One of the first things Americans and Canadians ask when considering a move to Costa Rica is: what happens to my health insurance? The answer surprises most people - and in a good way.
The short version: your coverage from home almost certainly stops working once you leave. Medicare does not cover care abroad. Canadian provincial plans are built for residents - and if you are not living in your province, they expire. What replaces them in Costa Rica is the CCSS: a public healthcare system that covers everything from primary care to surgeries, specialist visits, and medications - for a monthly contribution that is a fraction of what you were paying before.
This article breaks down exactly what changes, what it costs, and what you need to do.
1. Americans: What Happens to Your Medicare When You Leave
Medicare was built for the United States. It does not travel.
Medicare is a federal program. It covers hospital care and medical services inside the 50 states and U.S. territories. Once you move abroad - defined by Social Security as living outside the U.S. for 30 or more consecutive days - Medicare generally does not cover the care you receive.
The 2026 Medicare Numbers
| Medicare Component | 2026 Cost | Covers you in Costa Rica? |
|---|---|---|
| Part A (Hospital) - most people pay $0 premium | $0/mo (if 40+ quarters worked) | No - except 3 narrow border exceptions |
| Part B (Medical) - standard premium | $202.90/mo | No |
| Part B annual deductible | $283/year | - |
| Part A hospital deductible (per benefit period) | $1,736 | - |
| Part D (Prescriptions) - base premium | ~$35/mo avg. | No |
| Medigap Plans C, D, F, G, M, N - foreign travel emergency | Varies by plan | Partial - emergencies only, 60-day limit, $50,000 lifetime cap |
2. Canadians: Your Provincial Plan Has an Expiry Date Abroad
Your health card is tied to your residency in your province - not to your passport.
Canada's healthcare system is publicly funded but administered province by province. That means your coverage depends on where you live - not on being Canadian. The moment you are no longer considered a resident of your home province, your provincial health plan ceases to cover you.
| Province | Plan | Max. months abroad before coverage ends |
|---|---|---|
| Ontario | OHIP | 7 months (212 days) in any 12-month period |
| British Columbia | MSP | 6 months per calendar year |
| Alberta | AHCIP | 6 months per calendar year |
| Quebec | RAMQ | 183 days per calendar year |
| Other provinces | - | Generally 6–8 months - verify directly with your province |
3. The CCSS: What It Is and What It Actually Covers
Full coverage. No exclusions for pre-existing conditions. No age limits.
The Caja Costarricense de Seguro Social (CCSS) - known as "la Caja" - is the autonomous institution that runs Costa Rica's public healthcare system. It is not supplemental insurance. It is the primary healthcare system of the country, used by citizens and legal residents alike.
| Service | Included? | Notes |
|---|---|---|
| Primary care (EBAIS) | ✓ Yes | You are assigned to the EBAIS nearest your home |
| Specialist consultations | ✓ Yes | By referral from your EBAIS doctor - waiting times vary |
| Hospitalization and surgery | ✓ Yes | Wide range of procedures covered |
| Laboratory tests and imaging | ✓ Yes | Blood work, X-rays, ultrasounds, CT, MRI |
| Prescription medications | ✓ Yes | Dispensed at CCSS pharmacies per national formulary |
| Emergency care | ✓ Yes - everyone | Guaranteed regardless of immigration status |
| Prevention programs and vaccination | ✓ Yes | Free for all insured residents |
| Spouse and children of main insured | ✓ Included - no extra charge | Spouse is covered under the holder's contribution |
| Dental (basic) | ✓ Basic | Basic dentistry at EBAIS level |
| Pre-existing conditions | ✓ Covered - no exclusions | No underwriting, no exclusions by age or health history |
4. What the CCSS Costs - Pensioners and Rentiers 2026
Your contribution is calculated as a percentage of your declared minimum income.
The CCSS does not charge a flat rate. It calculates your monthly contribution as a percentage of your declared income base - which for foreign residents is tied to the minimum income requirement of your residency category. The exact rate and final amount must be confirmed directly with the CCSS, as figures vary by individual declaration and are updated periodically.
| Residency Category | Minimum Income Base | Est. Monthly CCSS Contribution | Spouse included? |
|---|---|---|---|
| Pensioner (Pensionado) | $1,000/mo | Verify directly with CCSS | ✓ Yes - no extra charge |
| Rentier (Rentista) | $2,500/mo | ~$150–$250/mo | ✓ Yes - no extra charge |
| Comparison: Medicare Part B alone (U.S.) | - | $202.90/mo | ✗ Spouse pays separate premium |
5. How to Register with the CCSS - Step by Step
The CCSS is a mandatory part of legal residency. Confirm the exact timing of enrollment with your immigration attorney.
CCSS enrollment is a mandatory requirement for legal residents in Costa Rica. The exact timing of this process in relation to your residency approval can vary - confirm the current steps with a licensed immigration attorney or directly with the CCSS before starting your application.
- Valid DIMEX - original and copy. The system verifies it is active.
- Passport - original and copy.
- Proof of address - recent utility bill in your name, or a signed letter from your landlord.
- Proof of income - pension letter or bank statements showing your monthly income (as required for your residency category).
- Go to your nearest CCSS regional office with all documents. Appointments can be made through the CCSS website (www.ccss.sa.cr).
- Declare your income category (pensioner or rentier) and present your supporting documents.
- The CCSS will calculate your monthly contribution and issue your insurance number.
- You will be assigned to the EBAIS (primary care center) closest to your registered address.
- Pay your monthly contribution by the 15th of each month to avoid arrears. Payment can be made at banks, online, or at the CCSS.
6. Should You Add Private Insurance on Top of the CCSS?
Many expats use both. The CCSS for coverage, private insurance for speed.
The CCSS is excellent for most situations - routine care, hospitalizations, surgeries, and medications are all covered at no additional cost at the point of service. However, specialist wait times can range from weeks to months depending on the specialty and region.
For this reason, many expats hold both CCSS coverage and a complementary private insurance plan. Private coverage gives you immediate access to specialists, broader choice of providers, and may cover services like advanced dentistry, vision, or certain alternative treatments that fall outside the CCSS formulary.
| Private Insurance - Reference Costs | Est. Monthly Cost |
|---|---|
| Individual plan (1 person) | $50–$120/mo |
| Couple plan (2 adults) | $120–$250/mo |
| Private GP visit (out of pocket) | $40–$80 |
| Private specialist visit (out of pocket) | $80–$150 |
Pura Vida Insider
Monthly residency news, CCSS updates, cost of living data and expat tips. Free, no spam.
We respect your privacy. Unsubscribe anytime.
Sources: Centers for Medicare & Medicaid Services (CMS) - 2026 Medicare Parts A & B Premiums and Deductibles, November 14, 2025 (cms.gov); CMS - 2026 Part D National Average Monthly Bid Amount and Base Beneficiary Premium ($38.99 base, $34.50 avg. premium), July 2025; AARP - Medicare if Living Outside the United States, updated 2026; U.S. News - Do I Have to Sign Up for Medicare if I Live Overseas?, January 22, 2026; Medicare.gov - Special Enrollment Periods; CMS - Welcome to Medicare: Living Abroad; Medicare Interactive - How to enroll in Medicare for those who first qualify when living abroad; International Insurance - Health Insurance for Canadian Citizens Living Abroad; ExpatInsurance.com - Your Guide to Canadian Health Insurance When Living Abroad, April 2026; Expat Financial - International Health Insurance Guide for Canadian Expats; Ontario.ca - OHIP Coverage While Outside Canada, updated January 2026; BDO Costa Rica - Ajuste en cuotas obrero–patronales de la CCSS a partir del 1 de enero de 2026, December 2025; CCSS.sa.cr - Aporte para el IVM aumentará a partir de enero de 2026, December 2025; CRIE.cr - The Requirements to Retire in Costa Rica, January 2026; Costa Rica Immigration (costarica-immigration.com) - Complete 2026 Guide. All costs in USD. Contribution estimates are reference figures - verify directly with the CCSS before making decisions. Last updated: May 15, 2026.
Enjoyed this article? Read more on our Blog →