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Staying Healthy in Costa Rica

Unlike other countries in Latin America, especially Mexico, Costa Rica’s water supply is good and perfectly safe to drink in San Jose in Costa Rica's Central Valley, and in the majority of small towns accross the country. In most places you can drink the water without fear of Montezuma’s Revenge (diarrhea) or other intestinal problems. However, be careful when you drink water in the countryside. We have lived in Costa Rica for years and have not heard many people complain about the quality of the country’s water. If you prefer, bottled water is available. Just as in the U.S., there are about twenty brands of bottled water in different size containers sold at the supermarkets. You will be pleased that Costa Rica’s water is soft for bathing and washing your hair.

Although the Costa Rican government takes precautions to monitor the quality of the water and the country has high standards of sanitation, there are some precautions you should take. Wash and peel all fresh fruits and vegetables. Avoid drinking fruit drinks made with water that are sold in stands on the street. You should also watch out for raw seafood dishes, like ceviche, served in some bars and restaurants. This type of seafood is soaked in lemon juice and not cooked with heat. I personnally love it and have never had a problem.

Costa Ricans are proud of their nation’s achievements in the field of health care. Their up-to-date, affordable state-run “cradle to grave” health care system reaches all levels of society by offering the same medical treatment to the poor as those with greater resources. Hospitals, clinics and complete medical services are available in all major cities and some small towns. Over 90% of the population is covered the Costa Rica Social Security system.

Many international medical authorities rate Costa Rica as having one of the best, low-cost medical care systems in the world when preventive and curative medicines are considered. The United Nations consistently ranks Costa Rica’s public health system as the best in Latin America and one of the top 20 in the world.

Costa Ricans are a healthy people. The infant mortality rate of less than 11 in 100,000 live births in Costa Rica is lower than that in the United States. This figure is on par with any industrialized country in the world. Life expectancy is 76.3 years for men and 79.8 years for women. Today, an 80 year old man has a life expectancy of at least 8 years more. This puts Costa Rica in first place in the world for life expectancy from this age forward. Actually it’s 8.4 years. Iceland and Japan follow with 7.7 years. The Costa Rica women at age 80 are actually expected to live longer than the men of the same age, 9.5 years slightly behind the women of Japan and France.

Hospitals have the latest equipment, and laboratories are excellent. You can feel safe having most operations without returning to the U.S. or Canada. Most surgical procedures cost only a fraction of what they do in the U.S. For example, a heart bypass operations cost about a third of what they do in the U.S.

Even if you are in good health, the probability of needing medical care increases with age. The security of knowing that good health services are available represents an enormous relief. Thus health care should not be a major issue in your decision to live in Costa Rica.

Most Costa Rican doctors are excellent and have been trained in Europe, Canada or the United States. If you don’t speak Spanish, you don’t have to worry. Many local doctors speak English, but most receptionists and nurses do not. Doctor’s fees for office visits vary. A good private specialist usually charges between $30 and $40 for each visit, although some doctors charge a little more and others a little less.

Unlike many other places, doctors in Costa Rica take time with patients to answer questions and listen. Doctors usually give you their office, home and cell phone numbers as well as mobile paging number. It is not unusual for the doctor to call the patient at home to follow-up on care and medications, and they will make house calls.

If you join Costa Rica’s national health care system, you do not have to pay for each office visit, only a small monthly membership fee. If you have any questions about medical fees or doctors, you should direct them to the Colegio de Médicos, which is the Costa Rican equivalent of the AMA.

To find a good English-speaking physician or specialist, talk to other retirees, look in the Yellow Pages under Médicos or look for links under Explore Costa Rica's "Resources".

Public medical facilities are so good that you don’t usually need private care. Most private specialists are required by law to work part-time in public hospitals. However, private clinics and hospitals do provide quicker services with more privacy, enabling you to avoid long lines and the bureaucracy of the public system.

In Costa Rica the term Clinica is used for private institutions that generally include inpatient medical/surgical facilities, doctor’s offices, laboratories, radiology, pharmacy, and outpatient services. Hospital generally refers to a public inpatient medical/surgical facilities that also provide laboratory, radiology, pharmacy and related services.

You will be happy to know you can receive first-rate care at any of San José’s three largest private hospitals. The Clinica Bíblica (Tel: 2257-5252, 800 911-0800, Fax: 255-4947,E-mail:asoserme@racsa.co.cr, www.clinicabiblica.com), in downtown San Jose, is now affiliated with the Blue Cross-Blue Shield network. By 2005 they expect to be affiliated with Medicare. It is a first-class private hospital with an excellent coronary unit. This fine hospital is staffed with doctors who are highly trained. Complete hospital services as well as lab work are available.

To find out about benefits for military retirees and their families and for disabled veterns call (506) 522-1500/221-7717 or E-mail: seguros@clinicabiblica.com.

In addition to the main branch in downtown San José the Clínica Bíbilica has smaller satellite branches with a doctor on duty, pharmacies and express delivery of medicines in Heredia (Tel: 260-4959), Cartago (Tel: 551-0511), San Francisco de Dos Ríos (Tel: 218-0035 ), and in the San Pedro Mall (Tel: 283-6058).

The Clínica Católica (Tel: 2246-3006, E-mail: info@clinicacatolica.com, www.clinicacatolica.com), in Guadalupe, a suburb of San Jose, is another fine private hospital with complete hospital and emergency services 24-hours a day, 365 days a year.

Hospital CIMA (Tel: 2231- 2781, E-mail cimahsj@racsa.co.cr, www.hospitalsanjose.net), in Escazu right off the highway, is the newest private hospital in the San Jose area and is affiliated with the Baylor University Medical Center in Dallas, Texas and managed by International Hospital Corporation of Dallas, Texas. It is a full service hospital that boasts the latest health care technology, state-of the-art medical equipment and the most sophisticated physical plant in Central America. It offers complete services including X-ray, ultrasound, emergency and intensive care, as well as an advanced coronary unit. The average cost of a room per day is between $130 and $140, very reasonable when compared to the cost of a hospital in the United States. They have an adjacent seven-story medical office building where over 100 specialists have their offices.

Hospital Cima (Tel: 2208-1800) recently opened a smaller branch in the eastern suburb of Los Yoses about 100 meters west of the San Pedro Mall. They also plan to open a full-service branch near Flamingo Beach in Guanacaste.

The Clínica Santa Rita (Tel: 2221-6433), near the court buildings, has an excellent maternity center. The Hospital Cristano Jerusalem (Tel: 2285-0202), in the Alto de Guadalupe, offers limited services. Although not a hospital, the Clínica Americana (Tel: 2222-1010), next to the Clínica Bíblica, offers private out-patient service and U.S.-trained doctors on call 24-hours a day. San Juan de Diós (Tel: 22 22-0166) is the public social security medical facility in San Jose.

Hospital Universitario de La Universidad de Iberoaméricana, Tel: (506) 2297-2242, Fax: (506) 2236-0426, E-mail: admisiones@unibe.ac.cr, located in San Jose’s suburb of Tibás, is the country’s newest private hospital. It is a full-service university hospital where specialists treat all patients with students as observers.

C.A.R.E. Tel: (506) 2353-7456 or (506) 2282-2626 (beeper) or (506) 637-8606 (Los Sueños Resort) or (506) 643-1690 Jaco Beach) is a private emergency medical center located in the Jaco Beach area. They offer Medical consultation, an advanced life support ambulance, minor surgery and special events coverage. The clinic’s regular hours are from 8am to 6pm.

If you have to enter a private hospital, costs will generally be well under a hundred dollars a day. This includes a spacious private room and bathroom, cable T.V with English channels. Private and semi-private rooms are often have an extra bed or sofa bed so a relative may spend the night, if necessary.

We know an American who spent a couple of days in the private Clínica Católica hospital and said, “The attention was first class, the food was as good as home cooking, and the same care would have cost thousands of dollars in the States.” It is important to know that payment can be made at most hospitals and clinics with any major credit card. Foreign medical insurance is not accepted, but you may get a reimbursement from your health insurance company if they cover you abroad.

Health Visions Costa Rica Tel: (506) 2265-6394 or 367-3251,836-2328, E-mail: retireeva@racsa.co.cr or see www.healthvisionscostarica.com, is a service provider of all retired military, disabled veterans, qualified widows and their families health care in Costa Rica. HVC is structured in such a way that total medical care and medications are provided with no out of pocket cost to qualified members. We know a lot of veterans who are very pleased with this organization’s services. HVC is currently located in the Philippines, Panamá, Costa Rica and expanding to all of Latin America.

The following documents are required to be elegible:

A current U.S. military retired ID card
65 years or over must have Medicare Part B
Current ID cards for all dependents under 21 years of age; up to 23 years of age if in college with proof of enrollment
Copy of DD 214
must be enrolled in DEERS.
Unremarried widows must have the documents above for their husband
Emergencias Médicas Tel: 2290-4444 is a private company offering quick ambulance service. For a small yearly fee you can take advantage of their first-rate service.

Emergencias Metro is another company offering emergency medical transportation and care. You may contact them at Tel: 2263-2983 or emergenciasmetro@yahoo.com.

Low Cost Medical Insurance

Costa Rica’s health care system is available to retirees (pensionados) and other foreign residents. Residents may join the Caja Costarricense de Seguro Social (Costa Rican Social Security System) and enjoy the same inexpensive medical coverage as most Costa Ricans do. Most foreigners do not enroll in this system because of the long waits for medical appointments, some medications and other delays. However, the emergency care they provide is very good. They also have clinicas all over areas of Costa Rica.

Most foreigners and retirees opt for the medical insurance offered by the government’s insurance company—the National Insurance Institute or INS. Everyone is eligible to apply, including permanent residents, pensionados and even tourists. Elderly people have to submit to a physical before they can be insured. The medical policy covers expenses due to illness, accidents, hospitalization, office visits, lab work, medicines and medical costs in foreign countries. However, if you do incur medical expenses abroad, the INS will only pay the amount of the same treatment in Costa Rica and you have to pay the difference.

When you purchase a policy, the INS will supply you with an identification card and a booklet that lists the names of affiliated groups such as hospitals, doctors, labs and pharmacies. Most surgical procedures are covered 100%. You only pay a small deductible for office visits, labs, medicines and treatments. If you seek medical services not affiliated with the INS, you have to pay up front. You then submit a claim to the INS and will be reimbursed in a few weeks.

Depending on age and sex, the annual cost of this insurance is around $800 for a man between 50 and 69. For example, rates for a 18-39 year old man run around $250 per year; for a 70-year old man around $1,800; woman of all ages pay an average annual rate of about $1500. Women of childbearing age pay slightly more than men. There is a discount if more than one person is insured on the same policy. It is easy to enroll an entire family for a low monthly rate. If you belong to a group of fifteen or more people—like the Residents Association (ARCR) or American Legion— you can obtain around a 20% discount.

There is a ceiling of around $17,000 per individual. Since medical costs are so low in Costa Rica, this policy is more than enough to take care of your medical needs. Retirees and other residents need not worry about lacking adequate medical coverage in Costa Rica. For information, go to the Residents Association (ARCR) or contact them at: (Tel: 011-(506) 2233-8068), Fax: 011-(506) 2222-7862) or see www.arcr.net . You can reach the National Insurance Institute at (506) 2223-5800.

The INS now offers a new international insurance policy that covers your needs in Costa Rica and the rest of the world. This new medical policy covers medical expenses due to accident or sickness. Here are some of the items covered: Hospitalization and ambulatory expense, maternity, prosthesis, organ transplants, air evacuation, repatriation of remains, funeral costs and a yearly check-up and eye test. The rates are high but the coverage is very complete.

Comparing Costa Rica’s Health Care Plans

Here is a brief comparison of the C.C.S.S. (Caja Costarricense de Seguro Social) and the INS (Instituto Nacional de Seguros) medical plans available in Costa Rica.
C.C.S.S. - National socialized system.

Covers doctor’s visits, medications, examinations and hospitalization.
Doctors are assigned to the patient.
Covers pre-existing conditions.
Covers all medications including dental and eyes.
Some reasons to consider this plan.

Have pre-existing health condition and do not qualify for INS insurance.
Take medication on a regular basis.
Have it as major medical in case of serious illness.
Monthly premiums cover all illnesses for the member and his immediate family for that month. The cost, younger than 55 years old, $55 per month; 55 years or older $37 per month.

INS - The semi-autonomous governmental insurance company.

Covers 80% of the cost of doctor’s visits, medications, examinations and hospitalization.
Individual chooses the doctor.
Does not cover any pre-existing medical condition.
Does not cover most dental or eye exams, treatments or glasses, preventive medical check-up, illness or disorders related to female reproductive organs during the first 12 months of coverage, or birth of a baby during the first 6 months of coverage.
Some reasons ARCR members have the INS plan.

Can choose a doctor.
Can make doctor’s appointments with less red tape.
Rates of coverage depend on age and sex, 20% deductible for each doctor’s visit.

This program generally saves between 20 to 25% of the cost of medical, laboratory and doctor costs. Currently about 400 medical professionals are affiliated with the plan. Members receive a directory that gives the name of a doctor or medical service by specialty, the location, phone number and percentage of discount. Members of Association of Residents of Costa Rica (ARCR) quality for a discount of 35% in this plan, which sells for around $125.00 for a family or $100.00 for a single person. For additional information contact Servicios de Salud de Costa Rica Tel: 2256-4747.

Medibroker Tel: 0-191-297-2411/44-191-297-2411, Fax: 0-191-251-6424, www.medibroaker.com, is a company which offers medical coverage for retirees, expats and others living in Costa Rica and abroad. They have various plans from which to choose.

While checking out Costa Rica areas, to see if it is the place for you to settle, you can get temporary medical insurance as a tourist through the Costa Rican Social Security office and the International Organization of Cultural Interchanges (O.I.C.I.). Contact them at 011-(506) 2222-7867.

Medicines and Pharmacies

Pharmacies are numerous in Costa Rica and they stock most standard medicines available in Europe, Canada and the U.S. In general, the cost of most medicines is lower than those in the U.S. Most drugs requiring a prescription in North America are freely available “over the counter” in any Costa Rican farmacia . Exceptions are strong pain relievers and narcotics that require a special prescription. In Costa Rica, pharmacists are permitted to prescribe medicines as well as administer on-the-spot injections. They are also available to answer your questions and give free medical advice about less complex conditions.

Some pharmacies open 24-hours a day are in downtown San Jose at Clínica Bíblica Hospital, 2223-6422; at the Clínica Católica Hospital, 2225-9095; and at the Farmacia del Este in San Pedro, 2253-5121.

The main branch of the Fischel pharmacy (2223-0909), across from the main post office in San Jose. It has a doctor on duty to give medical advice. Fichel will deliver medicine and prescriptions in most areas. Many of their employees speak English. They also have smaller pharmacies in other locations around San Jose and in Heredia, Alajuela, Cartago and Puntarenas.

For home delivery call them toll-free at 800 Fischel (800-347-2435). Recently, Fischel opened the country’s first online pharmacy. They offer the sale of prescriptions and over-the-counter products. In addition, their staff of pharmacists and doctors will answer your questions. Their site also provides general information on topics such as proper use and storage of medicines. Fishhel doesn’t give very good discounts.

Farmacia Sucre and Farmacia Catedral are other large pharmacy chains in the Central Valley.