Posted on May 16, 2022
- Published on April 18, 2022 – excellent article from Rebecca Clower of Blue Water Properties – a fellow realtor from the Flamingo area.
One of the most important considerations before moving abroad is your health: your wellbeing, lifestyle, and access to medical care in your new home. It’s a question I get often, so I thought I’d dig into some details on healthcare in Costa Rica.
You can find a lot of Big Claims about Costa Rica’s healthcare, including the off-cited WHO ranking: 36th-best in the world (one spot higher than #37 United States) and a longer-than-average lifespan (as of 2019, 80.3 years vs. 79.1 in the USA). But those are just numbers and, in practice, healthcare is about a lot more than an intangible (albeit impressive) statistic.
So, what is healthcare in Costa Rica really like? In this post, I’m breaking down public (Caja), private, and mixed medicine (medicina mixta) care, with details on costs, pros and cons, and a few insights along the way. (As always, please get in touch if you have specific questions about healthcare or living in Costa Rica.)
Public Healthcare in Costa Rica: The CCSS
The Caja Costarricense de Salud Social, often shortened to la Caja (or, in writing, la CCSS), is the “Costa Rican Social Security Fund” – but not that kind of social security. This is Costa Rica’s public healthcare (and, yes, pension) service.
The Caja can be a huge topic that covers a lot of ground so, for the sake of brevity (and because I’m writing a blog post, not an entire book), I’ll stick to the broad strokes with a few important details. Starting with this: When you become a resident, you will be required to join the Caja.
Monthly Caja Costs
Unfortunately, there’s no one answer here. Officially, a Caja contribution is calculated at 5% to 12% of your monthly income.
In practice, it’s not quite that simple. First of all, many residents don’t work, at least not locally. In that case, your Caja payment would be 12% of your declared monthly income. That said, your mileage may vary.
For starters, “monthly income” is also a debatable term, especially if you don’t work, or you freelance (and earn differently each month), or are retired, or a dozen other possibilities. Furthermore, if you’re over a certain age (60-65; the laws are changing), your monthly quote will be lower because it won’t require a pension contribution. If you’re married, one spouse may be covered by the other spouse. Etc. etc.
All this said, expect a Caja payment… but I can’t tell you exactly what to expect. As a ballpark figure, you’re most likely looking at $100-$350/month per individual or couple. But again, your mileage may vary.
Cost of Caja Healthcare
This one’s an easy one: Beyond your monthly payment (known locally as a contribución or “contribution”), you’ll have exactly zero out-of-pocket costs for Caja services. That’s right: You’ll never pay a single colón for any Caja healthcare or prescription medicine, ever.
Pros and Cons of Caja Healthcare
Here’s where I get to the section that could fill a book. There are so many upsides and downsides to the Caja that it’s hard to summarize. I’ll do my best.
Before I get into it, know that many Costa Ricans live their entire lives under only Caja healthcare. It’s doable – but it probably won’t be like what you’re used to. Here’s what I mean:
Excellent Preventive Healthcare
As a recent New Yorker article highlighted, The Caja shines at public health – as in, keeping the public healthy (as opposed to treating a sick public.) In large part, that boils down to preventive healthcare: Get into the system and you’re on the road to regular blood panels (and other tests), check-ups/check-ins, colonoscopies/endoscopies, men’s & women’s health visits, and more.
Superb Emergency Healthcare
Ask almost anyone and you’ll hear the same thing: If you break a bone or have an accident, the public hospital is a great place to be. Not only will you receive excellent emergency care but, come what may, you won’t pay anything, no matter how many life-saving measures are required.
And No Such Thing as a Pre-Existing Condition
You read that correctly: With the Caja, there’s no such thing as a preexisting condition. Come as you are.
But, There Are Long Waits for Almost Everything Else
Preventive medicine can be scheduled ahead: See you in six (eight… twelve…) months! Emergency medicine is literally green-lighted to the front of the line. Everything else… well, be prepared to wait. Hoping for a not-so-urgent knee or hip replacement? Get in line. (And FYI, that line could take a few years.)
The Patient-Doctor Relationship Is Somewhat Impersonal
Public healthcare can be very formulaic and, among other things, that means that you won’t “choose” your doctor or your clinic or your anything, really.
You’ll go to your local clinic or Ebais, where you’ll be assigned a doctor based on your residence. Need to see the specialist? They’ll be here every third Tuesday and no, it’s not the same specialist you saw last time; it’s whoever is assigned to the next pass-through. Even if you’re pregnant or planning a major surgery, your prenatal/pre-op visits likely won’t be with the same professionals every time, and your birthing experience or surgery won’t be with anyone you’ve met previously.
And Some Services/Medicines Just Aren’t Available
The services you’re used to – for example, a 20-week pregnancy ultrasound or a specific type of imaging – may not be considered “necessary” to the Caja. And if it’s not necessary, you’re not getting it. Ditto for medications: The Caja has a set list of medicines (mostly generics) that it provides; if your prescription from back home isn’t on that list, the Caja will offer a substitution. If you choose not to take the substitution, you’ll have to pay out-of-pocket (privately) for your medications.
In summary, it’s safe to say that there’s not a lot of choice with public healthcare and, sometimes, you’ll have to advocate for what you need but, when you receive healthcare, it’s of a high caliber.
Private Healthcare in Costa Rica
Ah yes, another topic that could fill chapters and chapters of a book. Another topic that I’ll try to distill down to some of the most salient details.
Costs of Private Healthcare
Don’t blame the messenger, but this is another one of those can’t-be-answered questions. But, for different reasons than for public healthcare.
Typically, private healthcare costs are broken down into three possibilities:
Option 1: Pay Out-of-Pocket
If you plan to use private healthcare sparingly, you’ll probably elect to pay out-of-pocket for the occasional visit. To see a general practitioner (GP), expect to pay about ¢25,000-¢45,000 ($40-$65), depending on the doctor and your location. Specialists (ex. an ENT or allergist) will usually run ¢50,000-¢80,000 ($80-$130) per visit.
Option 2: Purchase Private Insurance
If you plan to opt for mostly private healthcare, with some pinch-hitting from the Caja for potential emergencies, then you’ll most likely opt to purchase private insurance.
As it does elsewhere around the world, policy premiums vary depending on many, many factors – among them, your age and preexisting conditions. Yes, preexisting conditions are important to private insurance (and can really hike up your costs, if they’ll cover you at all). That said, premiums locally usually fall into the $125-$500+ per month and typically have a deductible AND still, only cover up to 80% of your costs.
Option 3: Buy a Medical Discount Plan
Discount plans, including the ever-popular Medismart, offer a sort of middle-ground for private healthcare, offering discounts on in-network care, in exchange for a very modest monthly fee (currently, <$14 for the primary plan-holder and <$7 for additional plan members).
Pre-existing conditions are fully covered but keep in mind, this isn’t insurance: You’ll pay for everything out of pocket, only at a reduced out-of-pocket rate. For example, a GP visit is ¢8,000 ($13) instead of ¢40,000 ($65) and a visit to the cardiologist will run you ¢23,000 ($37) instead of ¢57,000 ($92). Still, you’ll pay for everything, so if you need surgery, prepare to pay not only your doctor but your hospital fees, your OR fees, your medication costs, your overnight costs, and etc. etc.
Pro Tip: Most residents, if they’re inclined toward private healthcare, run a split between public and private (also see below, re: Medicina Mixta) and stick to private healthcare for smaller costs and public healthcare for major surgeries, emergencies, and other big-ticket healthcare items.
Pros and Cons of Private Healthcare
In addition to the cost, here’s what you should know about private healthcare in Costa Rica:
The Costs Add Up
As you may have gleaned from the above, the cost of private healthcare varies. And it can vary wildly. If you’re older (say, 55+), prepare for your private insurance premiums to hike. (Older than 80 and they can climb sky-high.) Require a specific medication that’s not on the Caja list? It can be 4x, 5x, 10x the cost you pay back home.
That said, Costa Rica’s out-of-pocket healthcare costs, even for private healthcare, don’t even begin to approach U.S. costs. For example, while birth can cost $10,000-$25,000 in the U.S., it’s usually about $5,000 in Costa Rica (even at the “fanciest” hospitals). Lasik eye surgery? $1,500 vs. $4,500 in the U.S. So, it’s all relative.
But You Can Choose English-Speaking Doctors
One of the perks of private medicine is that you can choose your doctor. Don’t like your choice? You’re free to go somewhere else. And this freedom of choice means you’ll have full access to Costa Rica’s wide network of English-speaking professionals (many of whom studied in the U.S., Canada, and Europe).
And Private Doctors are Everywhere
While with Caja healthcare you’ll have to visit your assigned clinic, Ebais, or hospital, with private healthcare, you can visit anyone, anywhere (unless your private insurance deems otherwise). And that’s a great thing because Costa Rica’s network of private doctors, specialists, labs, and pharmacies is vast, reaching into even the most rural areas.
Wait Times are Short
Need an appointment with a specialist? You can probably get one today. With private healthcare, your wait is almost always very, very short.
And You’ll Be More of a Participant in Your Healthcare Decisions
Whereas with public healthcare in Costa Rica, your attending physician views your need as a true need (and therefore “prescribes” the resulting procedure, surgery, etc., if it’s available at all), with private healthcare, you have more latitude in your healthcare decisions. Want that Lasik surgery? You can have it. Prefer to give birth in a birthing pool or standing up? The choice is yours.
In summary, private healthcare is all about balancing your preference and comfort with your willingness to pay for those things. Again, most residents choose a balance of public and private: When the cost is relatively low, go private; with costlier procedures or surgeries, go public, when possible.
Mixed Medicine: A Balance of Public/Private Healthcare in Costa Rica
Medicina mixta, or mixed medicine, is a popular schema for local healthcare. Without getting into all the technical details, mixed medicine essentially mixes public and private via doctors and specialists who work both for the Caja and in private practice.
So, what’s the big deal? In a nutshell, mixed medicine can help you jump the line: Book a private appointment with a doctor or specialist who also works with the Caja, and you can avoid some long waits. If you’re seeing a specialist, mixed medicine can also offer a fast-track to Caja prescription medications – and an English-language fast-track, at that!
As mixed medicine is really just a mix of public and private healthcare, there are no specific pros or cons, costs or concerns associated with it. Essentially, use it when it works for you. When it doesn’t, revert to your choice of full-public or full-private healthcare.
From Special Places and Karl Kahler
Living in the dry tropical forest of Guanacaste during months with names like January, February and March, you begin to wonder if it will ever rain again.
Skies are blue, cows are dry, and your car looks like it hasn’t been washed in months.
Hundreds of thousands of tourists flock to this place during this supposedly ideal period.
“Honey, should I pack a raincoat?”
Depending on the time of year, you may or may not find rain gear necessary.
“Sweetheart, what part of ‘February’ don’t you understand?”
When to expect Costa Rica rain
Guanacaste is a true outlier in Costa Rica because it’s the driest region in a very wet country. There are parts of Costa Rica that get 7 meters of rain per year – that’s more than three Shaquille O’Neals. Yet Guanacaste is almost always perpetually sunny from December through April.
The unique ecosystem here is known as “dry tropical forest,” with the “dry” indicating that it doesn’t rain here as much as it normally does in other tropical regions. Much of Guanacaste looks like the plains of Texas, or the savannas of Africa.
December through April is called “summer” in Costa Rica, while the rainy season from May through November is called “winter.” There is no spring and there is no fall.
Of course, the weather patterns are totally different on the Caribbean coast, where the gods of rain make their own rules. They say there are two seasons in the Caribbean: the rainy season and the really rainy season.
But here in Guanacaste, a strange thing happens at some point in April after months of clear skies. Dark clouds drift in, you hear thunder in the distance, and the sky changes to a weird yellow color.
Next thing you know, it’s pouring rain, and you’re so delighted you want to go out and dance in the mud puddles. But first you have to close all your windows, or everything you have is going to get wet.
It takes a lot of rain to make a rainforest.
Rainy season lovers
It’s no secret that the locals here love the rain. It smells great, it washes everything clean, and it gives you a great excuse to take a nap.
During the dry season, dust tends to accumulate on all the plants, especially next to roads. Costa Rica is never ugly, but sometimes it’s a bit dusty.
Then that first downpour washes everything clean – every leaf in the forest! The rain also prompts fresh growth, making new plants spring up everywhere. Costa Rica becomes, if possible, even greener in the rain. This is why the rainy season here is often called the “green season.”
You’ve probably been told that if you come to Costa Rica you need to bring rain gear. Yet you’ll almost never see a Costa Rican wearing a raincoat. Some Ticos live 100 years without ever owning a raincoat.
So what do they do when it rains? They find a roof to stand under, that’s what. Downpours here tend to be brief. Oh, and a lot of people carry umbrellas.
You rarely see Costa Ricans wearing raincoats, though they often carry umbrellas.
One remarkable feature of the Costa Rica rain is that it almost always occurs in the afternoon. This means that even in the height of the rainy season, both tourists and locals can go about their day in the morning without getting wet.
Go ziplining, go fishing, go birdwatching, go shopping, whatever, but do it early. By midafternoon, you’ll be looking for shelter.
It usually rains in the afternoon, allowing you to enjoy the outdoors in the morning without getting wet.
And there’s no finer pleasure than to be under a roof during a Costa Rican thunderstorm. Sometimes it rains harder than you thought possible. And then it rains even harder than that. And then it rains harder still!
You find a hammock, a rocking chair, a comfy bed. You find a book, a magazine, you scroll through your Facebook feed.
Lying in a hammock under a roof is a great way to enjoy a rainstorm.
Then the power goes out.
“Honey, we need to buy candles.”
“No, YOU need to buy candles. It’s raining, we only have one umbrella, and you’re the husband.”
“OK, I’ll be right back.”
“Be careful not to get wet.”
Rainy season haters
Judging from Costa Rica’s tourism numbers, most visitors come here between December and April looking for blue skies and sunny beaches. Perhaps they come from rainy, cold places like Seattle or Sweden and they just want some sun for a change.
That, of course, is fine. But, but, but….
The dry season, by happenstance, coincides with Costa Rica’s two biggest holidays – one is the week between Christmas and New Year’s, and the other is Semana Santa, the week before Easter.
Never mind the tourists – during these holidays most Ticos travel too, and almost all of them go to the beach. Prices for everything are through the roof: lodging, restaurants, transportation, tours, you name it. Merchants can charge what they want because demand is so high. Everywhere you go is more crowded, and driving can take hours longer because there are so many cars on the road.
Most parts of Costa Rica are more crowded during the Christmas and Easter holidays.
But why? Why not visit Costa Rica during the rainy season? Are you afraid of getting wet?
Costa Rica is one of the most biodiverse countries in the world, with 1 out of 20 animal species living here, in a country that occupies just 0.03% of the world’s landmass.
Enjoy the rain — it’s only water!
Why are there so many animals here, and why are there so many plants?
Rain. They love the rain.
The Meaning of Pura Vida in Simple English and Real Life
Perhaps no other country has a motto so charming, so universall…
Category: Discover Costa Rica
Published on April 13, 2022 by Karl Kahler
Borrowed from my good friend and great realtor Michael Simons!
Costa Rica is Truly Free!
In his first official act as President, Rodrigo Chaves eliminated the obligation to be vaccinated and the mandatory use of the mask. Also, the refusal to be vaccinated will no longer be grounds for dismissal in the public sector. Only front-line health care workers are required to be vaccinated and wear masks.
The first decree, No. 42543 canceled the former government order of mandatory vaccination against covid-19 for public employees. The second decree, No. 42544 cancels the mandatory use of facemasks in public spaces. The mandatory use of face masks will only be mandatory for front line health care workers.
The newly elected President said that the purpose of the decree was to give Costa Ricans freedom and responsibility to make their own decisions about their health.
You no longer need any COVID test, health pass or insurance to visit Costa Rica. Unfortunately, the pathetic leaders of Canada and the USA, still require you to take a COVID test and/or show proof of vaccination to return.
Why on God’s earth would you go back?
Come on down baby. AND STAY!
This article will appear in the June edition of Howler Magazine. Candy and I will be famous 🙂
Snowbirds in Paradise
After spending all our lives enduring the cold Canadian winters of western Canada, my wife Donna and I decided to make the giant step toward living part time in paradise. I had worked as a surface land man in the oil and gas industry and travelled many an icy road on cold snowy winter nights. Prior to that I was a forest ranger and spent time in many parts of Alberta freezing in the cold. My wife Donna was a dental hygienist and she also spent a lot of cold evenings commuting to work in Calgary on icy snow covered roads. After spending many winter holidays in Costa Rica and enjoying the sunshine, warm beaches and friendly people, we made the decision in 2007 to live part time in paradise.
For many snowbirds the idea of leaving the Canadian health care system is worrisome despite the great private and public health care here in paradise! So, if that is your worry, try the part time snowbird gig! Depending on your province, you can spend 180 days or more outside of Canada each year. A lot of people miss the Canadian seasons, so how about just missing one season – old man winter that can be 6 months or more, as recent snowfalls in Calgary in May prove! For American snowbirds, you will find the private health care system here to be top notch for half the price. Many Costa Rica specialists spend a lot of time in the best medical universities and hospitals in the USA and many speak English.
We enjoy our life here in paradise and keep busy travelling the country and doing the things we love to do. Having lived in Playas del Coco and Playa Hermosa (Guanacaste beach towns), the mountains of Guanacaste (incredible back country horse back riding) and Escazu in the central valley (beautiful weather), we are back living in Playas del Coco on the NW Pacific coast. Over the 15 years of living in paradise, we have had many adventures in this wonderful little country. To keep us busy, we teamed up with the number one real estate firm in the NW of Costa Rica – Tres Amigos Realty Group. What a great group of people from all over the US and Canada and Costa Rica! They keep us young and busy.
The Guanacaste area has a lot to offer! Great weather year-round and you can pick your climate for the day! Stay at the beach and enjoy the year-round warm ocean water or head out to the mountains (1 hour drive) to enjoy cool breezes, hot springs, canopy tours, horseback riding – whatever your pleasure. Only 25 minutes to the international airport makes our NW coast the most accessible, both coming and leaving paradise.
So, if you are thinking of making the move or just spending part of the year in the sun, give us a call or email. We are here to help you plan your escape to paradise! With our 20 plus years of visiting and living in Costa Rica, we can answer the questions you may have about the health care, culture, the people, security, where to live and even help you pick your weather. The transition has not always been easy adjusting to a new culture, but our experience can help you avoid some of the bumps along the way – Pura Vida!
Tres Amigos Realty Group
Costa Rican Cell: 011-506-8996-8683
Toll Free from US/Canada: 1-587-703-7924
Until 2018, the immigration (residency) process was relatively straightforward. Even though the DGME (Immigration) mandate was to process correctly prepared and submitted applications in 90 days, they went past that deadline. Still, my application approvals (and that of other competent service providers) averaged 4 to 7 months. Then came the crisis in Venezuela and Nicaragua (not a coincidence). Through its agreement with the U.N., Costa Rica was obligated to take in many refugees that it could ill afford. This overwhelmed the already faltering DGME system. Residency application approval times ballooned to 12, then 15, and 20 months.
Then came covid. Total system shutdown for many months. In October of 2020, in addition to questionable travel restrictions unsupported by natural science, one of the most onerous overkill initiatives within the immigration process was a burdensome appointment system that barred the door from smooth logistics for most applicants and, for many, turned into a nightmare. As though that was not enough, since March 16 this year, in fulfilling the requirement of post-residency application approvals of enrolling in CAJA, applicants were shocked to learn that they had to now enroll in a pension fund that they would never collect. In many instances, it resulted in a doubling of the previous monthly CAJA premiums.
Cumulatively, these issues caused despair for many current and would-be applicants for residency, as reflected
in social media conversations – and most certainly in my email inbox.
In response to those emails, I speculated in articles that there existed a strong possibility of a reversal of this discouraging degradation of services to residency applicants and an imminent reversal of that CAJA pension enrollment.
My speculations seem to have been bolstered as of yesterday’s seismic event: The inauguration of the 49th president of Costa Rica.
If this man and his very carefully chosen new team succeed in just half of their lofty goals, there will be a massive change for the better for all those engaged in the residency process (let alone all Costa Ricans desperate for change.)
One of the ideas mentioned during the election campaign was that if a bureaucracy cannot process an application in 90 days (assuming it was prepared correctly), it will automatically be considered approved. I am not holding my breath for that one, but indeed things like after-service surveys may produce steady nudges for vast improvements through better management and staff training.
So I encourage you, the discouraged, to read the compelling speech delivered by newly elected President Rodrigo Chaves this past Sunday. He is fluently bilingual, has spent much of his professional career in the U.S. and abroad, and “gets it” about how Costa Rica has to up its game to compete on the global market. Including making things much more attractive for foreign investment, tourism, and retirement. The screeching wheels of infuriating bureaucracy are about to receive and thorough lube job by a new breed of ministers carefully chosen for their skills and competency and who will be held to strict account.
Hopefully the stake of accountability has been driven through the heart of nepotism and indifference.
BTW: Within ONE HOUR on the job, President Chaves nixed the face mask and vaccine mandates. Free at last.
Therefore, there will no longer be justification for these ridiculous appointment systems. Look for them to be disallowed. Soon.
I translated the following speech to English for your benefit.
It will get you up to date on the country you chose to retire in and should provide a clear perspective to alleviate your fears and uncertainties.
With the solemnity, gravity and sense of historical responsibility that the times impose on us, I am honored to receive this presidential sash in times of extremely important challenges, not only for the future of our country, but for the very destiny of humanity. (Attention globalists. LG)
The Costa Rican people, by electing me, placed in my hands the responsibility of leading the country’s destiny for the next four years. With reverence and humility I say: they have and will have in me, during all that period, a faithful Mandatory – that is to say, someone who, from this moment and until May 8, 2026, will aspire, with all my efforts, to fully abide by your mandate, to fulfill and ensure that the will of the Sovereign People is fulfilled in all tasks of the State, within the rigorous framework of the Law that governs us.
The moment we live in is crucial. We are the ones called to make a historic change. And that call is imposed with the force of the voice of the people who demand from the polls an enormous obligation to the entire political class, which includes, of course, the three powers of the Republic.
It is time to leave behind the old practices that cost us so much, and rightly so, the Costa Rican people.
We are seeing ourselves before a mirror whose image we do not like, because it presents us with two faces that do not seem to reconcile. In short, the least benefited and the most vulnerable class of our country.
It is no coincidence that, in 2020, before the pandemic, about 60% of people between the ages of 18 and 22 said they had not finished high school. We see in that same mirror the face of working people, of people who have been concerned with training in the hope that their families have the standard of living they long for, that they deserve, or that, despite not having formal studies, they have used their ingenuity and their ability to work to get ahead. But at the same time it is the face of hundreds of thousands of people who see the day end without a job with which to face the personal needs of the next morning. It is also the face of nearly a million people trapped in informal employment. (Costa Rica’s population is 5,100,000 – LG)
It is a country whose soil has the capacity to feed us all, but it is also a country where hunger sits on the table of hundreds of thousands of people, who do not earn enough to even buy the basic food basket. .
It is a country whose bicentennial democracy, with proven roots in our civic culture, has captivated the peoples of the world. But at the same time, we see in that mirror in which we look at ourselves, detachment and mistrust of the parties and traditional politics, which does not imply any renunciation or denial of democratic values, but, on the contrary, expresses the desire for a more authentic experience of Democracy and supposes a more genuine and transcendent assessment of its fundamental practices.
The image reflected is that of a country that, over the decades, has built a strong, robust institutional framework, but that in recent years has seen, with shame, impotence and just anger, how the institutions have not provided quality public services or cleaned up their structures of the infamous ballast of corruption.
The outrageous waiting lists of the Costa Rican Social Security Fund, (CAJA) which for years have subjected thousands of Costa Ricans, is not only a systematic violation of the right to health, but is also humiliating and distressing for those who medical care means life or death.
Not even the rulings of the Constitutional Chamber have moved the foundations of the Fund. We look at ourselves with astonishment in that mirror because it is not the Costa Rica that we want. We do not want the country where the streets wear out the clock of life in endless prey. We do not want the country of rural areas that see with sadness and helplessness, from afar, how the gates of development and the economy only grow in the central zone of the country.
(Note: Most ex-pats live in the rural parts of Costa Rica. – LG)
This is the mirror in which all of us, Costa Ricans, are looking at ourselves. A mirror full of contradictions, of dreams that refuse to be part of our reality, of dreams that do not have the shoes to run, much less the wings to fly. Those contradictions are more than figures in academic studies. They are more than the alarming data that, year after year, the State of the Nation reveals to us. Those contradictions hurt us.
These contradictions make the life of our citizens harder, more difficult than it should be in a democratic, peaceful and rich country like ours. These contradictions hurt in the absent bread on the table, they hurt in the young people who must make the difficult decision to leave their studies to contribute to the family support, or, worse still, in the young people who have fallen into the hole bottomless drug addicts, or have joined the ranks of organized crime.
Will we, compatriots, be able to make history?
Will we be able to really lead Costa Rica towards the future it deserves?
Will we be able to make the people who live in this great country dream again, and not just dream, but have the opportunity to build that dream into reality?
That is the great challenge that we must overcome.
I know very well that the challenge seems very hard. And it is! But, compatriots, let’s not fall into the trap of despair. Let us not allow ourselves to be overcome by the darkness that some have wanted to sell us, as if they wanted us to think that change and progress are not possible. Prominent figures of the ruling political class, flippantly, and perhaps as an excuse for not having made the decisions that should have been made, have made us believe that Costa Rica is an ungovernable country.
It is not about ungovernability, but about making the decisions that need to be made, no matter how complex and controversial they may be. It is also a question of courage, even though these decisions go against the interests of small groups, those who have used their influence and power to benefit through public policies that have only diminished the welfare of the majority.
“The country is happiness, pain and heaven for all and not feud or chaplaincy of anyone,” José Martí told us, with words that speak to us not from the past, but from a tremendous present, from the permanent struggle for the desire for good common expressed in the citizen’s will.
I am very clear that if I put forward the beacon of that citizen’s will, I will never get lost.
If I put forward the path that each one of the men and women who voted for me, and also those who did not, have outlined for me, I will never use the excuse that this country cannot govern itself, because the order of the people is that it govern.
And that I do it with leadership, with energy, with determination, with humility, but, above all, with the conviction that each of my decisions and those of my team are guided by a will that has spoken, that demands of us, that it requires us to act for the good of the majority.
I say this, of course, bearing in mind more than anyone that the change that the country demands is not about an ambition or a personal project of a man named Rodrigo Chaves, but about rescuing a democracy, and that is up to all of us .
In the long history of more than 200 years of democratic life in the country, this possible historical accident, this, for many, unpredictable setback of the political orders, comes to raise the possibility of definitively changing the course of our lives.
As Margaret Mead said, “Never doubt that a small group of thoughtful and committed citizens can change the world. In fact, it is the only thing that has achieved it.”
This change cannot be achieved by the will of a single person, but by the character of the thousands of Costa Ricans who, with their honest work and unquestionable dedication, build the country day by day. Costa Ricans who have demonstrated countless times the greatness of their spirit, leaving our country high in the most varied disciplines of sport, in the most beautiful forms of art and in the most innovative scientific discoveries and research.
Costa Ricans who, from the most diverse and complex conditions, today seek, with the best of their efforts, with the frankness of their actions and the commitment of their work, the honest sustenance of their tables and the modest tranquility of their families .
I know that at this moment many of these brave Costa Ricans must be watching or listening to this speech from their homes, worried more about the hunger that attacks their bodies than about the possible virtue that they can find in the words of this servant who speaks to you today.
I am aware that my eloquence should be the improvement of the conditions of thousands of Costa Ricans and not the beauty of a speech.
I also know that many others, disenchanted by the ghost of the unfulfilled dreams of previous governments, will not take the trouble to follow with an attentive ear the simple words of this man whom they decided today to name with such a high honor.
To all of you I address myself and say, see me as what I am, a humble instrument to fulfill the mandate of the people, a people that together can achieve the urgent change that history imposes on us.
See in me a counselor, who, in the full use of his powers, will seek no less than the best in the administration of this Government that unites us all, and nothing other than a future of peace, dignity and work for future generations.
See in me a facilitator, who, through a respectful and attentive dialogue, will seek the conciliation of a people that today is divided between deputies, unions, businessmen and institutions that for years have undermined each other’s development to obtain some benefit at the expense of the majority.
Today I tell you that the idea that they want to sell us of a tidy house – vanishes before the reality of the country. The reality is very different and it is a reality that is undeniable for us! As much as some want to continue scamming us.
Today we bravely face the imminent obligation to repair the country and fight with the conviction that God protects us and that it is only through the honest work of our hands and not through the indolent spirit of conformism that we will be able to build a worthy homeland for our children. and daughters.
We’re not just going to tidy up the house. We are going to rebuild it! This is the sign of our times, it is the urgent urgency for change, the deaf cry of a democracy that we will not let disappear!
I will not accept defeat, we do not have to accept defeat! I will never accept it because I know that the wealth of this country goes beyond its ecological diversity; it goes beyond its unique culture and traditions in the world; it goes even further than its unrepeatable history.
It is its people that make this country rich. My people, you are the ones who enlarge our homeland.
People who know as well as I do that there is a need for more employment, to lower the cost of living, for more tranquility in our homes and streets, to dream again, to trust again, to believe again that leaders still exist politicians who seek the best for the country.
It is the fundamental need of a country like ours! It is the plain certainty that our democracy is strong and that it will not be overthrown!
Costa Rica is a great collective force that beats like a heart full of hope.
This collective strength throbs in every corner of our nation, in the constant rush of the streets, in the commercial waves of the ports, in the offices and their comings and goings of papers and computers, in the sweet breeze of the countryside that feeds us, in the warm aroma of the home where our sons and daughters are raised.
I address this youth and tell them: Young people! I know that they must be tired of hearing that they are the future of the country, when their future is mortgaged to them from the cradle. A girl is born today in Costa Rica and, instead of carrying a loaf of bread under her arm, she carries a signed promissory note with thousands of dollars in debt. We are going to dismortgage the future of these young people. We will build your tomorrow with a prosperous present full of opportunities.
Women, you are part of that incessant beating of the Homeland. We will not tolerate the harassment they suffer every day and in all spaces of society. It is not possible for women to be afraid of walking alone in the street, it is not possible for women to be afraid in their own home, in their own work, in a park, at a concert. That is why my first political commitment as president-elect will be to stop discrimination and harassment against all women in all areas of our country.
We owe older adults, the inextinct force of our nation, more than we could name because the benefits we enjoy today as a country are the fruit of their efforts. You will not be abandoned anymore, because you deserve a fair old age, you who with your work built the foundations of this your country.
To our original peoples, who happily today, for the first time in Costa Rican history, have the representation of an indigenous deputy, I want to say: You will be included! We will repair that historical debt that fills us with shame and that has separated us as if we were different, when in reality we are all Costa Ricans with common desires and hopes.
I assure the LGBTIQ population that we are not going to go backwards in the recognition of the rights that they have achieved throughout their struggles for equality and appreciation for diversity, struggles that I respect and that I guarantee will continue unscathed in their victories.
To the public universities, origin of much of the force that has moved the country and that, I have no doubt, will position us in unimagined places, I say: we respect your autonomy, but we also recognize that autonomy does not mean or allow waste.
It is an arduous task to forge the future of youth, which requires effectiveness and efficiency in the use of public resources.
To public employees I say that the responsibility of their positions carries the weight of giving the country the commitment and dedication to serve their fellow citizens and support them, but they know that abuse and exploitation will not be tolerated.
(IE: Bureaucracies will be held to much higher standards of SERVICE – how-did-we-do? surveys.)
To the private sector, the primary driving force behind our economy, I say: we will let you work. We will also remove the obstacles that have historically prevented entrepreneurs from taking the place they deserve as key players in the country’s development. Yes, we will let them work, but we also say to those businessmen who have lost the “north” of ethics: Do not corrupt our officials! We will not allow that! Don’t expect the government to give away to some what belongs to everyone: the private monopolies are over! The privileges of public policies to favor some at the expense of the majority are over.
To investors, the country is responsible for its debts, we have never failed to pay, we will do what we have to do to honor our obligations to our people, to our public employees and to our creditors.
To our unions, we remind you that the issue is not government or the private sector, but a fair but firm search for the well-being of all the people who work in the country. The forces of the opposition are also forces of the people. They are also that common heartbeat that unites us as a country. Let’s build bridges that recover the people’s so damaged trust in their political leaders. Let us show Costa Rica the greatest courage of all: the ability to sit at the table, look each other in the eye with transparency and reach consensus that will bring peace, tranquility and development to our nation.
I also have something to say to those who use our territory as a bridge to export and store drugs: consider yourself notified. Find another territory! We will not tolerate their presence in our homeland.
To the corrupt, to those who direct organized crime, to those who frighten our citizens in the streets, we will not give them respite.
If the State cannot guarantee the security of its inhabitants, we have failed as a country, and failure is not admissible for those who serve the Homeland with love.
To the international community, we remind you that our tradition is and will be pacifist.
In Costa Rica, thank God, there is not a single armed and trained soldier as such, we do not have a cannon, much less a war tank or a combat plane, nor do we have artillery or armored ships that sail our seas. We are not a military threat to anyone at all. And it is in fidelity to this pacifist and civilist tradition that we call on the powers of the world and other governments to make a real commitment to harmony, reason, peace and respect for human dignity.
Let us pray for the peaceful solution of Russia’s war against Ukraine.
To you, to all of you, I am writing, paraphrasing the poet T. S. Elliot, saying that what we often call the beginning is often the end and that to reach an end is often to begin again.
That is, the end of a government becomes our starting point.
With the fear of God, which I consider to be the basis for the wisdom of a ruler, I end by saying:
This is our time. We are working, deciding, improving.
Costa Rica, the best is yet to come!
May God bless you and may God bless Costa Rica.
May work and peace always live. Thank you very much.
Updated on May 14, 2022
From Outlier Legal Here is the link to their website for more information www.outlierlegal.com
As noted in an article we recently published, there are new Costa Rican Social Security Fund (better known as the CAJA) rates that apply for residents in Costa Rica who sign up after March 16, 2022.
This time, we are going to share some issues we have noted with this regulation and how it affects the people who already have obtained residency or are in the process of applying for it.
For further details, check out our past publication regarding the new CAJA rates for migrants. We will also post more articles about this in the upcoming weeks, since it is a matter our legal team is analyzing profoundly.
What is the main change in CAJA rates?
The significant change with the regulation is creating the requirement for certain foreign nationals (immigrants) with residency in Costa Rica to pay for additional insurance. Specifically, the additional insurance refers to making contributions to the pension system.
Previously, Immigrants were only required to pay the portion of the CAJA fees only covering for health care services, which is called Insurance for Illness and Maternity (Seguro de Enfermedad y Materninad or SEM for its acronym in Spanish).
However, the recent modification is requiring immigrants to pay for the insurance portion which covers pension or disability income (Invalidez, Vejez y Muerte or IVM for its acronym in Spanish).
So, this is the main change. Before, immigrants were not required to pay for IVM — now, they are.
Who is actually affected by this change?
We can review this from two perspectives. On the one hand, whether it affects people who already have residency, and on the other hand, whether it affects all categories of residency.
Regarding the former, people who already have their residency and DIMEX cards on hand are not affected by this change. Conversely, it affects all people who have not completed the residency process and do not have their DIMEX cards, and thus have not yet signed up for the CAJA insurance for residents.
The regulation does not establish (and thus there is no clarity of) whether people who will renew the residency in the future will see their CAJA fees increased during the process of renewal of CAJA benefits. This is a subject to be explored.
Regarding the latter, according to regulations it should only affect a few categories of residency, not all. However, due to the lack of clarity of the language, it can be inferred that the intention is to apply it to all categories of residency.
Section 1 of the regulation states that it is applicable to “all Costa Ricans who reside in the national territory, or rentistas and pensionados who do not work directly or indirectly”. These people can register as voluntary registrants.
Now how do we define rentistas, pensionados or voluntary registrants?
According to the regulation:
- A pensionado: a person who does not work (either as self employed or as an employee) and receives a pension from a foreign pension system.
- A rentista: a person who does not work (either as self-employed or as an employee) and receives income.
As noted above, there is no clarity. While they initially state in section one that these regulations should apply to Costa Rican rentistas and pensionados, later on in Section 16 is established that the regulation is applicable to all migrant people (immigrants) who do not work in Costa Rica.
The issue with this is that there are several other categories of residents who are not pensionados or rentistas who do not work in Costa Rica, or do not have an income in Costa Rica, who are considered immigrants under the language of the regulation.
Considering the language of the regulation, we can establish that it is applicable to pensionado (retired) and inversionista (investor) residents, and the inconsistent language may result in also being applicable to other categories such as rentista residents.
A primary healthcare facility from the CAJA in Nicoya, Guanacaste
Specific issues with the regulation
As noted above, this new regulation is applicable to people who do not have residency yet and it shall not affect the people who already have residency and DIMEX card. We must go a step further.
The registration with the CAJA is a requirement for the residency process. It is not possible to complete the residency process and obtain the DIMEX unless foreign nationals are registered with the CAJA. Thus, this makes the CAJA requirement an intrinsic part of the residency process.
This new regulation (if at all) should be applicable to people who initiate the process of residency since March 16, 2022 (first day of validity of the regulation). Conversely, it should not be applicable to people who have initiated the residency process prior to March 16, 2022.
Thousands of foreign nationals have come to Costa Rica and decided to apply for residency under the expectation that certain regulations will be applicable to them.
At the moment we see how many people who are finishing the residency process which they started a long time ago (considering how long the residency process takes and how long it takes the Immigration Department to grant appointments for filing due to the Covid-19 pandemic) are hit by the surprise that their CAJA fees have almost doubled from what was initially expected.
Another significant issue is whether the requirement to pay the IVM insurance is reasonable for foreign nationals.
As noted, the IVM is a pension for disability and retirement for old age. Is the CAJA going to pay pension to foreign nationals with residency (as defined in the regulations) who make contributions to the IVM? The answer is no. How come?
Well, in order to receive a pension from the CAJA, the contributor (in this case a person with residency) must have made a minimum of 180 monthly installments, which adds up to fifteen years of contributions.
So, if we apply this to a person who obtained residency as a pensionado we must imagine a person who currently receives a government pension from abroad which requires to be at least 65 years old to qualify for that government pension.
Therefore, we are telling this person that they must pay into a pension system in CR for 15 years for them to start collecting a pension when they reach 80 years of age.
That is not reasonable.
As noted in previous occasions, foreigners have protections under the Costa Rican Constitution, which demands for them to be treated equally as Costa Rican nationals.
Thus, these protections and the right to equal treatment extend to many areas of the Costa Rican life and legal system. When it comes to the topic at hand being the modification of the regulations for the registration of certain immigrants, we spotted some issues affecting the equal treatment.
Namely: Right to work and income-based fees from the CAJA. In this instance, Costa Rican nationals are allowed to enroll with the CAJA as voluntary registrants. The CAJA fees are going to be based on their income, but they are allowed to work.
Consider that the objective of the IVM is to supplement income (in the manner of a pension) when people stop working, by receiving a pension. This is allowed to Costa Rican nationals, but foreign nationals are required to bear the financial burden without being allowed either to work nor to receive the pension.
This is not equal treatment; it puts foreign nationals at a disadvantage when requiring to bear the financial burden with no access to economic activity or the possibility of having access to the benefits which is the purpose of the IVM system.
D. Access to healthcare
This is not an exhaustive list, but last we will like to address the issue regarding the ability of receiving healthcare services for foreign nationals.
Among other things, the new regulations include the limitation to receive medical assistance within six months of registering with the CAJA.
Under the Costa Rican Constitution, access to healthcare is a fundamental right and as such it cannot be limited in such manner. This type of limitation is not applicable to other CAJA registrants such as people on payroll.
The sole purpose of healthcare coverage of CAJA is to provide medical assistance when people need it.
CAJA is not a for profit corporation, and the objective of the organization is not to generate money — rather, it is to provide healthcare (and income security) to the population at large.
I understand that for many decades the Costa Rican government and the population at large have been concerned about the impact that immigrants have in the healthcare system (and other public services such as education and judicial services), but the solution is not to generate undue burdens and discriminatory practices to a section of the population.
Rather, the CAJA must focus on collecting the money owed by the largest debtors to the system, particularly the government. The Costa Rican government owes billions of colones (hundreds of millions of dollars) to the CAJA, which are not being paid.
We have a commitment to protect the rights of our communities as contemplated in the Constitution. As noted, we have identified some legal issues with the new regulations, and we are currently evaluating the legal avenues we can take to address these challenges.
Certainly, we cannot guarantee success, but as usual, we will give it our best shot. Sometimes we succeed, many other times we learn better.
Updated on April 14, 2022
A big question many North American tourists have when they travel to Costa Rica is how much they should tip. It’s a natural question, especially for Canadians and Americans who live in a culture where you tip everyone from the restaurant staff and taxi drivers to bellhops and tour guides. Not tipping can be considered rude and insulting, right? Is that the case in Costa Rica, too? Here’s a quick guide on tipping in Costa Rica, so you have a better idea of how much cash to have in your wallet during your travels here.
Tipping culture in Costa Rica
First, you should be aware that most hotels and restaurants will add 13% tax and a 10% service charge to your bill. This means a 10% tip is already included in your bill, and no additional tip is needed. Ticos very rarely tip when they go out to dinner, though this may seem odd to North Americans.
Since tipping isn’t something Costa Ricans are used to, most workers in the service industry aren’t going to be offended if you don’t leave a tip. However, it doesn’t mean they won’t appreciate the extra money. Wages for workers in the service industry fluctuate wildly, depending on where the business is located and the type of establishment at which they work. For example, in Tamarindo, a hotel restaurant marketed to international tourists will generally have higher wages than a soda – a small restaurant that serves a predominantly local clientele. Therefore, a tip may be an essential income supplement for some employees.
Illogically, however, it’s mostly the wealthy tourist centers in Costa Rica that have gravitated toward a tipping culture. Businesses in places such as Tamarindo, Potrero and Playas del Cocos will often have jars with the word propinas (Spanish for tips) on them by the cash register. [You can argue that tipping has led many business owners to cut costs and to use tips as an excuse to pay less than a living wage, but that’s a topic for another blog.]
What should you tip in Costa Rica?
Cultural aspects aside, there are some things you should know about restaurant and bar tabs, hotel bills and other services you may hire while traveling in Costa Rica.
First, as noted, restaurants usually include a 10% service charge in your bill, so you’ll be paying this “tip” whether you want to or not. Most restaurants will indicate impuestos incluidos (“taxes included”) somewhere on the bottom of their menus. You’re free to add something extra if you think it’s warranted, but if you calculate your tip as a percentage of the entire bill, you’ll be tipping on the 23% already added for taxes and service. Still, no tip will be unappreciated, even if it’s 1,000 or 2,000 colones ($1.50 or $3).
Costa Rica hotels also add the 13% sales tax and 10% service charge. They may give you a receipt with a vacant tip section, but you may wonder exactly where this money will go, and you shouldn’t don’t feel obligated to add anything. Sometimes hotel maids leave an envelope in your room welcoming a tip, and if they’ve done a good job, feel free to leave them a couple of bucks. Or if a bellhop enthusiastically hustles your bags to your room and shows you how everything works, there’s no harm in handing him a small bill.
If you rent a car in Costa Rica, you’ll undoubtedly need to fill up with gas. Bear in mind that self-serve gas stations are non-existent in Costa Rica – so do not attempt to put gas in your car yourself. Full-service attendants will take care of that for you. They may also offer – or you can simply ask them – to wash your windshield and check your oil and tires. If gas station attendants provide these kinds of services to you, one could argue that they’ve earned a tip of 1,000 colones or so.
At many beaches and other tourist areas, you’ll find yellow-vested parking attendants enthusiastically waving you into a space where they’d like you to park. They’ll give you a friendly greeting as you get out of your car and will often say “Se lo cuido” – “I’ll watch it for you.” And when you get back, they’re more than happy to help you back out of your space, even if it means stopping other cars on the road.
It goes without saying that these attendants are expecting a tip, even if it’s a dollar. Some of them may be employed by nearby hotels and restaurants, or they may be part of a community service initiative designed to keep popular tourist areas safe. But they definitely rely on tips for the majority of their income, and they earn it by spending all day in a parking lot watching cars. And there’s value to you in knowing that you can relax on the beach for four hours knowing that someone is keeping an eye on your car. It’s always a good idea to carry small bills when you drive to tip people like this.
Boat captains, taxi drivers and tour guides
As a rule, Ticos don’t tip taxi drivers. In big cities such as San José or smaller pueblos such as Villarreal, taxi drivers don’t usually expect a tip from locals. However, in this day and age, they may expect a gratuity from someone who doesn’t speak Spanish and is a tourist. As a rule, a tip of 1,000 (red bill) to 2,000 (blue bill) colones is sufficient, depending on the length of your journey.
Tipping is more common when it comes to boat captains or tour guides. For example, if you take an all-day fishing excursion, you may want to tip the captain up to $50 for bringing you to the sweet spots and helping you hook all those marlins. The same goes for any tour guide, who may be herding you and dozens of disorderly tourists around while trying to educate you on local culture while at the same time directing you to the nearest bathroom and trying to get everyone back on the bus on time. It can’t be easy.
Tipping in Costa Rica
Tipping in Costa Rica is a matter of personal choice and comfort. Many domestic and international tourists travel through Costa Rica and don’t tip. It doesn’t mean you shouldn’t. It just means that anything extra you give will be much appreciated, but not expected.
You shouldn’t experience the aggressive transactional expectation of being harassed for tips or made to feel guilty about not tipping. You should find a relationship of mutual respect and professionalism, where a tip is earned and not taken for granted. So, if it makes you feel good about your Costa Rican travel, then, by all means, share your propinas.
Posted on March 31, 2022
Costa Rica is on its way to the total lifting of the sanitary measures activated as a result of the COVID-19 pandemic.
Find below the sanitary measures that have been lifted and that are about to be lifted in the coming days:
The mandatory use of a mask remains in force, as well as distance measures (1.8 meters), cleaning, and disinfection of workplaces.
To obtain legal advice in Costa Rica on immigration and labor law, do not hesitate to contact us.
Posted on March 30, 2022
Playa Ocotal is a wonderfully peaceful place to enjoy swimming, snorkeling, and relaxing in the sun. Scenic hills and cliffs hem in the beach, and the Catalina Islands sit just offshore. The quaint village of Playa Ocotal is located a few minutes south of the popular beach town of Playas del Coco, where visitors can find numerous restaurants and nightlife options.
The calm waters of this part of the Pacific beckon sport fisherman from all corners of the globe
Fisherman anchor at Playa Octal, a safe haven at night away from the open ocean
The tranquil beach of Ocotal is situated in Costa Rica’s stunning Guanacaste Province on the northern Pacific coast. In Guanacaste, you will encounter an amazing world of pristine white sand beaches lined with swaying palm trees, endless summer days, and breathtaking sunsets. The region is home to a vast stretch of tropical dry forest that houses abundant wildlife and beautiful birds.
Playa Octal provides welcome relief from the otherwise inaccessible shoreline in this region. This black sand beach is an incredible pearl located within the beauty of Guanacaste.
Activities near Playa Ocotal
Playa Ocotal is a fantastic place to scuba dive with Manta Rays, schools of tropical fish, turtles, sharks, and octopus. Sport fishing, Surfing, Horseback riding, and sailing are also popular activities in this area of Costa Rica.
The fish are bountiful in this part of ocean, and fishing thrives in this area
The hills of Ocotal are home to beautiful Villas with incredible views of the beautiful beach and ocean. Bahia Pez Vela just over the hills to the south is a unique resort with ocean view and beach access villas and home to a great restaurant. While Ocotal itself is home the famous Father Roosters with its renowned Margaritas on the Beach. Los Almendros on the north side of the beach has great condos and Villas as well. Great for a vacation get away or a permanent retirement home. Do not miss the opportunity to visit Playa Ocotal when you are in Guanacaste. Just 30 minutes from the International Airport. You can be on the beach within two hours depending on customs and immigration. Still the best location in the area are beaches of Playa Panama, Playa Hermosa, Playas del Coco and Playa Ocotal.
Posted on March 30, 2022
CAJA sticker shock.
For those who don’t yet know, one of the requirements for residency here in Costa Rica is that you must enroll in our national healthcare system (CAJA) upon approval of your residency application. You will be means-tested to assess “fairly” what you can afford to pay—the greater your income, the higher your CAJA premium. As of March 16th of this year, the premiums took a significant hit. More on that below.
Some crucial perspectives:
Those from countries like Canada, the U.K., or the E.U. will be familiar with such public systems. And mostly unimpressed. Particularly in the U.K., these universal “free” systems are bankrupt and not functioning well for those needing care for something more than a broken wrist. If you are over age 70, you may be blocked from certain types of care no matter the urgent need. Private care remains your only option. (Henry Ford and Beaumont Hospitals in Detroit get a lot of business from cash paying Canadians unable to get served through the “free” public system across the river in Ontario.) I mention Canada because it is often held up as a glowing example of a public healthcare system. Plus, I have lived in and gained citizenship there before returning to Costa Rica.
I remain shocked at how many math-challenged Canadians think that their healthcare is free. Nothing could be further from the truth. As with all public – government-run services, it is, in fact, grossly overpriced. Costs are also primarily influenced by Big Pharma. (Another dark subject we can skip for now.)
Quick example: In London, Ontario, I accompanied my late father-in-law to a local hospital for bladder issues. During the 7 hour visit, I noticed a steady parade of sickly-looking adults and many kids coming through the emergency room doors. At the time, there was some overblown swine flu terror. Most visitors were seen, patted on the head, and assured that what they had was just flu. I observed this for hours before inquiring of the triage manager what the hospital charged the government for each of these visitors with only the flu.
“Between $800 and $1,100 each.”
So much for free.
The point I am trying to drive home here is that if you require any medical attention, one way or another, you are going to pay dearly for it. (Which is why there is much emphasis on preventive care in poor Costa Rica.) At the same time, you will also pay for others who cannot afford to pay anything. Yes, we are our brothers’ keepers and, as such, must help out in a fair and equitable manner. The strong helping the weak and vulnerable. That is the stated mandate of any public insurance system. But those public systems are the most susceptible to abuse and fraud. Why? No one sees the bill from the medical provider to the government, which makes for a massive lack of transparency and accountability.
Unlike Canada, in Costa Rica, the public and private healthcare systems operate side by side. Many ex-pats and Ticos use both. When in a hurry for things not very costly, they go to the private clinics a la carte. If they can endure the long wait times with the public system (CAJA) on more serious issues, for economic reasons, they wait it out and get their medical attention at CAJA, where for the most part, the service is still world-class.
Unfortunately, that combination of side-by-side public and private systems opens up the opportunity for some doctors to double-dip. (certainly not all) They straddle both systems, and to make a complex story short, CAJA gets abused through over-billing and illegal use of their facilities.
Delinquency in paying premiums is also a pervasive problem involving high-profile corporate entities. (And even political candidates!) The other daily drain on the system is the steady flow of Ticos with nothing more than a sniffle, headache, or hurt feelings seeking emergency attention for such trivial matters. After all, they think: It’s free, and I get personal attention sorely lacking in my life at home. I wager that if everyone had to pay just 3,500 colones (USD$5) at the triage desk, visitor traffic would be reduced by 30% or more. There are other issues and complexities, but these are the broad strokes for now.
Costa Rica is hardly unique. This is a global problem over which entire elections are won or lost.
This was all happening before March of 2020.
Then COVID hit and was accompanied by economy destroying overkill social distancing restrictions of movement. Through studies by highly credible Johns Hopkins researchers and many others, those restrictions to movement have been proven ineffective and needless. The results? Those restrictions caused the permanent shuttering of over 1,600 businesses in San Jose alone. Think of all the employees and suppliers. Then consider the tax contributions collected from all those people. The country-wide unemployment spike caused a massive drop in CAJA contributions, creating shortfalls to the system. This is despite many dire warnings from cooler heads against these overkill social distancing initiatives. They continue to wreak economic havoc here in Costa Rica and around the world. ANY kind of insurance coverage is destined to see a spike in premiums this year. As are taxes, oil & gas, food, transportation, fertilizer costs to mention just a few.
You cannot have the populace stay home and get paid with printed money to do so and not have that followed by a tidal wave of inflation. We were warned over and over. Yesterday’s highly criticized economic predictions labeled as conspiracy nonsense are now today’s realities.
So read what follows through the above perspectives.
CAJA Has Two Parts:
The CAJA system here is comprised of two elements: Healthcare coverage – and – pension contributions. Think Social Security (U.S.) or CPP (Canada.) Anyone approved for residency under the various categories must enroll in CAJA before having their residency (DIMEX) cards given to them. Up to March 15th, 2022, their enrolment was only required into the healthcare portion of the system. The pension portion was only a requirement for native Costa Ricans.
Foreigners now signing up for CAJA must participate in both parts of the system: Healthcare and Pensions.
Post-March 15th, monthly premiums for those approved as Pensioners (Pensionados) or Investors (Inversionistas) have almost doubled. While Rentista has not been mentioned in this new initiative, the CAJA staff apply the exact formulas for that category at CAJA signup. There is a constitutional law in Costa Rica that does not allow retroactive applications of these new rules. Therefore, all those previously signed up need not worry about similar rate increases. At least not yet.
For those still awaiting approvals on their Pensionado or Inversionista residency applications, count on these new premiums to apply when signing on to CAJA. Following your signup, there is a system to challenge the assessed premiums. But I am putting more faith in class action and group communications of protests rather than individual efforts unless you have deep pockets to play in court.
How much will you be assessed?
When Pensionados sign up, CAJA staff will now ask to see your proof of pension submitted to the DGME with your residency applications with which the DGME approved your applications. CAJA will use that monthly pension to calculate your monthly premiums.
For Rentista, they will use the USD 2,500/month figure on the approval Resolucións. (Based on three separate client encounters just last week.) Rentista is not mentioned in the new rule changes – yet. Count on an amendment.
I am uncertain precisely what math will be used to calculate premiums for those that qualified for Inversionista. This method may have changed with these new rules. I will cover that in more detail in a subsequent article, and by that time, I also hope to have official clarity on Rentista registrations.
*So that you know what to expect, refer to this latest chart used by CAJA in the attached Image*
1) Pensionado with USD $1,500/month income:
(1,500 x 6.24%) + (1,500 x 7.24%) = $201 Monthly CAJA Premium.
2) Rentista with USD $2,500/month income:
(2,500 x 8.2%) + (2,500 x 7.65%) = $396 Monthly CAJA premium.
I do not yet have clarity on one other question: What is the age break – if any – on someone who gets the CAJA pension premiums added to the mix? IE: If I am a Pensionado aged 60 – 65 – 70+, and I pay into the CAJA pension system, at what age can I expect to start collecting my benefits? (It may be that I overlooked the answer in the voluminous 112 page PDF announcement from last September in La Gaceta. I’ll keep investigating this week.)
This all comes as a severe jolt to many who budgeted for lower monthly premiums. I know there will be massive blowback on this issue from many quarters. My constructive suggestion is that the ex-pat community form groups and send professionally and rationally written letters and emails of protest to their respective embassies to leverage the impact of such protests. Don’t leave it to someone else. Fight requires effort.
Also, here is the contact information to the “complaint department” at the ICT (Costa Rica Tourism Board):
Email – [email protected]
Be sure all such communications to her are officially translated into Costa Rica Spanish by an official translator. (Not abysmal Google translate). In the meantime, we will endeavor to get more meaningful information to guide all applicants through this situation to affect a fair outcome for all concerned.
There may also be more help on the way to reverse or adjust these rates by the new government to be sworn in after the April 3 runoff election. Though still not impressed with either choice, I have switched my allegiance based on stated intentions by one of the candidates/parties currently leading in the polls. Make much noise about this issue in public forums, Embassies, and to the ICT, so the pressure builds on the politicians and bureaucrats responsible for this poorly thought out change to the system. (Hopefully many will be replaced with new blood not part of the good ole’ boys club.)
Comparatively, even with all its flaws and problems, the Costa Rican healthcare system still offers better value for the healthcare premium dollar when compared accurately to other countries. Also of significant consideration: The unique healthy environment of Costa Rica and abundant, economical field-to-table fresh produce available year-round remains one of the main benefits of living here. I have lost count of how many clients have told me of dramatic improvements to their health and reductions in prescriptions in just their first year of living here. This lessens the need to access CAJA. Let’s not lose sight of what remains of significant benefit.
And no matter what happens in the future, one thing will never occur in Costa Rica: