How to Use the CAJA (Public Health System) as a Retiree in Costa Rica

How to Use the CAJA (Public Health System) as a Retiree in Costa Rica

CAJA (pronounced CAHA) is the public health and medical system in Costa Rica. 

As temporary or permanent residents, retirees have access to this public system, including doctors, clinics, specialists, and hospitals.

In this article, I will discuss basic information regarding CAJA, the quality of treatment, the cost, how to use it, and hospitals in the system. I will also briefly share my own experience, along with some tips for navigating the CAJA system.

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Key Takeaways

  • When you get residency status in Costa Rica, you need to be in the CAJA, which is basically a public healthcare system.
  • As a retiree, CAJA costs around 7% to 10% of your monthly declared income.
  • CAJA covers both chronic diseases and pre-existing conditions, which are great for retirees in Costa Rica.
  • While the waiting time can be long, the overall healthcare quality is good.
  • Expats in Costa Rica use a combination of both public and private healthcare systems.

Coverage

The coverage provided by CAJA are extensive and include:

CAJA logo
All CAJA health facilities have this CAJA logo.
  • Chronic disease
  • Pre-existing conditions
  • Doctor consultation
  • Medication
  • Diagnostic tests
  • Surgery
  • Preventive care such as routine check-ups, vaccinations, and screenings.
  • Dental care
  • Ambulance services
  • Emergency room care
  • Hospitalization

Because of the extensive coverage, especially for chronic diseases and pre-existing conditions, many retirees choose to retire in Costa Rica

Legal residents have access to and 100% coverage of all these services.

Healthcare System Statistics 

Costa Rica’s outstanding health system ranks 36th in the world according to the World Health Organization. 

This ranking is higher than those of the United States, Cuba, and New Zealand. Healthcare in Costa Rica is also ranked 20th in the world by the United Nations. The system is known for its high-quality doctors and treatment. According to the World Health Organization, the average life expectancy is 80.8 years compared with 78.5 years in the United States.

Expats looking to retire overseas are drawn to the comprehensive care, affordability, and strong public health programming available in Costa Rica. 

Much of the country’s high life expectancy can be credited to the long history of the national health care system, which began in 1949.

The OECD reported that less than 1% of the population fails to seek medical treatment because of financial considerations.

Over the years, this has resulted in citizens and residents who are healthier and live longer lives.

Treatment Quality

Many expats in Costa Rica use the public health system regularly and with great success.

Public health facilities may appear older and less up-to-date than facilities in retirees’ home countries; however, many of the country’s top doctors work in the system, some in both private and public hospitals.

Hospital San Juan de Dios Costa Rica
While public health facilities in Costa Rica may look old, healthcare quality is great. Photo: Hospital San Juan de Dios Costa Rica

As it is said, “Don’t judge a book by its cover.” Health care services are excellent, and in most cases, public hospitals have procedures and care systems that equal those of private hospitals in the area.

Personally, I have been very pleased with the service, treatment, and care I have received from CAJA. I have found the personnel to be caring, professional, and skilled.

Wait Time

Because it is a public system and deals with the entire population of 5.1 million, sometimes one must wait for appointments that are not considered emergency or urgent.

For emergency treatment, routine doctor visits, prescriptions, specialist treatment, and surgeries, the system works very well.

All records are computerized in an enviable system that other countries have emulated.

Sometimes people from other countries with different systems remark that the system is slower, but I have always found it to be reasonable. I can get an appointment at our local clinic in less than a week, sometimes the same day.

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For example, in my case, once I can make an appointment, I generally need to wait only 30 minutes to see a doctor.

In some clinics, they have a set number of appointments for that day, and if you come early, you can sometimes get an appointment the same day.

If something is urgent, there is always the option of going to the urgent care/emergency department.

Cost

For retirees, the monthly cost for public health services depends on your type of residency and how much monthly income you reported on your application for residency.

If you enter as a pensionado retiree, you pay a lower rate than if you enter as an investor or a rentista (self-supporting with guaranteed income).

Most retirees pay between 7 and 10% of their monthly income.

However, the good news for retirees is that this is based on the amount you initially report. You are only obligated to report one source of retirement income if you come in under the pensionado (retiree) category.

Hospital Nacional de Niños surgery team
The cost of surgery is fully covered by CAJA. Photo: Hospital Nacional de Niños

But remember this important point: for that monthly amount, all medical services, medications, procedures, surgeries, etc., are free.

Your spouse can come into the system as your dependent for a slightly lower amount.

Once you are enrolled with CAJA, you don’t need to pay any money when visiting public healthcare facilities in Costa Rica.

It is also a feature of Costa Rica’s social policy that all nationals, foreign nationals, and visitors should be treated in emergency services regardless of their status.

You will be treated in emergency care services even if you do not have residency or if you are visiting the country. However, if you are not registered in the Costa Rica healthcare system, you will be expected to pay for services.

How to Use the CAJA

The first thing is to make sure that when you get your residency, your lawyer assists you in registering with the CAJA.

This is part of the residency process, and your lawyer should help you and advise you as you do this. Once you are registered, you will have an asegurado number (insurance number – also called the numero patronal).

If you are registering with the CAJA on your own rather than with your lawyer, you will need to do the following:

  1. Make an appointment at the CAJA office (known as CCSS) nearest to where you live.
  2. Gather these documents for your appointment:
    1. A proof of residence such as an electric or water bill or a copy of the lease.
    2. A copy of the final resolution issued by the Department of Immigration approving your residency.
    3. A copy of your apostilled marriage certificate used in securing your residency if you are adding a spouse as a dependent.
    4. Your passport.
  3. Attend the appointment during which the CCSS official will evaluate your information, income, age, etc., and then set the percentage that you must pay according to your income.

Whether you register at the CAJA with your lawyer or by yourself, you will then need to also register at your local community clinic, known in Spanish as the EBAIS (Equipos Básicos de Atención Integral de Salud).

This is a simple process in which you go to the clinic and present your number from the CAJA and identification.

This facilitates a smoother time when you use the system for the first time. If your spouse is your dependent with the CAJA, he or she will need to do the same.

How to Visit a CAJA Hospital

Here is a likely scenario of what may happen when it is time to make your first appointment.

You’ll need to go to the reception area at your local clinic and request an appointment. They will ask for your DIMEX card.

If you have already registered, all your information will be there, and they will issue you an appointment with a doctor.

  • Visit a doctor: When you return for your doctor’s appointment on the specified date, go to the reception area and present the appointment slip you were given. They will register your presence in the computer system and enter you in the queue for the doctor.
  • Vital checks: You will go to a nurse’s station and wait for your name to be called. The nurse will check your blood pressure, weight, and ask general questions about your health condition and medications.
  • Wait for your queue: Then you will be asked to wait outside the doctor’s office until the doctor calls your name. (I usually wait about 30 minutes for my appointment to begin.)
  • Doctor consultation: The doctor will see you, asking questions about why you are there and conducting any exams he or she feels are necessary.
  • Prescriptions: If prescriptions are issued, the doctor will give you the written prescription as well as enter it into the computerized system. Once the appointment is over, you will go to the Farmacia (pharmacy) in the EBAIS (clinic) and present your prescription.
  • Getting Your Prescription: They will ask for your DIMEX card and your insurance number (numero patronal). Normally, they will tell you to return after 12:00 pm if your appointment was that morning. They will ask you to return the next day if your appointment was in the afternoon. (They need time to process the prescription.)

Seeing a Specialist

This scenario above is for routine doctor visits, dental visits, etc.

If a specialist consultation is determined to be necessary by the doctor, he or she will issue a request for an appointment with a specialist (such as oncology, cardiology, etc.). This will be entered into the computer system.

As you leave, return again to the receptionist and show her the request for a specialist appointment. She will make sure the request is logged into the system. You will be told that when an appointment is available, you will be notified of when and where.

baby delivery at Hospital México Costa Rica
CAJA also covers baby delivery. Photo: Hospital México Costa Rica

Specialists generally work out of one of the hospitals, so if you live near a hospital, you can take the specialist request to the hospital yourself and ask for an appointment directly.

Since there is no hospital close to where I live, I have the system assign me an appointment.

CAJA Hospital Expectation

This is a general description of what to expect when you need to see a doctor. Each EBAIS, of course, is different, with some being larger and some being smaller, so practices may vary a bit, but the process is fairly standardized throughout the system.

Depending on the time and specific clinic or hospital, you may have to wait for treatment; however, very urgent cases are, of course, treated immediately.

There are 30 public hospitals located throughout the country:

  • 16 of those are in the Central Valley (greater San Jose area)
  • 14 are in other areas around the country.

Retirees are advised to research the hospitals in the area where they might be thinking of living to make sure there is adequate care available for their needs and to ensure it is available nearby.

The best and most well-known public hospitals are the following:

  • San Juan de Dios Hospital (downtown San Jose). One of the largest public hospitals in the country, providing a wide range of medical services. It is known for providing excellent emergency care and specialized surgical procedures.
  • Hospital Nacional de Niños (downtown San Jose). Specializes in pediatric care and has highly trained medical professionals. It is rated as one of the top hospitals for children in Latin America.
  • Hospital Mexico (La Uruca, San Jose). Known for its advanced diagnostic and therapeutic procedures and state-of-the-art facilities. Considered one of the top hospitals in Latin America.
  • Hospital Enrique Baltodano Briceño (Liberia, Guanacaste). Serves the entire Guanacaste region. Offers all treatment services.

If you have serious health conditions, you should live near the Central Valley, where the most advanced and extensive care options are available.

My family and I live 75 minutes away from the hospital in Puntarenas and the same distance from the hospital in Quepos. We are also only about 90 minutes from a major hospital in the San Jose area.

In addition to the 30 hospitals in the public system, which have 6,000 beds, there are an additional 500 clinics and about 1,000 community clinics (EBAIS) that offer basic medical attention in remote areas.

CAJA or Private Hospitals for Retirees?

Many retirees use a combination of the public system and private medical providers. For some treatment modalities, private doctors or hospitals can provide service faster.

Each case must be decided individually depending on the patient’s condition, diagnosis, location, finances, etc. Regardless, you will find health care services to be excellent in both the public and private sectors.

There are at least four excellent private hospitals in the San Jose area with state-of-the-art facilities and practices:

  • CIMA (Escazu), Clinica Biblica (San Jose)
  • Hospital Catolica (Guadalupe)
  • Hospital Metropolitano (Lindora/Santa Ana).

There are many smaller private hospitals and clinics throughout the country that also offer high-quality care.

Tips for Using the CAJA

  1. Use the lowest retirement source of income: When registering with the CAJA, my lawyers advised me to select my lowest retirement source of income above $1000 (that’s the minimum). I had one pension of $1000 per month, so my monthly rate for the system is based on that, and it covers both me and my wife, who is considered my dependent. As always, each case is reviewed individually based on the information submitted to the CAJA. Seek advice from your lawyer and ask that they be present during your appointment at the CAJA. $1,000 per month is the minimum amount accepted as monthly income.
  2. Medication: When I had my first appointment with a doctor, I requested that two medications be provided through the CAJA. She approved one medication immediately for six months but ordered a series of lab exams, an EKG, and a chest x-ray to provide a baseline of information about my health. The lab tests were taken and processed at the local EBAIS (clinic). The results were available quickly. I returned for an appointment with the doctor who reviewed the results thoroughly with me. The EKG was done at the local clinic also, and the results were shared with me immediately. The x-ray was done at the hospital in Quepos later. The doctor reviewed the results with me in a follow-up appointment.
  3. Be patient: The system has its quirks, but it works. I’ve been very pleased with the doctor assigned to me. If an English-speaking doctor is required, mention that to the receptionist when you make your first appointment.
  4. Ongoing prescription: If you have an ongoing prescription, it will be good for a certain number of months. Each month, you will return to the clinic farmacia to pick up your medication.
  5. Monthly cost: Legal residents are required to register with the CAJA and pay the monthly cost, whether or not they plan to use it.
  6. Research hospitals: Since members of the CAJA are welcome to use any hospital or EBAIS in the system, do some research on a good hospital/clinic in your area before you go there.
  7. Ask questions frequently: Once you have initiated care in the system, the professionals will guide you through appointments and next steps. Ask questions frequently of the doctors, pharmacists, nurses, and receptionists. If the language is a barrier, take someone with you or use a dependable translation app to assist you.
  8. Emergency care: Emergency care is always available at local EBAIS clinics or any public hospital in the country.

Now, on to You

Retirees who are legal residents in Costa Rica have some of the best health care options available to retirees anywhere in the world.

The public system offers excellent treatment and care for any conditions for only the monthly cost, which is considerably lower than average insurance rates in the United States, and comes with no co-pays or other costs.

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In addition, private doctors and hospitals also provide outstanding care for a fraction of the cost of medical care in the United States.

Paul Maxfield
As an educator and nonprofit leader, Dr. Paul Maxfield has traveled to 58 countries and lived in four: The United States, The Cayman Islands, Costa Rica, and Honduras. He and his wife, Brenda, live in Costa Rica and have two children and six grandchildren. He is the author of When Far Away Is Home and Straddling Two Worlds.

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