The part that catches people out
Medicare is a domestic programme. It does not follow you abroad, and there is no version of it that does for a resident of another country. People who have paid into it their whole working lives find this genuinely hard to accept, and it is the single most common healthcare surprise among American arrivals.
Plan for it before you move, not after.
What replaces it
The Caja. Costa Rica’s public health system. Enrolment is compulsory once you have residency, you pay a monthly contribution based on your income, and it covers you comprehensively including prescriptions and major procedures. It is the reason a lot of people move here and stay.
The trade is time. The Caja is slower for non-urgent things than Americans are used to, and waiting lists for elective procedures are real.
Private care, paid cash. This is what nearly everyone also does, and it is why the system works in practice. A private consultation, a scan, a dental visit or a specialist appointment costs a fraction of the American equivalent and you get it this week rather than next quarter.
Most residents run both: the Caja for the serious and expensive things, cash privately for anything they want dealt with quickly.
The gap before residency
Between arriving and being approved for residency there is a window where you are on neither. Work out what covers you in that window before you get on the plane. Travel medical insurance and international policies both exist for it, and this is a question for a broker rather than for a blog.
What it means for the budget
Healthcare is one of the lines where the comparison with the United States is not close, and it is a large part of why a modest income goes further here. The monthly ledger on this site puts a real figure on it alongside everything else, and the comparison tool will put it beside what you pay now.
General guidance from one expat, not medical, insurance or legal advice. Confirm anything that matters with a professional.
