Healthcare is the #1 question American retirees ask about Costa Rica — and the #1 surprise is this: Medicare generally does not cover care outside the United States. The good news is that Costa Rica’s healthcare is excellent and affordable, so most retirees are better off than they expect. Here’s how it works in 2026.
Does Medicare work in Costa Rica?
No — with very narrow exceptions, Medicare pays only for care in the US. Some retirees keep Part B anyway for trips home; others drop it. Instead, you use Costa Rica’s two-tier system below.
The Caja (public system)
Legal residents join the CCSS (“Caja”) for a modest income-based monthly fee that covers doctor visits, hospitalization, surgery, and prescriptions — no exclusions for pre-existing conditions. Read Caja vs. private insurance.
Private insurance & hospitals
Most expats pair the Caja with private care for speed and choice. Top private hospitals — CIMA, Clínica Bíblica, Hospital Metropolitano — offer US-trained, often English-speaking doctors at a fraction of US prices. See top hospitals.
What it costs
A private doctor visit often runs $50–$90; many procedures cost 40–70% less than in the US. International health plans for retirees are widely available. Overall, healthcare is a major reason Costa Rica’s cost of living is low.
Getting residency for Caja access
To join the Caja you need legal residency — the Pensionado program (~$1,000/month pension) is the common path. See every residency path.
Where to live for medical access
The Central Valley has the best hospital concentration — a key reason it’s the top choice for full-time retirees. See retirement communities.
Frequently asked questions
Should I keep Medicare Part B? Only if you’ll seek care in the US; otherwise many drop it.
Are pre-existing conditions covered? The Caja covers them; private plans vary.
Is care in English? Widely at private hospitals in the Central Valley and major towns.
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