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I just want to clarify and confirm my understanding of this:
If one has a pre-existing condition and is looking to settle down in Costa Rica your only options are the “Caja” system (Government Healthcare) or paying for everything “out of pocket” correct? The chances of being able to purchase “private insurance” in order to be able to go to CIMA or use their doctors is essentially “slim and none”. Do I have that correct? Thx.
That is not quite correct but it’s close. INS, traditionally the national “optional” insurance monopoly for all of Costa Rica, has excluded from coverage all pre-existing conditions. They will, however, issue coverage for all other conditions.
So suppose you have a history of osteoarthritis but otherwise your health history is entirely normal. INS’ coverage would not cover complications of your arthritis, but they would still cover (say) a broken bone, a heart attack, a stroke, pneumonia, etc.
If, like me, you’re diabetic, INS would probably surcharge you to cover cardiac events even if you have no history of cardiac problems. That’s because most diabetics die of heart disease. Likewise, other “associated” diseases and conditions might occasion a surcharge.
Some or all of this may change as other insurance companies enter the Costa Rican market in the wake of the passage of CAFTA as Mapfre has done already in the realm of vehicle insurance.
Is “INS” the Government healthcare system? When I think of “Government” healthcare I think of long lines…hours and hours of waiting…months to see a specialist…etc. which is why I’m differentiating between that system and the availability of private insurance.
Like you, I am diabetic and in the event I decide to explore living in CR I want to be able to have the ability to see not just an endocrinologist every 3 to 4 months but a retina specialist..podiatrist…etc. I am very “proactive” when it comes to my care because I feel that’s the best strategy to avoid complications and that involves the discipline of going to these various specialists on a regular schedule which I have here in the US. If that is not a realistic option in CR then it makes my decision making process very easy.
Thanks for the feedback.
[quote=”bogino”]Is “INS” the Government healthcare system? When I think of “Government” healthcare I think of long lines…hours and hours of waiting…months to see a specialist…etc. which is why I’m differentiating between that system and the availability of private insurance.
Like you, I am diabetic and in the event I decide to explore living in CR I want to be able to have the ability to see not just an endocrinologist every 3 to 4 months but a retina specialist..podiatrist…etc. I am very “proactive” when it comes to my care because I feel that’s the best strategy to avoid complications and that involves the discipline of going to these various specialists on a regular schedule which I have here in the US. If that is not a realistic option in CR then it makes my decision making process very easy.
Thanks for the feedback.[/quote]
No, INS [b]IS NOT[/b] the Costa Rican national health care system. INS is a private company which, for many years, has enjoyed a governmentally-granted monopoly on “optional” insurance. This is not unlike your local electricity utility which has a governmentally-granted monopoly to provide electricity in your area.
[u]INS is a private insurance company[/u]. In the past, if you wanted additional insurance coverage on your vehicle, if you wanted homeowner’s insurance, if you wanted life insurance, or if you wanted health insurance, your only option was to purchase it/them from INS. With the passage of CAFTA, that monopoly status is slowly changing. Now Mapfre and maybe other companies are offering optional vehicle insurance and other forms of insurance will follow.
By contrast, the CAJA [b]IS[/b] the national, governmentally-operated health care system. Whereas INS pays to purchase health care services from private sources, just like any American insurance company, the CAJA provides those services directly through its own clinics, labs, hospitals, pharmacies, etc.
If you become a legal resident of Costa Rica, you will be required to enroll in the CAJA, but you will not be obligated to actually use it. You will be free to also purchase insurance from INS, from Mapfre, or from whomever you like and be covered under the terms of their policies. Or you can obtain your health care services in the private sector and pay cash.
Nothing prevents you from seeing your private practice endocrinologist whenever you like. Nothing prevents you from having an A1c done at your whim. Nothing prevents you from using the drugs of your and your endocrinologist’s choice. Likewise, you can see an opthamologist whenever you wish. But you must understand that that freedom comes at a price. Either you’ll pay cash for those freedoms or you’ll have to obtain health insurance that will pay for them, and INS will not, inasmuch as they exclude pre-existing conditions from coverage.
You should also know that podiatrists do not practice in Costa Rica.
Since you’ll be required, as a legal resident, to enroll in the CAJA, you might consider a “blended” approach. See your endocrinologist privately but obtain your meds from the CAJA, if they provide whatever the endo prescribes (and they do not provide everything).
[quote=”bogino”]Is “INS” the Government healthcare system? When I think of “Government” healthcare I think of long lines…hours and hours of waiting…months to see a specialist…etc. which is why I’m differentiating between that system and the availability of private insurance.
Like you, I am diabetic and in the event I decide to explore living in CR I want to be able to have the ability to see not just an endocrinologist every 3 to 4 months but a retina specialist..podiatrist…etc. I am very “proactive” when it comes to my care because I feel that’s the best strategy to avoid complications and that involves the discipline of going to these various specialists on a regular schedule which I have here in the US. If that is not a realistic option in CR then it makes my decision making process very easy.
Thanks for the feedback.[/quote]
The health care system in Costa Rica, both public and private, is very good and very attentive to legitimate health care needs but you have to understand how it works and how to “play the game”, particularly with regard to access to specialists.
Most of the Caja doctors also see private patients and are affiliated with one of the many private hospitals and clinics such as Clinica Biblica, CIMA, Clinica Catholica, etc.
In your case, as a diabetic, you need to establish a relationship with an endocrinologist. What you do is to call around to the private hospitals and clinicas and ask if they have an endocrinologist who also works for the Caja.
Once you find one, make an appointment for a private consultation. The charge should usually be around 30,000 to 40,000 colones. Take your medical records with you and explain your needs. He should be able to prescribe your medications and schedule most or all of your routine follow up appointments through the Caja. If you need or want to see him more frequently or sooner than the Caja appointment schedule, bite the bullet and pay for another private appointment. Even paying for occasional private appointments, you’ll probably find your out of pocket expenses to be less than they are in the US.
[quote=”Jim S.”][quote=”bogino”]Is “INS” the Government healthcare system? When I think of “Government” healthcare I think of long lines…hours and hours of waiting…months to see a specialist…etc. which is why I’m differentiating between that system and the availability of private insurance.
Like you, I am diabetic and in the event I decide to explore living in CR I want to be able to have the ability to see not just an endocrinologist every 3 to 4 months but a retina specialist..podiatrist…etc. I am very “proactive” when it comes to my care because I feel that’s the best strategy to avoid complications and that involves the discipline of going to these various specialists on a regular schedule which I have here in the US. If that is not a realistic option in CR then it makes my decision making process very easy.
Thanks for the feedback.[/quote]
The health care system in Costa Rica, both public and private, is very good and very attentive to legitimate health care needs but you have to understand how it works and how to “play the game”, particularly with regard to access to specialists.
Most of the Caja doctors also see private patients and are affiliated with one of the many private hospitals and clinics such as Clinica Biblica, CIMA, Clinica Catholica, etc.
In your case, as a diabetic, you need to establish a relationship with an endocrinologist. What you do is to call around to the private hospitals and clinicas and ask if they have an endocrinologist who also works for the Caja.
Once you find one, make an appointment for a private consultation. The charge should usually be around 30,000 to 40,000 colones. Take your medical records with you and explain your needs. He should be able to prescribe your medications and schedule most or all of your routine follow up appointments through the Caja. If you need or want to see him more frequently or sooner than the Caja appointment schedule, bite the bullet and pay for another private appointment. Even paying for occasional private appointments, you’ll probably find your out of pocket expenses to be less than they are in the US.[/quote]
If you consider living outside of San Jose the CAJA system seems much more efficient. Also Check some US companies prices on international coverage only. NOT US coverage.INS is about $1600 for us but would have been over 5K$ if it included US of Empire coverage. They don;t want to pay $22 for two Tylenol either.:roll:
[quote=”bogino”]Is “INS” the Government healthcare system? When I think of “Government” healthcare I think of long lines…hours and hours of waiting…months to see a specialist…etc. which is why I’m differentiating between that system and the availability of private insurance.
Like you, I am diabetic and in the event I decide to explore living in CR I want to be able to have the ability to see not just an endocrinologist every 3 to 4 months but a retina specialist..podiatrist…etc. I am very “proactive” when it comes to my care because I feel that’s the best strategy to avoid complications and that involves the discipline of going to these various specialists on a regular schedule which I have here in the US. If that is not a realistic option in CR then it makes my decision making process very easy.
Thanks for the feedback.[/quote]
My wife and I use Caja exclusively. She is diabetic and has fibromyalgia and receives regular check-ups. She was also diagnosed with stage 1 breast cancer and is now cancer free but gets regular check-ups for this too.
I just went through appendicitis, peritonitis, hernia, septic infection from inappropriate home care and spent 29 out of 62 days in the hospital.
In our experience the Caja system is quite similar to medical care in the U.S. and the stories about long lines and long waiting times come from overwrought Americans.
Very interesting topic as I’m in Costa Rica for the first time for two months and have some chronic health issues. This information is helpful as I consider returning next year perhaps for a longer stay.
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