If you’re planning to buy land, retire, or relocate to Costa Rica, there’s one important connection you need to understand: Residency = Healthcare Access.
Costa Rica’s public healthcare system, the Caja Costarricense de Seguro Social (CCSS)—better known as the Caja—is only available to citizens and legal residents. That means, if you want access to universal healthcare here, securing your residency is the first step.
This guide will walk you through the main residency categories, how they tie into healthcare, and the exact steps to enroll in the Caja once you’re approved.
Why Residency Matters for Healthcare in Costa Rica
- Caja is mandatory for residents. Once you’re granted legal residency, you must register and start contributing monthly to the public healthcare system. Contributions are income-based, typically ranging 7–11% of declared income.
- Proof of Caja enrollment is required. Immigration will not issue your residency card (DIMEX) until you’ve registered with the Caja.
- Coverage is comprehensive. The Caja gives you full access to public hospitals, clinics, doctors, prescriptions, maternity care, and major surgeries at little to no additional cost beyond your monthly contribution.
👉 In short: Residency = Caja enrollment = full healthcare access.
Residency Categories That Lead to Healthcare Access
There are several residency options, but the three most common for expats are:
1. Pensionado (Retiree Residency)
- Who it’s for: Retirees with a lifetime guaranteed pension or social security income.
- Requirements:
- Proof of at least $1,000 USD/month income from a pension or government retirement program.
- Must transfer this income into Costa Rica monthly.
- Proof of at least $1,000 USD/month income from a pension or government retirement program.
- Healthcare tie-in: Once approved, you register with the Caja and pay based on your declared income (in this case, $1,000/month).
2. Rentista (Fixed Income Residency)
- Who it’s for: People without a pension, but with stable financial resources.
- Requirements:
- Proof of $2,500 USD/month income guaranteed for at least 2 years, OR
- Deposit $60,000 USD into a Costa Rican bank (the bank releases $2,500/month for 24 months).
- Proof of $2,500 USD/month income guaranteed for at least 2 years, OR
- Healthcare tie-in: Caja contributions are based on that declared $2,500/month.
3. Inversionista (Investor Residency)
- Who it’s for: Those investing in Costa Rica’s economy.
- Requirements:
- At least $150,000 USD investment in real estate, business, or certain approved projects.
- At least $150,000 USD investment in real estate, business, or certain approved projects.
- Healthcare tie-in: Contributions vary depending on declared income from the investment.
💡 Other residency routes: marriage to a Costa Rican, having Costa Rican children, or employment sponsorship can also qualify you. But the three above are the most common for expats purchasing property.
Step-by-Step: How to Enroll in the Caja After Residency
Once your residency application is approved, here’s how to move forward with healthcare enrollment:
Step 1. Get Your Approval Resolution
- Immigration (DGME) issues a resolution letter confirming your residency approval.
- This letter is what you’ll take to the Caja.
Step 2. Schedule Your Caja Appointment
- Visit your local EBAIS (community health clinic) or regional Caja office.
- Bring your resolution letter, passport, proof of income, and local address.
- Appointments may need to be scheduled days/weeks in advance, depending on the office.
Step 3. Income Verification & Contribution Calculation
- Caja staff will review your declared income (pension letter, bank statements, investment proof).
- They calculate your monthly contribution (usually 7–11% of income).
- You’ll receive a payment slip or bank account instructions for contributions.
Step 4. First Payment & Registration
- Make your first payment at the Caja or through an authorized bank.
- Return proof of payment to the office to activate your account.
- You’ll receive a Caja membership card.
Step 5. Primary Care Assignment
- You’ll be assigned to a local EBAIS clinic based on your home address.
- This clinic becomes your first point of contact for check-ups, referrals, prescriptions, and emergencies.
Step 6. DIMEX Card Issuance
- Immigration requires proof of Caja enrollment.
- Once confirmed, you can proceed to get your DIMEX residency card.
What the Caja Covers (and Doesn’t)
✅ Covered:
- Primary care & specialist visits
- Surgeries & hospitalizations
- Maternity care
- Prescription medications (if on Caja’s formulary list)
- Emergency services
❌ Not covered (or limited):
- Some brand-name medications (generic equivalents usually provided)
- Non-essential cosmetic procedures
- Faster elective surgeries (you may wait months)
Why Many Expats Still Add Private Care
- Shorter wait times: Private consults often available within days.
- Specialist access: Easier to choose your doctor.
- English-speaking doctors: Especially at private hospitals in San José.
- Flexibility: You can pay cash or use private insurance.
👉 Most expats use Caja for major/catastrophic coverage and medications, while relying on private clinics for speed and convenience.
Pro Tips for a Smooth Process
- Hire a residency attorney. They’ll guide you through DGME paperwork and set up your Caja appointment.
- Bring multiple copies. Always carry copies of income letters, passports, and resolution documents.
- Keep receipts. Caja contributions must be current to maintain residency.
- Learn the basics in Spanish. Many admin staff in rural Caja offices may not speak English.
Bottom Line
If you’re planning to buy land or relocate to Costa Rica, healthcare and residency go hand in hand.
- Choose your residency path (Pensionado, Rentista, Investor).
- Secure your approval from DGME.
- Register with the Caja to unlock full public healthcare coverage.
- Consider supplementing with private care for flexibility and speed.
With residency + Caja, you’ll have peace of mind that you and your family are covered in paradise—allowing you to focus on building your new life in Costa Rica.
