Be Prepared – Tourist vs Resident

Have you ever had an accident while you were traveling? Did you or someone you know fall ill while traveling? This is something that we do not think about before we travel or move to another country. The most important thing you can do for yourself and your traveling loved one is to pre-plan what you will do if there is a health related incident.

In Costa Rica, there is a private health system and a public health system. The private health system is private pay generally unless you have insurance that will cover you. If this policy is outside Costa Rica, then you most likely will have to pay up front and seek reimbursement. If you are covered by the public system CAJA then you will be covered without prepayment. It is possible to receive treatment in the public system, but there will be a charge that will need to be paid upon discharge.

Costa Rica enjoys a good health care system. Most doctors in the private system will be fluent in English. Less in the Public sector. We have used dental treatment and medical treatment in the private system and medical treatment in the public system.

If you are coming as a tourist, it is best to purchase a good travel insurance policy. You must be careful when purchasing if there are exclusions for pre-existing conditions. If you are from the US, these offerings will be state specific as each state has laws and regulations that regulate the sales of insurance products to their residents. Make copies of your passport, insurance cards, medication list, and any medical conditions that you must give to any health care provider in case you cannot speak for yourself. Also, documents with your medical doctor’s contact numbers at home. These should be hard copies, not pictures on your phone.

Some of you reading this may be in the category of perpetual tourists. You may not have insurance that covers you within Costa Rica, or you may have private insurance purchased in Costa Rica. Personally, we have a Medicare Advantage plan that will cover us for 6 months in Costa Rica. The problem is that the use of this insurance will most likely mandate the bill to be paid in full at the time of service. This is not a big deal if it is something small, but if, like a friend of mine, you have a heart condition pop up while you are here, that bill can be big! Not including the air ambulance that is now about $15,000 USD one way! There bill was huge, and the travel insurance refused to pay. (This travel type policy was several hundred dollars monthly). After months of fighting, they got the travel insurance to pay some of the bill, but in an emergency you want your focus to be on getting care…not how to pay so you can get the care.

Whether you are a perpetual tourist or a resident, you may decide you would like to purchase a health care policy in Costa Rica. Although these policies will allow you to enter the private health care system as a patient, they are not without a cost. If you are over 60 years of age, prepare for a high premium. If you are young, this may be a viable option for you. If you choose this route, make sure you know what you are getting and how you will be covered.

We have opted to use what many call a blended plan. Private pay for tests, with the exception of blood work, and then use the CAJA for treatment. Many of the doctors are the same doctors that work in both systems. This helps get the testing quickly and diagnosis and if surgery and further treatment is needed they use the public CAJA system.

Many Expats are afraid to use the CAJA. They do not think that the Costa Rican system will be good enough or modern enough. I have many friends who have used the CAJA for cancer surgery and treatment, ophthalmology issues, orthopedic surgeries and more. Although there is a wait in some instances, my friend who had cancer had the testing private paid, and her surgery was about two weeks later through the CAJA. We use our local clinic for medication refills and have used the emergency room once. The doctor at our local clinic does not speak English, and we are not fluent in Spanish. We communicate through Google Translate, which has worked very well. When we go back home, they refill the medication for three months to take back with us.

I can tell you for me, it is comforting to know that we have health coverage while we are in the country. Last year, my husband collapsed while working on the quad. I am a former nurse, so I did not rush to call 911 – it ended up he had overdosed himself on his inhaler and was fine after a bit of rest. I was so incredibly happy we had residency and health care if it was needed.

Many of us are also interested in having additional coverage to the CAJA system as Residents or if you are not a Resident you may want to have health insurance during your stay. If your plan is to come on vacation for a few weeks, then a traditional travel insurance policy may be for you. However, make sure you read the fine print and ask lots of questions. Some of these have provisions for pre-existing conditions that can leave you uncovered.

For longer coverage periods, you may want to consider opting to purchase medical insurance specifically for Costa Rica. At Quatro Legal we are here to help. Our strategic alliance for our clients offers medical insurance through our alliance, BMI- Ugalde Consultores. BMI offers several options of plans depending on the coverage you need.

The bottom line here is no matter if you are a tourist, perpetual tourist, or a resident, have a well thought out plan that you can follow for your medical care while in Costa Rica.

Debbie Davis
Expats Sales Manager
dld@quatro.legal

Disclaimer: The information provided in this blog post is for general informational purposes only and is not intended to constitute legal advice. While we strive to ensure the accuracy and timeliness of the content, laws and regulations are subject to change. For the most accurate and up-to-date information, please contact our office directly. Some images may be AI generated.