Health Insurance Options
Posted by Julia on: Mar 18, 2010
Costa Rica is widely known for its low cost and high-quality health care. While medical costs are significantly cheaper than in the U.S., it is still possible to accumulate hefty charges, particularly in cases of emergency. Many expats protect themselves from potential financial disaster by purchasing health insurance coverage through the government-owned company INS (Instituto Nacional de Seguros), which held a nationwide monopoly until the recent CAFTA free trade agreement.
INS offers both regional and international plans for foreign and national residents. Although some private companies also provide health insurance in Costa Rica, they are a bit more expensive. As of early 2010, most expats choose a government INS plan, or enroll in the socialized medical program known as the Caja (pronounced cah-hah).
INS vs. the Caja The Caja is the country's public health insurance system, available to all citizens and legal residents. It is short for Caja Costarricense de Seguro Social (CCSS), the Costa Rican Social Security Fund. Treatment is restricted to Caja-affiliated doctors and certain hospitals, which often equals lengthy wait times for routine check-ups and general surgery. There are ten major public hospitals -- four in San Jose, including the Children's Hospital -- affiliated with the Caja. For non-emergencies and everyday medical care, small clinics are located in almost every community. The cost to affiliate with CCSS is based on a sliding scale and is roughly 10-11.5% of your income.
While INS's insurance plans are more expensive, they are also much more flexible and convenient. Members are free to enjoy a broader network of options and have the ability to choose their doctors from modern private hospitals like CIMA and Clinica Biblica. Children are permitted to remain on their parents' plans until the age of 25, which is an advantage because collective family-plan rates are lower than individual ones. Prescription drugs, certain medical exams, sick visits and hospitalization are covered at 70% cost, and surgeon and anesthesiology costs are covered at full cost. Currently, private medical insurance costs about $50-$100/month per person, depending on age, gender and other factors.
For all INS plans, a waiting period of ten months is required before using maternity benefits or filing claims for preexisting conditions. A 24-month wait is necessary for transplants (unless it is needed because of an accident). Injuries due to professional sports and high-risk activities -- like canopy tours or whitewater rafting -- are excluded. There is an annual exception of $10,000 to treat recreational diving or soccer injuries (Costa Ricans certainly do love their soccer!).
To apply, candidates must complete a questionnaire about their history, listing specific conditions like epilepsy, alcoholism, high blood pressure and mental illness. It may be necessary to have additional medical records sent from your U.S. physicians if questions about a condition arise.
The INS regional plan covers clients under 70 years old for up to $200,000 per calendar year. This can be used toward expenses like walk-in care, surgery, lab work, exams and medications required during a hospital stay within Central America. It also secures a wide range of emergency care including air ambulance service and heart, liver, lung and bone transplants. A free health checkup with eye exam is included after the first year.
One of the perks to the Regional Plan is a low annual premium. For example, a 25 year-old male on an individual plan would pay just $497 per year, and a female $592; a 50 year-old male would pay $995 and a female $1,131. While it does include some coverage while traveling in a foreign country, most procedures must be pre-approved and $200,000 doesn't go as far in a country like the U.S.
The INS International Plan is quite similar to but much more extensive than its regional counterpart. It covers up to $2,000,000 per year and includes additional benefits like travelers' insurance and up to ten days of hotel stays abroad due to injury. Reimbursement is possible anywhere in the world -- and not just for emergencies. Doctor visits have a $10 deductible within network in Costa Rica or Central America, and a $20 deductible for international and out-of-network visits.
International Plan premiums are quite reasonable. For individual plans, a 25 year-old male would pay $986 per year, and a female $1,173; a 50 year-old male would pay $1,967, and a female $2,236. It is important to note that leaving Costa Rican soil for more than six consecutive months invalidates coverage.
International Plan with Large Deductibles
The International Plan with a large deductible is a slight variation of the aforementioned International Plan, except that it allows for lower premiums and higher deductibles. For individuals wanting a $15,000 deductible, a 25 year-old male would pay $305 per year, and a female $343; a 50 year-old male would pay $571, and a female $618.
Deductibles also come in $10,000 and $5,000 increments, with the lower deductibles corresponding with higher yearly premiums. Prices are even lower still if paying on a collective family plan.