibility of the driver (Traffic Act 9078).
Each year, it is payable from the second half of November and is incorporated in the automobile registration known as “Marchamo” for each car, in the management which is named as Mass Billing.
The INS, year after year, incorporates a number of improvements to the Compulsory Motor Vehicle Insurance, so that people can have a major medical coverage in the event of an accident traffic.
The Compulsory Insurance for Motor Vehicles offers the services of medical, surgical, pharmaceutical, hospital and rehabilitation; prostheses and medical devices, cash benefits for temporary or permanent disability or death, funeral expenses and the transfer of the body; relocation expenses of the injured; payments lodging and food for people who are injured when with the supply of medical services – health or rehabilitation must move from a place other than his habitual residence; for those injured in a traffic accident in accordance with the 9078 Act.
As of January 1, 2015, coverage of Compulsory Insurance for Motor Vehicles (SOA) will be up to ¢ 6,000,000.00 (Note: about $11,350 USD) per deceased or injured person or even paid for motorcycle or moped type vehicle coverage.
The Road Traffic Act 9078 Article No. 66 states:
The coverage limit per person is individual and not transferable as provided below:
a) To a basic amount in combination to cover medical or financial benefits.
b) The amount set out in the preceding paragraph will double coverage of exclusively medical services in the presence of any of the following situations:
i. The injury is not secured to the sickness and maternity scheme of the Costa Rican Social Security Fund (CCSS).
ii. The injured is under eighteen years of age.
iii. Life of the injured are taken into risk.
c) Until a basic amount per person to cover compensation in the event of permanent disability, either total or partial. Do not deduct any amount in respect of services specified in paragraphs a) and b).
d) To a basic amount per person to cover compensation in the event of death, which no amount is not deducted.
e) In all cases where the amount of coverage in items a) and b) of this section expires, proceed in accordance with this law.”
Semana Santa, or Easter Holy Week, is one of the biggest holidays of the year in Costa Rica and much of Latin America. To some, Semana Santa just means a long weekend at the beach, as the Thursday and Friday before Easter are national holidays. Children take exams during the first part of the week, looking forward to the days off just ahead. Families pack up tents and camping supplies or make reservations at one of the country’s many beach resorts.
For others, Semana Santa is more importantly one of the holiest times of the year, marking the death and resurrection of Jesus. In many towns throughout the country, San Ramon included, the last days of the life of Jesus are re-created with dramatic processions. These photos are from one such procession in our town of San Ramón.
by Norman Siegel
We are learning the system! The first CAJA 101 lesson — always take all your paperwork from the doctors with you.
One purpose of our visit to our EBAIS (local clinic) doctor last month was to get prescriptions for our medications through the Caja. We had been paying for them out-of-pocket at the local pharmacy. We were told that the prescription for one of the meds Frankie needs for blood pressure couldn’t be written by our doctor; it had to come from a specialist. We had an appointment already set up with the specialist for a month from then, but wondered how we could get the medication in the meantime from the CAJA? We asked the doctor and she gave us a referral to the ER at San Rafael Hospital. We went there, waited in line for about 20 minutes, and saw a doctor who did an EKG. He wrote Frankie a prescription for this medication and we got it that same day!
The ER doctor also wrote a note to our EBAIS doctor, explaining that since Frankie does need this med, she could write the prescription for us when it ran out. So, at the end of the month, we went back to our EBAIS doctor with the letter and she was, in fact, able to write a prescription for this medication.
We took it to the clinic pharmacy to be filled, and were told that the pharmacist also needs the letter from the ER doctor in order to fill it for Frankie. The pharmacist also said that they don’t normally stock that medication, but with the letter from the ER doctor, she could get it for us. Since we didn’t know this ahead of time, we didn’t have a copy of the letter with us. She said we should go home, get the letter, and go back to the hospital to have it filled; then next month bring in the prescription with the letter and she would get it for us.
So, home we went, and then back to the ER, where they told us to go to the hospital pharmacy to get it filled. We walked over to the pharmacy, and were told that, since the doctor who wrote the Rx was not a specialist, we needed to have the Director of ER sign it also. We went looking for him, and found out he had gone on vacation — all the while, not speaking Spanish very well yet, but making ourselves understood.
A very helpful nurse told us he would try to help us. He took us to the secretary, and she said the doctor filling in would be back soon. We waited, and when he came in, he apologized numerous times for the waiting, and trouble we had getting taken care of. He signed and stamped the prescription, and back to the pharmacy we went. They took it and said come back in the morning to pick up the medication.
This took a couple of hours, but if you have the patience, a good attitude, and are polite, you can get things done. You just have to learn how to work the system!
Bio: Norman & Frankie Siegel were both born in Pennsylvania, Norman in Scranton and Frankie in Philadelphia. They have lived in New Jersey, Florida, Georgia, and Arizona, which lead to their adventurous life. They have owned every type of RV made and have also had two boats. To see all the states, they took a job as team drivers in an 18-wheel truck, going cross-country for seven years. In 2006, while managing properties, Norman wanted to move to Costa Rica. But since Frankie was not ready to leave the States, all he could do was study and read up on all there was to offer here. When the “RFL in CR” newsletter started, he followed it every month. One morning in the fall of 2013, Frankie woke up and said, “Why not now?” That’s all it took. They found an apartment on-line in Alajuela and booked a flight. They arrived in Costa Rica on January 28, 2014 and have been living the “Pura Vida” life ever since. In December of that year, they moved to San Ramon to better enjoy their life and are actually living at the Cabinas where Paul & Gloria spent their first four years in Costa Rica.
- Our Caja Experience, by Norman and Frankie Siegel
- Alajuela to San Ramón, Another Adventure, by Norman Siegel
Updated April 1, 2015. Originally published 3/8/2012.
The Caja is Costa Rica’s public health care system. The full name is the Caja Costarricense de Seguro Social (CCSS). For many expats living here, their experience is limited to getting their carnet (health system enrollment card) at the Social Security office and getting prescriptions or lab tests through the Caja. But in Costa Rica, healthcare really starts at the EBAIS, the local clinic.
EBAIS is short for Equipos Básicos de Atención Integral en Salud. In English, it means “Basic Teams of Global Health Care.” The EBAIS is the first level of care in Costa Rica. These clinics provide both primary and preventative health care to all of the individuals in a community. A typical EBAIS serves about 4,500 people, and there are over 1,000 EBAIS clinics in Costa Rica.
There are 81 cantons (counties) in Costa Rica, and all of them are composed of districts. Each district has at least one EBAIS; some have more, depending on population. The county of San Ramon is composed of 13 districts, one of which is actually the town of San Ramon, where the county seat resides, population 10,500.
We go to the EBAIS located in our district, Santiago. Luckily, our EBAIS in Santiago is open three days a week — Mondays, Wednesdays and Fridays. On Tuesdays and Thursdays, the staff travels to other parts of the district.
Each EBAIS team is made up of at least a physician, nurse, medical records technician, and pharmacist technician. Our EBAIS also has a Técnico de Atención Primaria, a visiting nurse who travels by motorcycle to do home visits throughout the community. Our EBAIS is also staffed by a second visiting nurse and, every two weeks, there is also a lab technician on-site to take blood and other samples for analysis. Results are available within another 14 days for review by the doctor.
Going to the EBAIS is convenient because it is close to where we live. It makes me feel a part of the community to go to our local EBAIS. Being Expats, we may be somewhat of a novelty at the EBAIS, but everyone greets us with smiles. The other patients are curious about where we live and how long we’ve been in Costa Rica. They are very respectful toward us and each other, especially their senior citizens. Every month there are posters and information available on a featured medical condition. One month it might be cancer awareness and another month a focus on the special medical needs of seniors.
This is the first time in my life that I love going to the doctor’s. Every time I go, I get a warm and fuzzy feeling because I sit there and watch the families come in – young, old, pregnant, children, everybody in the community. Those with chronic conditions, like diabetes and pregnancy, get seen first by the doctor.
There is no phoning ahead for an appointment, unless it is an emergency. The standard procedure for everyone is to show up between 6:30 and 7 am and get in line to see the medical records technician/ receptionist when the EBAIS opens at 7am. She gives you an appointment time for later in the day – first come, first served. Then you go home and return later at your appointed time.
The waiting room is plain but clean. There are wooden benches and hand-made signs on the doors. No wallpaper, potted plants and cushy chairs here. It is basic and it works. The money is spent on healthcare, not décor.
You wait until your name is called – we usually come prepared with something to read but the wait usually isn’t any worse than in a doctor’s office in the U.S. The first stop is the Nurse’s office to have your blood pressure and weight taken, and to go over the purpose of your visit, as well as any other information needed, with everything noted in your chart. You go back to the waiting area until the doctor calls your name. Usually we are there for about an hour from start to finish. If we have prescriptions to be filled, that takes no more than 10 minutes at the EBAIS pharmacy.
We see the same clinic staffers every time we go and they have gotten to know us as well. The atmosphere is relaxed, though professional. We may joke with the visiting nurse and chat with the receptionist about her recent vacation. Often the doctor is wearing blue jeans under her white lab coat, and the whole staff stops for a coffee break together at 9:30am. There are no constantly ringing phones or stressed-out employees. There are no staff members calling insurance companies to check patients’ coverage. People waiting to see the doctor know the system and patiently wait for their turn. All-in-all, it’s usually a tranquilo place.
We can visit the doctor on any day the EBAIS is open for current medical problems, however we go at least every six months for the doctor to write our prescriptions for the following six months. At that time, the doctor might also write orders for other medical tests that might be necessary like EKGs, ultrasounds, Xrays, blood tests, etc. If the tests are deemed urgent, they are done quickly, sometimes in a matter of days. But routine tests may take months to get scheduled.
Current residency law requires that all residents must join the Caja. However, very few expats actually use the EBAIS system, either because their Spanish isn’t good enough or they don’t understand how it all works. The system can be daunting if you don’t understand it. We certainly didn’t understand it at first. But every time we see the doctor at the EBAIS instead of going to a private doctor, we save $50. We both speak and understand enough Spanish to see the Spanish-speaking EBAIS doctor for most things, but if a more complicated health issue arose, we wouldn’t hesitate to see our private doctor who speaks English.
Many of the private doctors are also members of the Caja. This means that you can see a private doctor for care, and that doctor can then write prescriptions which can be filled in the Caja, and orders for tests that can be scheduled through the Caja too. So, though you pay to see the private doctor, there is no charge for the tests or any of your prescriptions which the Caja stocks. Sometime seeing a private doctor can speed up the referral process and you can, in a sense, jump ahead in the line. Many Costa Ricans also use a combination of public and private medical care.
The visiting nurse visits the sick and also travels to homes to administer flu shots to seniors. Last February, Vilmar, our local visiting nurse, stopped by on his motorcycle with a small cooler containing flu vaccines and gave Gloria and I our flu shots right on our porch. Now, that’s service!
In Costa Rica, they bring healthcare to the people. If only the richest, most powerful country in the world would take some pointers from Costa Rica. How can a developing country make health care available to its residents and the U.S. can’t?
Our newest tour is 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 five 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 of our featured speakers. 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)
- A local private medical and dental clinic
- A local Seguro Social office where you would sign up for the Caja (national healthcare coverage)
- A pharmacy
- A health food store (macrobiotica), and more!
- If the Costa Rican healthcare system could meet your needsand 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.
Introductory prices: $550 for a couple, $450 for a single.
Please contact us if you are interested in booking this 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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