Thinking about a move (or land purchase) in Costa Rica and wondering how healthcare actually works? The short answer: most long‑term expats use both systems—Caja (public) for comprehensive coverage and private care for speed and choice. Here’s the full breakdown, with real costs and what to expect.

The Public System (CCSS / “Caja”): What It Is & How It Works

Costa Rica’s Caja Costarricense de Seguro Social (CCSS) is the public system that provides broad, cradle‑to‑grave coverage—primary care, specialist care, hospitalizations, surgeries, maternity, and prescription drugs. Coverage is funded by income‑based contributions and available to citizens and legal residents. (International Citizens Insurance)

Eligibility & enrollment. Enrollment in the CCSS is mandatory for legal residents (temporary or permanent) and typically completed as part of your residency process. You’ll need proof of CCSS coverage to finalize residency. (CostaRicaLaw.com, CRIE)

What you pay. Many expat guidance sources cite a ~7–11% of declared income range for monthly Caja contributions (actual percentages vary by category and are set by the CCSS board). (International Citizens Insurance, Procuraduría General de la República)

Wait times (set expectations). Like many universal systems, non‑urgent care can involve queues. CCSS data and local reporting indicate average surgical wait times were roughly ~423–424 days around late 2024, improving only marginally year‑over‑year. Urgent cases are triaged faster. (Semanario Universidad)

A practical upside. Doctors often work in both systems (public in the morning, private in the afternoon). Many private physicians will write prescriptions you can fill at Caja pharmacies when you’re enrolled—one reason expats mix systems. (International Citizens Insurance)

The Private System: Why Expats Use It Anyway

Speed & choice. Private clinics and hospitals offer shorter waits, the ability to choose your specialist, and widespread English‑speaking staff at major centers (e.g., CIMA, Clínica Bíblica, La Catolica, Hospital Metropolitano). (hospitalcima.com, International Citizens Insurance)

Insurance & billing. Major private hospitals work with international insurers (Cigna, GeoBlue, Aetna, Allianz, etc.) and can often direct bill with a guarantee of payment. Cash/credit is widely accepted if self‑paying. (Hospital Clínica Bíblica, hospitalcima.com)

Typical private visit costs (cash). Expect about $60–$75 for a GP, ~$100 for a specialist; many common labs and basic imaging are under $100. (International Citizens Insurance)

Real‑World Prices: Costa Rica vs. U.S. (2024–2025 indicative ranges)

Prices vary by city, hospital, complexity, and whether anesthesia/contrast/surgeon fees are separate. Use these as ballparks.

Prescription medicines. Many expats find meds cheaper in CR; Caja covers drugs on its formulary. Broadly, U.S. retail drug prices are ~2.7–3x those in other OECD countries—one reason meds feel affordable in Costa Rica by comparison. (NCBI)

The “Mix & Match” Strategy Most Expats Use

• Use Caja for: ongoing/expensive meds, chronic‑care follow‑ups, maternity (preferential access), major hospitalizations, and catastrophic coverage. (International Citizens Insurance)
  
  

• Use private for: faster diagnostics (MRI/CT), elective surgeries you want scheduled quickly, second opinions, English‑first care, and continuity with a chosen specialist. (International Citizens Insurance)
  
  

• Layer insurance smartly: many residents keep Caja and either (a) private international insurance, or (b) a local discount plan (e.g., MediSmart for the Hospital Metropolitano network) to cut cash prices for imaging and consults. (International Citizens Insurance, osatropicalproperties.com)
  
  

If You’re Buying or Building in the Southern Zone (Uvita • Ojochal • Dominical)

You’ll likely combine local options with San José for big procedures:

• Public (Caja):
  
  

  • Hospital Tomás Casas Casajús (Ciudad Cortés, Osa) — nearest public hospital. (ccss.sa.cr)
    
    

  • Hospital Fernando Escalante Pradilla (San Isidro de El General) — larger regional public hospital ~1–1.5 hrs inland. (Asociación Costarricense de Hospitales)
    
    

• Private (nearby):
  
  

  • Hospital Las Américas (San Isidro de El General) and multiple private urgent‑care/clinics. For complex surgeries, most expats go to San José (CIMA, Clínica Bíblica, La Católica) for top subspecialists. (HospitalLasAméricas, clinicadeurgenciaspz.com, ExpatDen)
    
    

How people actually do it: see your local GP or private clinic in San Isidro for quick labs/imaging; escalate to San José for advanced specialists/surgery; use Caja for meds and big‑ticket backup.

Practical Steps (and Tips)

1. Residency first, then Caja. Build CCSS enrollment into your residency timeline; your attorney will usually coordinate the appointment. (CostaRicaLaw.com, CRIE)
   
   

2. Price out private care. Before you need it, email CIMA or Clínica Bíblica for quotes; both post international insurance info and can advise on direct billing. (hospitalcima.com, Hospital Clínica Bíblica)
   
   

3. Shop diagnostics. Prices do vary—platforms like HuliHealth help you see providers, fees, availability, and reviews. (hulihealth.com)
   
   

4. For maternity: ask for updated package pricing (room type, epidural, neonatology, length of stay). Prices have risen since the 2019 example. (Two Weeks in Costa Rica)
   
   

5. Keep documents handy: passport/Dimex, Caja card, private insurance card, and any prior imaging/reports (paper & digital).
   
   

Bottom Line

• Caja = broad, affordable coverage + a safety net for big stuff—but longer waits for non‑urgent care. (Semanario Universidad)
  
  

• Private care = speed, choice, English‑speaking staff, and transparent cash prices or direct billing with international insurers. (hospitalcima.com)
  
  

• Most expats (and many locals) combine both to get the best of each system. (International Citizens Insurance)