Tired of Caja Confusion? Costa Rica’s ‘Healthcare Mystery’ Finally Explained

Terry:
Good day to you and welcome to another edition that’s going to prove to be very informative for you, the viewer, as we visit again with Quatro Legal and Xu. Welcome, Xu. It’s good to have you today. And Debbie with Quatro Legal. I’m Terry from Howler Magazine. We hope these webinars will give you the information you need from the source. And because there’s so many places you can get information and there’s a lot of confusion, it’s great to go to the source for this competent information.

Caja is the big subject for today. Tell us a little bit about yourself, Xu or Debbie, and then tell us, Debbie, what’s all going on with Caja and all the requirements and is it that difficult?

Debbie:
Okay, we’re going to cover it all, Terry. Thanks for having me. I’m telling you, I believe that Caja is like one of the mysteries of the universe that keeps people from applying because they just don’t understand it and they don’t know how much it’s gonna be. And so it’s really always an important educational opportunity to learn that because that way you know that when you get approved for residency, you’re gonna be able to afford this monthly fee.

And I’m here with Xu today and what I would like to tell everybody out there is that I know you have questions and you’re excited to be here just like we are, but I also know you have friends that may or may not have this or be on right now with you. So if you could please share this with them, you know, all you have to do is send them the link via email or WhatsApp or text or however, and let them know as well because the more people who understand, then when you’re out and about at a function, you know, you can say, look I just learned all about this. Now I’m not afraid of it. And if you could also make sure and like our webinar series, it helps us to bring more of these educational opportunities to the expats in Costa Rica. And you can subscribe to our channel as well. And then that way, again, we can bring more to you.

So Xu, please tell us a little bit about the Caja.

Xu:
Thank you, Debbie and Terry for having me today. And yes, well, an informed client is a happy client. So we’re going to talk about Caja and the difficulties that you can find along the road. And the Caja or the Costa Rican Social Security Fund is an institution that was created back in 1941 to provide healthcare and social security benefits to the entire population in Costa Rica.

Services are available for residents, temporary and permanent Costa Ricans. Basically, anyone can use Caja. The registration process, it’s what we’re here for today.

Terry:
Great. Who all qualifies for the Caja? Do I have to be a resident exactly? Or can you explain that?

Xu:
Now for clients that have been approved as a temporary resident or also as a permanent resident, they need to enroll into Caja because it is a requirement established by the immigration directorate in their approval resolution.

The immigration directorate gives 90 days, so you can complete this registration process and it will be completed for main applicants in one of the 75 offices scattered across the country and for dependents, it will be in, they will be registering in the local clinic.

Terry:
Okay. So in layman’s terms, what exactly is the process? How is it calculated? And how does it work? Help me. What is it similar to in the states if I was to use some references?

Xu:
And that’s very interesting because sometimes in the U.S. you think about Medicare, Medicaid, but it’s very different here in Costa Rica. So the registration process, well, we need to figure out the category of our clients.

So is our client a rentista? Is our client a pensionado? Is our client an investor? These are the most common categories for residents. So the process will be different for each of these categories. So for example, if you’re a pensionado, you will get registered with the letter that you filed at Caja offices.

They consider the amount in the approval resolution. You have to be careful. And something really important everyone should understand for Caja, you will have to pay a monthly fee. So, for pensionados, if we use the amount in the resolution, which is $1,000, that means that the client will have to pay between $80 and $100, depending on the dollar amount of that day.

Now, different is the case with rentistas, for example, and here it’s where it gets tricky, right? As you all know, rentistas are approved because they have an income of $2,500. So the amount that they will have to pay monthly will be from $350 to up to $370. So really important for the clients and for everyone to understand the categories that they want to pursue and also understand how Caja will impact, right?

Because now you think about coming to Costa Rica and staying for 20 years and paying $375 monthly for something that you probably already have a version of like an international medical insurance. So it’s tricky. That’s why I’m here. And then the other category that we work with a lot is the investor category.

I really like working with this category because the monthly fee that they will have to pay will be fixed and based on the minimum income, which is $750. So that means our clients will be able to pay somewhere between $75 and $100. No more than that. So you have to balance between if you go for a rentista, that you have to take a big consideration into Caja and how it works for the other categories.

Debbie:
And that’s a significant difference, isn’t it, Terry?

Terry:
Yeah. So is this something I can just do? What’s the benefit of using Quatro Legal to help me maneuver this process?

Xu:
Well, first, we provide the service anywhere in the country. If our clients live in Pavones or if our clients live in Guanacaste, we have understanding and a lot of experience with working with offices in Santa Cruz, offices in Nicoya, in Pérez Zeledón.

So we understand Caja, which is a very complex institution because of the nature of it, how they work and all of that. We provide that security that the process will be smooth, will be fast and we’re not going to have any bumps in the road, right? Because we’re dealing with public institutions.

And for the main applicant, the registration must be in person. There’s no way of using a POA different from dependents. So we also provide that bilingual service and assistance with the client in the Caja office. So the client only will have to sit over there in the chair of the Caja office and we will handle the registration from beginning to end, along with the requirements and all the documents needed.

Terry:
Super. So what’s the time frame like if I come to your office and until it takes effect? What can I expect? There’s a lot of different processes and they take a lot of different time. So what does the Caja time span look like?

Xu:
Because it really depends. Like, if our clients live in the city, you require appointments to go get registered in the city, but you don’t require appointments to get registered in Guanacaste. So it really depends on where the client lives. Although also we have clients that only come to Costa Rica to finish the registration process and they come for a week, no more than that. So we have to schedule everything. And that means that we accommodate every client’s request.

The process should be done. Unless it’s a rural area, very far away. If you live very far away in a very not known area, the registration will take a little bit more time because they don’t have the resources, like the big offices in the cities.

But it’s a very fast process. That can be done the same day, depending on where the client lives.

Terry:
Is there any way that, say I think the amount is too high or y’all tell me that I need to reconsider this? Is that a painful process? Or is that something that’s common that I can change, especially if my status as a resident changes?

Xu:
That one is a tricky one, Terry, because if you’re a permanent resident, we can think about a readjustment because you have already lost your restricted category which was rentista, pensionado, or investor then you can use the minimum income to start paying Caja. So yes, readjustments for permanent residents are something that we do, a service that we provide, but it doesn’t work that way for temporary residents because then Caja says, how are you going to demonstrate that your income has changed?

For example, a rentista at $2,500. You have been approved with a category that says that you have to have a $2,500 income. So unless there is a change in public policy that we have never seen in this country, it will be very hard to change that main requirement for a temporary resident. So what I tell clients is just to wait until they’re able to file for permanent residency.

And soon as they have their permanent residency approved, we go to Caja and request their readjustment.

Debbie:
Hey, hang on a second. I have a question. So, Xu, you know, this IBM added on a couple of years ago, I think like March 13th or something like that.

If you are the people who were approved before IBM started, and you now have your permanent. If you’re re-evaluated, will you still just pay the Caja or will you have to pay the IBM since you’ve been re-evaluated?

Xu:
The re-evaluation works for both regimes, but under no circumstance, they will eliminate one of the percentages. Like, they will still have to pay for at least a super small percentage for IBM. So it’s not like completely cut off to zero, the IBM or the SEM regime. No, it’s distributed almost equally.

Debbie:
Okay. So, they could end up paying a little bit of the IBM if they were reevaluated if they weren’t paying it before. Is that what you’re saying?

Xu:
Well, we would have to see how the office works because and also how like, the status of the dollar on that same day, it could vary, it could vary a minimum amount, but it’s not like something that will be extremely considerate, like, for example, you’re paying $25 and then you’re going to pay $100, no, that’s not going to happen. It varies by a minimum percentage.

Debbie:
Right. Well, I was just thinking about that because probably no one has done that yet, because of when that was passed, I think it will be another year before anyone will be approved for permanent residency that hasn’t been paying the IBM because, you know, next year, if somebody has had theirs for 2 years, this next upcoming 2025 is when they would start their application right for permanent. They wouldn’t be approved till probably 26. So we’re probably not going to really see a lot of that impact and what they’re going to plan to do until 2026. Anyway, I would just anyway, but so Terry, sorry. What were you asking me?

Terry:
Oh, you’ve been here a while or coming here a while. What’s your experience? What was your experience?

Debbie:
We’ve had a very good experience with Caja. You know, if you’re on Facebook or social media for more than 10 seconds, you’re going to have five people tell you 10 different stories about Caja. Ourselves, what we use it for is we go to the doctor.

Now I’m going to tell you, we are not fluent in Spanish. My Spanish is not quite kindergarten and I can only do anything in present tense. So that’s limiting. Generally what I do is I print out what I want to tell them before I go, the doctors, most of the Caja doctors now are all using Google translate.

So it makes it fairly simple. And so, you make your appointments online. Now, if you have trouble and it seems like they’re booked up a lot, you can go to your actual clinic in your little community and get an appointment. You have to go in the morning and then they’ll give you an appointment and then you go back.

So it’s to me, it’s been fairly simple. We generally use it more for we get like our lab work done when we’re there every year. Any medications we get. And they have a very simple system for that they give you a little slip of paper, right? And on that slip of paper, it tells you what days to come and on those days you come. They just hand you your bag of your prescriptions.

And so it’s very simple. In our clinic at least if we go there before we leave and I tell them we’re going to leave and I show them my plane ticket to leave. We’ll get three months supply when we leave the country. And so for some medications, especially inhalers, that is a great thing because in the states, even with Medicare and pretty good insurance, they can be expensive.

We haven’t, you know, knock on wood, had any big emergency type thing happen. My husband did go to the ER. It’ll be almost two years in February. We had a little, pretty good fender bender on the quad. And he had an x-ray by the time that he was in and out of the ER before someone could come pick me up and take me there, and we were probably 30 minutes away.

So I thought that was really quick and they did the x-rays. They did more lab tests and all that kind of thing. What people will tell you is the difference between there and the States, you know, cause that’s what I’m most familiar with. You’re going to wait longer there for testing. So if you go into your Caja and they decide that you need an MRI or they decide you need some specific type of x-ray or if they decide whatever, then you’re going to wait for that.

And so what most people do there is they will pay out of pocket for the testing. I have a very good friend that, a few years back, thought she needed a test. And so she went and paid out of pocket for a colonoscopy. Unfortunately, that colonoscopy came back positive. They transferred her from the private doc’s office that did the test to the Caja and all of her surgery, all of her chemo, everything was covered.

And she is just as good as she can be now, which is really wonderful because I was really worried about it. But she is just doing great. So like a lot of people use it like that. And so, yes, you would have some out of pocket, but certainly nothing that you would otherwise, people can buy private insurance in Costa Rica for some of us who are challenged with a little bit of age on us. It’s pretty expensive. Some of that is because it’s like world coverage. It will also cover you in the States. And so far, I’ve not seen a product that just was specifically just for Costa Rica. And so for younger folks, I think it’s pretty reasonable. You can also, a lot of people will get travel insurance.

There are policies now of travel insurance that will cover you for longer than just like we’re kind of used to getting it for 2 weeks. It’s not. It’s much more specific and much broader insurance.

The only company I’ve ever used, because people ask me that is Berkshire Hathaway, but I know I’ve looked at other policies. There’s a ton of them out there. You just have to really be careful about if they cover pre existing conditions. And most of them will, it tells you right there, and a lot of them will say yes, as long as you buy the ticket within whatever their dates are for their policy, then you’ll be covered.

So that’s kind of it. A lot of people don’t like to wait for testing, but you know, my friend that went through that experience, she got that colonoscopy back. She was in for her surgery in two weeks. That’s about the same as it’s going to be anywhere.

You know, in the States, it’s gonna, by the time they find out, they gotta schedule everything, and the doctor’s gotta be free, and it’s gotta be his day, and all that kind of stuff. I thought that was very reasonable. But you just gotta kinda know how to use the system and what you can, does that make sense? Is that what you’re asking me?

Terry:
Yeah. Xu, to wrap this up, tell me, just in a nutshell again, the advantages of me considering Caja, why do I need to call the number, send an email, talk to Quatro Legal about this?

Xu:
Well, first, because the process is not easy. There is a language barrier that we’re here for and that we want to make the process as smooth as possible.

We have experience and providers all across the country that are very familiarized with Caja’s policies, depending on the territory, and also the bilingual service and personal assistance that we provide in each of the appointments. Of every family member that needs to be registered and also the time that we take, it’s usually something very fast and that we will have results for our clients as soon as possible.

But that’s why we’re here for, to provide an excellent experience with the Social Security Registration.

Debbie:
Sorry, Terry to interrupt. I want to tell you something. As the person who has sat in the chair while someone was at the Caja desk to do our Caja, I can tell you it was the greatest thing ever because it’s just kind of a worry.

It’s a worrisome thing. You know, it’s new. It’s different. It’s new and it’s different. It’s all in Spanish. You know, and there’s very few expats that are fluent enough in Spanish. I mean, I can read way more Spanish than I can converse, but I still would not depend on being able to go up there and sit by the desk by myself.

So I loved someone going up to the desk doing that and then just bringing my papers and say, okay, here’s what it is. This is what you’re going to pay. And I can tell you the relief for us to get that number was monumental because of all of these stories that you read and people say things and you don’t understand. So having somebody like Quatro that will actually go there and sit at the desk for you, it’s great.

Terry:
So you can’t really put a rate on having a peace of mind.

Debbie:
That’s right. I agree.

Terry:
Xu and Debbie, thank you so much for joining us for this edition. Please share this with other people. Once again, so much information, misinformation is out there. Consider Quatro Legal when it comes to you finding out what you need to know about Caja, the registration, the process, and how to get it for you. Thank you for joining us. Have a great day.

Xu: Thank you, guys.

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