Buying Additional Medical Insurance

By Leonard Timm


Last summer, my wife and I decided to evaluate adding private medical insurance to the coverage we already have through Costa Rica’s National Healthcare System, CAJA. 

However, we had two concerns; first, the medical services provided by CAJA are very “basic”, often slow and generally of lower quality than what we have grown to expect back in the U.S.  While CAJA is quite inexpensive (approximately $50/month for the both of us), should we find ourselves needing catastrophic medical care, we wanted the premier medical services which are only provided at Costa Rica’s preeminent private hospitals (i.e. Clinica Biblica, CIMA or Hospital Catolica).  Secondly, CAJA stops at the border.  We needed insurance that would cover us when we traveled outside of Costa Rica, especially when visiting the U.S. 

Since Sally and I are too young to qualify for Medicare, it seemed that our best solution was to augment our existing CAJA coverage with good, private medical insurance.  We assessed the risk/benefit of the added insurance options in a pretty loose manner.  If it seemed reasonably priced with reasonable coverage, we would buy it.  In addition, since we are in relatively good health (physically as well as financially), we felt that we could handle some medical expenses without “breaking the bank”.

After checking a few competing insurance plans, we settled on INS, the Instituto Nacional de Seguros.  INS is a Costa Rican governmental operation that offers private insurance plans to Costa Rican residents.  In other words, Perpetual Tourists need not apply. 

While they have many plans from which to choose, all can be boiled down to two basic types.

  • REGIONAL PLAN:  This covers you only when you are in Central America for up to $200,000 per year but may be extended to pay up to $400,000.  In our case, the plan’s premiums cost us (in total) $2,200 per year for the $400,000 annual option.

  • INTERNATIONAL PLAN: This, as its name implies, provides coverage worldwide, whether you are in or out of Costa Rica.  Because medical care outside of Costa Rica can be more expensive, this plan will pay up to $2,000,000 per year in benefits.  This sounds like a lot, but should you suffer from a long term, chronic ailment, this amount can be consumed quite quickly, especially if you are in the US.  The premiums for International Plan would have cost us $4,600 per year.

  • ARCR MEMBERS TAKE NOTE:  If you are a member of the Association of Residents of Costa Rica ARCR), you can qualify for a 10% discount off any INS plans purchased.


The most important thing to consider when evaluating any potential insurance provider is how they handle pre-existing conditions. 

In the case of INS, regardless of any plan you choose, they do not cover preexisting conditions… ever.   Let me make this point crystal clear, Sally and I have friends here in Costa Rica who both husband and wife have cardiac stents.  These medical devices were implanted many years ago as a preventative measure against future heart problems.  As a result, both individuals, who are in good health, with perfect blood pressure and cholesterol levels, will not receive any benefit from INS if they have any sort of cardio-vascular related event. 

This will include a stroke, heart attack, high blood pressure or even swelling in the extremities.  If INS can tie a medical problem back to anything that is heart or circulatory related, no benefits will be payable.  



We quickly nixed INS’ International Plan but we still needed a plan to cover us when we were outside the region.  Next we checked international travel/medical policies with Bupa Worldwide Insurance.  Bupa would cover every time we left the borders of Costa Rica for up to 30 days.  There is no coverage limit.  Although they exclude preexisting and current health conditions, it may be possible to petition Bupa to include them, especially if you have been free and clear of symptoms for 2 years or more. 

You will be required to pay for your treatment (up front) and receive reimbursement (after the fact).  Sally used the coverage for a $150 doctor visit on a U.S. trip last winter.  She submitted her receipts (electronically scanned PDF files) and the reimbursement was deposited directly to our bank account within a few weeks.  So far, so good! 

Like most insurance plans, premiums are based on age group.  Together, our first year with Bupa cost us $400.  Next year we will receive a 25% discount when we renew.  As far as I’m concerned, this is the deal of the century – full coverage in the United States for $300/year!   Of course, you can buy single trip coverage.  But, if you travel much out of country, for less than a month at a time, this is the best arrangement.


Last spring we paid $2,200 for INS Regional and another $400 for Bupa International.  Along with our $50/month payment to the CAJA, we are spending right at $3,200 a year (almost $270/month) for our healthcare.  That’s not bad when you consider couples back in the States are paying $1500 month (or more) for less coverage!

So here it is 2012... like many of its neighbors, Costa Rica is teetering on financially hard times.  The government is trying to do the only thing it knows (i.e,. raise taxes) to stave off inevitable disaster.  A not-so-little thing called the Costa Rican budget deficit has caused price increases on just about everything the government can easily tax or sell and that includes groceries, gasoline, government services and it appears, medical insurance.

When it was time for us to renew our policy in April, we were informed that our rates were being bumped to $3,200, from $2,200!  In fairness, my wife’s birthday moved her into a higher priced age bracket, but the lion’s share included almost a 40% rate increase, and that’s after the ARCR discount.

We decided to let our policy lapse as it no longer met our loose “cost/benefit criteria.”  From my perspective, it is quite likely the government will continue to raise the insurance rates to even higher levels.

We could change our minds some day.  Costa Rican insurance is still inexpensive (by U.S. standards).  In the meantime, we will continue to use CAJA for any prescription medications that qualify under their rules and pay out of pocket for everything else.  And when we travel, we also enjoy the benefits of full coverage through Bupa Worldwide. 

I realize, self-insuring can be very risky but it’s a risk we are willing to take.   At least we can take solace in the fact that if we did have to pay out of pocket, our medical expenses would be drastically less in Costa Rica than in the United States.  Should even that threaten to “break the bank”, CAJA hospitals are still a fully-covered option.

Buena suerte!

If you’d like to do a little checking yourself, I’ve included some (English speaking) contacts to get you started. 

EDITORIAL DISCLAIMER: The listing of these contact names, this DOES NOT constitute an endorsement of these products, companies or individuals by the editors and publishers of


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