I keep getting emails from all of you awesome folks asking about healthcare in Costa Rica. This week, that conversation goes in-depth with health insurance options for expats.
The great news is that Costa Rica has a fantastic healthcare system that's accessible to locals and foreigners alike (in part). And more and more people are going down to Costa Rica just to get a procedure or surgery, which would cost them way too much or be impossible to get in the U.S. (Canadians have that covered!)
Even if you’re not an official resident and therefore don’t qualify for Caja, you have other options for great healthcare in Costa Rica. Many expats and visitors opt for a combination of Caja, private pay and also keep their U.S. health insurance coverage to patch together the best possible medical coverage.
Here are a few other options outside of Caja:
INS (Instituto Nacional de Seguros)
INS offers medical insurance autonomous of Caja. It’s a group plan offered by the Association of Residents of Costa Rica. It’s a government- run private plan (you’ll never see that in the U.S.!) that is available to legal residents or non-residents who pay into the system. If you sign up with INS, you’ll have access to about 200 affiliated doctors, hospitals, labs, and pharmacies throughout Costa Rica.
However, it does have a limit of $17,500 per year for treatment costs and does not cover pre-existing conditions or routine check-ups. INS pays out 80% of the cost for prescription drugs, examinations, doctor visits, hospitalization and treatment and 100% of surgeons’ and anesthetists’ fees.
The costs for NIS range from $60-$130 per month based on gender, age, and other health factors.
International health insurance policies:
If you’re not yet a resident of Costa Rica or will be going back and forth to the U.S. or traveling to other countries frequently, you might want to check out your options with international health insurance.
There are a handful of companies that offer insurance plans that will cover you anywhere you go in the world – including Costa Rica. Unlike the INS option that has an annual premium cap of $17,500 and excludes preexisting conditions, most worldwide health insurance plans cover up to a $2 million up to a $5 million lifetime limit.
The premiums might be a little higher than you’ll pay with INS or Caja, but they usually cover far more and offer greater flexibility. Just bear in mind they may reduce your premiums if you specify that you’ll only need coverage in certain countries.
For instance, most of them will still cover you when you go back to the U.S. (we exclude Canadians from this conversation because they have their health insurance all set up!) as long as it’s for 30 days or less. Plans do differ so check out some of the biggest international health insurance providers like Bupa International Insurance.
None – be your own insurance company:
With the sky-high cost of medical treatment in the U.S., it’s ingrained in us that we need a health insurance plan at all times to cover our medical needs. However, some expats choose not to carry medical insurance in Costa Rica at all.
Instead, the logic goes that they can just save the cost of the monthly premium in their own savings account, and have it there to pay for any private medical care if needed since the cost of health care is so reasonable in Costa Rica.
While I’d still never recommend going without some major medical plan in case of serious accidents, sudden sickness, and hospitalizations, but for expats who are in great health and have significant savings as a safety net, this is a viable option.
Again, I wouldn’t recommend this long term and maybe look at travelers insurance or something temporary so that you have base coverage on your way to establishing residency and Caja.
U.S. based health insurance:
Some U.S. citizens that move to Costa Rica choose to keep their U.S. based health insurance coverage, whether that comes from Medicare, our government-run healthcare system, from a spouse, or an old employer.
They may pay out of pocket for basic care in Costa Rica like doctor’s checkups and dental cleanings, but then go back to the U.S. for more major care or procedures.
If you have affordable health insurance – maybe subsidized with credits so the monthly premiums are low – you may want to keep this option and just get annual medical care taken care of when you make the trip back to the states periodically.
But, for most expats that don’t have affordable care taken care of back home, this might not be a great long-term choice.
The healthcare conversation is SO important for expats or visitors in Costa Rica, and I have lots of great, invaluable information for you in the Moving to Costa Rica Handbook!
Costa Rica may be known for its perfect beaches and sunny climate, but the wildlife is even more remarkable in the Central American nation. Despite being only the size of West Virginia, Costa Rica is home to more than 500,000 different species, making up an astounding 4% of all the plant, insect and wildlife species on the entire Earth!
In recent weeks, I introduced you to sea turtles, howler monkeys, toucans, and the famous three-toed sloth that you'll find down south.
Today, I'll highlight six more cute, cuddly, and cool animals and species that you'll encounter in Costa Rica!
Off the Pacific coast of Costa Rica in places like Golfo Dulce, divers may catch a glimpse of the rare and beautiful spotted dolphin, or Manchado del Pacifico in Spanish. They are found all over the world in tropical and subtropical waters, as far as China, Japan, India, New Zealand, and also in the Gulf of California and Mexico.
Spotted dolphins have a patch of dark skin below their dorsal fin that’s covered with white spots, and dark spots flecking their white underbelly. These majestic creatures gather in huge groups of 1,000 dolphins or more in deep seas and swim so fast that they often keep up with fish boats, playfully jumping in the air and crossing in front of and behind the boat. Spotted dolphins can live up to 45 years. But too often, large numbers are killed by fisherman, intentionally or unintentionally, or by ocean pollution.
Costa Rica has several species and types of iguanas, including the Green Iguana, which can get up to six feet long! But despite their size, they’re not dangerous to humans, eating only plants, insects, and small animals (unless you force yourself onto a nest, in which case the mother might whip her tail at you, which can cause some damage).
Black Iguanas are full herbivores, and Costa Ricans call them garrobos or gallina de palo – which translates to ‘tree chicken’ in English – because their meat is said to taste like chicken. In Costa Rica, you’ll also see plenty of smaller Geckos climbing up walls, across ceilings, eating mosquitos and pesky insects, and making their signature amplified chirping noises that often perplex first-time visitors.
The Great Tinamou
Considered one of the oldest lineages of birds in the world, the great tinamou has an interesting trait that allows them to survive in the Costa Rican jungle among so many predators like snakes, jaguars, and others. The tinamou’s rare practice that ensures their evolutionary survival has to do with how they reproduce.
These birds lay bright green eggs, which easily attract other tinamou to their nest. Since this species in polygynadrous (multiple males mate with multiple females), other males and females lay their eggs in the same spot. Soon, there are so many eggs piled up that even though predators eat roughly 75% of all tinamou eggs, there is no way they can eat them all, and the species lives on.
White-Headed Capuchin Monkey
These are some of the most intelligent and evolved animals on earth, actually using tools, weapons, and other implements from their environment to get food. They’re also one of the only animals to use natural medicine, rubbing
certain plants over their bodies in what appears to be a use of herbal medicine. White-Headed Capuchin Monkeys live in groups of 40 or so and have an astounding life expectancy of 54 years. White-Headed Capuchins are easily spotted in most of the National Parks in Costa Rica.
Ocelots are nocturnal cats that populate every country south of the U.S. except for Chile. They’re about twice the size of an ordinary housecat, ranging from 38 to 60 inches long and 20 to 35 pounds. Since they are lighter than other large cats like pumas, cougars, mountain lions, etc. and have huge paws, they’re great at climbing trees.
Once hunted for their furs so much that they were listed as a vulnerable species, ocelots have replenished their numbers and now are frequent in Costa Rica – though their habitat, like many animals’ – is shrinking because of commercial development.
When biologist Charles Darwin embarked on his legendary voyage throughout the Americas, he documented 14 species of finches – birds that were later named “Darwin Finches.” Of those 14 species, 13 lived in the Galapagos Islands, but only one species lives elsewhere; you guessed it – in Costa Rica.
In fact, the rare and beautiful 14th species of finch inhabited the island of Cocos off the Pacific coast of Costa Rica. The Cocos finches were remarkable because, unlike most finches that evolved sharper or different-shaped beaks to eat specific diets, these finches ate just about everything front nuts to crustaceans. Since their island was so small, they had to eat whatever food sources were available, on the island, which still doesn’t have human settlers living there.
I hope you enjoyed these cute and cuddly critters, but don't get too comfortable out in the wild in Costa Rica.
In fact, there are a whole lot of exotic, dangerous, and even deadly animals, from crocodiles to poisonous frogs and more. I'll highlight them in a future blog or you can discover the flora and fauna of Costa Rica extensively in the Moving to Costa Rica Handbook!
Most people visit Costa Rica or even move there for the tropical weather, nice beaches, and laid-back, sunny lifestyle. But there's another compelling reason to head down south to the land of pura vida: healthcare.
In fact, Costa Rica has a fantastic healthcare system that's accessible to locals and foreigners alike (in part). And more and more people are going down to Costa Rica just to get a procedure or surgery, which would cost them way too much or be impossible to get in the U.S. (Canadians have that covered!)
Here is what you need to know about medical procedures in Costa Rica:
Medical tourism in Costa Rica:
More and more people are visiting Costa Rica for elective surgeries, including cosmetic procedures. In fact, last year it’s estimated that more than 100,000 foreigners visited Costa Rica for medical procedures.
Costa Rica is most popular among medical tourists for cosmetic surgeries, knee and hip replacements, heart surgeries, and cosmetic dentistry, among others.
There are a host of clinics and options, but you’ll probably want to stick to the well-established bigger medical facilities in or around San José. When it comes to plastic and cosmetic surgery, you’ll find that Costa Rican doctors are world-class, with the latest laser technology and skilled in the newest procedures and treatments.
Prices for cosmetic surgery are probably 1⁄2 or even 1/3 what you’d find in the United States.
If you’re heading to Costa Rica for a procedure, remember to leave a couple of days before the surgery to relax and get acclimated, and book a week or two (whatever the doctor recommends) at a nice resort or hotel to recover afterward before you have to fly home. It will still cost far less than in the U.S., all travel expenses included!
Typical Costa Rican Medical Costs
Here are some estimates for typical medical costs in Costa Rica, compared to U.S. prices and with the percentage savings. These are only estimates, and you can get more accurate pricing by contacting the appropriate hospital in Costa Rica.
Procedure/Cost in U.S./Cost in Costa Rica/% savings:
Plastic and Reconstructive Surgery:
General and Cosmetic Dentistry:
Visiting the dentist in Costa Rica:
Dental procedures are covered by Caja, but for those visitors or expats who don’t yet have residency and access to the nation’s nearly free healthcare network, there are still plenty of great options for dental work.
In fact, dental clinics and small offices are abundant, especially in cities and communities that have a large foreigner, tourist or expat population.
Some of these clinics may not look like anything fancy from the outside. However, you’ll usually find that they are spotlessly clean and up to date on modern technology and equipment. It’s also easy to get an appointment as a walk-in, and they’re often more thorough than U.S. dentists because they’re not as pressured to keep an eye on the bottom line in Costa Rica.
I used to coordinate my biannual cleanings with trips to Playa Coco, where I found a great dentist and got a filling and crown there for about 1/10 the cost of what it would be in the U.S. Even dental lab work and dental surgeries are high quality and cost effective; another reason Costa Rica is an increasingly popular destination for medical tourists from up north.
More questions about medical care, moving to Costa Rica, or anything else?
I've got you covered with the #1 resource in the WORLD!
The Official Expat,
Google and the other search engines receive hundreds of thousands of inquiries about Costa Rica every day. A while back, I shared the first five of Google's top-10 queries (with my answers), and here are the final five:
The top 10 Google queries about Costa Rica (#5-10):
6. Do they use U.S. dollars in Costa Rica or do I need to change money?
These days, U.S. dollars are widely accepted in almost all areas that foster tourism in Costa Rica, including hotels, restaurants, airports, etc. ATMs usually give you the option to take out U.S. dollars, which you can then spend and receive local colones as change. But most people don’t need to hassle with changing money before they go or even when they get there. If you do change dollars to colones, do so at a bank or your hotel, but never on the street or with a freelance moneychanger.
7. Should I fly into Liberia or San José airport?
Both airports are great and offer many unique advantages depending on where you plan on visiting. The majority of travelers still fly into SJO – San José’s International airport – because of its central location and accessibility to the east or west coast.
But more and more vacationers fly directly into Liberia airport, in the northwest corner of the country in Guanacaste Province, which is where popular Tamarindo is located. It’s best to plan your destination in the country first, and then start searching for airfares and routes to the appropriate airport based on that.
8. What does “pura vida” mean?
Pura vida is a Spanish phrase that translates to “pure life.” It’s the Costa Rican national saying, used as a hello, a goodbye, a how are you doing, and also to express the chill, sunny, mellow vibe that people feel when they visit the country.
9. Do I need a visa to visit Costa Rica?
U.S. citizens do not need a visa to enter Costa Rica, only a valid U.S. passport (make sure it is still good for at least six months after your trip) and proof of a plane ticket to exit the country. Residents of the U.S., Canada, Australia, France, England, Ireland, New Zealand, Brazil, Mexico, and many other countries do not need a visa, and can enter and stay for 90 days as a tourist. But it’s a good idea to check with your embassy or the Costa Rican consulate just to make sure.
10. What’s the best place to book hotels/vacation houses/tours/package deals/transportation to Costa Rica?
The best way to ensure that you end up with the best vacation in Costa Rica is simply to contact a credible local tour operator. (I can suggest some I know and trust). They can advise you on the best and cheapest flights, arrange transportation from the airport and to and from your hotel, set up tours around the country, arrange plenty of activities, and even arrange a rental house or condo instead of a hotel.
Once you move to Costa Rica, will you have to pay taxes on income in your new home country?
But wait; do you still need to pay U.S. taxes (assuming you’re from there)?
What if you’re living in Costa Rica but working virtually, still earning a foreign paycheck?
How about taxes on social security and other forms of income?
And will all of this change if/when you become an official Costa Rican resident?
Ay Dios mío, there are some serious questions you need to answer when it comes to paying taxes in paradise.
Your body, mind, and soul may reside in Costa Rica, but for the sake of paying taxes, you’re still a citizen of your home country. That’s typically the scenario when United States citizens move to Costa Rica, or anywhere abroad.
No wonder many expats look for jobs in Costa Rica where they can earn wages “under the table” or in cash so they can avoid paying a large U.S. tax bill (not that I endorse that!) If you become a Costa Rican citizen you will have an additional tax obligation there.
Here is the exact verbiage from the IRS website:
Beyond that, the tax rules and codes, both in Costa Rica and the United States, are far too complicated for me to try and give you sage advice here.
The best I can do is urge you to consult with a CPA or professional tax preparer that has some experience dealing with taxation issues for expats abroad. Don’t take tax advice from online forums, rumors, or the word of other expats. Always seek professional advice on taxation issues.
That being said, there are some general rules we know about taxes in Costa Rica:
Costa Rican citizens enjoy the fact that there is no wealth or inheritance tax in the country.
• Sales tax is currently 13% (the equivalent to VAT)
• Sales tax is levied on all goods except for food, medicinal products, and a few other items
• Gasoline carries an additional tax
• Income tax and social security run at 10% - 15% for both depending on income level Taxes on property sales:
• Transfer of property title is approximately 2.75%, including transfer taxes and attorney’s fees
• Property tax ‘impuesto terretorial,’ annual - 1% of assessed property value (about 10 - 40% of market value) goes to the city government
• Certain areas have additional taxes for trash collection and street maintenance
• Capital gains - NONE
Additionally, for U.S. expats it’s important to know that the IRS taxes all income made worldwide. So you won’t be easily avoiding paying taxes back in The U.S. just by physically relocating to Costa Rica. The good news is that you may be able to avoid paying double taxes on income you earn in Costa Rica and then again to the IRS.
You may be able to avoid double taxation thanks to the Foreign Earned Income Exclusion (IRS Form 2555 or Form 2555-EZ) and Foreign Tax Credits (IRS Form 1116).
You may qualify to exclude from income up to an amount of your foreign earnings that is adjusted for inflation ($91,400 for 2009, $91,500 for 2010, $92,200 for 2011, $95,100 for 2012, $ 97,600 for 2013).
You can exclude or deduct certain foreign housing amounts - Housing Exclusion (IRS Form 2555) or Housing Deduction (IRS Form 2555).
But, you must file a tax return with the Internal Revenue Service to qualify for these benefits.
There are caveats, qualifiers, and exclusions, of course. So, once again, the best advice I can give you is to consult a certified tax planner that has knowledge and experience in helping expats. If you want to further inform yourself, I’ve heard The Complete US Expat Tax Book is a great resource.
I’ve lived in Costa Rica or abroad for ten years now, and still file and pay my U.S. taxes every April 15 as if I was still residing in the states.
Want more information about taxes, insurance, medical care, housing, and just about everything else you can think of concerning moving to Costa Rica?
Check out the Official Expat's Moving to Costa Rica Handbook.
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