Pros and cons of Caja health care

From the print edition

We’re reading a lot about the Costa Rican Social Security System (Caja) these days, and it seems its pension fund is going to run out of money in a few years. This column will address instead the health care provided by the Caja. Even foreigners now must enroll in the Caja and pay dues.

Is it a waste of money? That depends on how you look at it. The care afforded by the Caja is widely criticized, and the usual complaints are: enormous queues, long waiting periods for non-urgent surgery and tests, no choice of hospital, clinic or doctor, and limited access to certain medications.

On the bright side, Costa Ricans have one of the longest life expectancies in this hemisphere, probably because of the Caja’s birth to grave care. Additionally, the Caja can’t turn anyone down; if you have legal residence you are eligible for Caja insurance, even if you happen to be at death’s door.

Pre-existing conditions will not be excluded, and once your Caja dues have been paid, there is no other charge or cost, deductible or copay. Additionally, there is no age limit for enrollment, and there’s no limit to the cost of the care Caja provides. It will not kick you out when you become long in the tooth, just keep paying your monthly fee and coverage will continue. The fee does not increase as a person gets older – it is a flat rate for everyone. 

For many foreigners, the Caja is the insurer of last resort: When people can afford private insurance and have few pre-existing conditions, they often opt for an insurance policy, which enables them to receive care at the best private hospitals and clinics without having to put up with the bureaucracy and inefficiencies of the Caja.

But when people emigrate, often their insurance policy in their original country will not be applicable in Costa Rica, so they have to change insurer, and most insurance companies will exclude those with pre-existing conditions. (Some don’t – talk to your insurance broker.) Those expats buy insurance to get good care in case of accidents or ailments, but they fall back on the Caja for health care despite pre-existing conditions.

The opinions and viewpoints expressed are those of the writer, whose purpose is to give the reader a better understanding of insurance in Costa Rica. For more information, contact David Garrett at david@unicencorredora.com.