CAJA, INS, and private insurance: which one suits you as a foreigner
Many people pay double out of fear. The reality is that all three options complement each other, they don't compete. Here are the real 2026 prices and the combinations that make sense for your profile.
The three options, side by side
CAJA (CCSS)
US$50 – US$200 / monthPros
- Unlimited access to public hospitals, clinics, and EBAIS.
- Covers everything: emergencies, chronic conditions, maternity, oncology, transplants.
- No pre-existing conditions exclusions.
- Mandatory as a resident: you're already paying, use it.
Limitations
- Long wait times for specialist appointments (3–9 months) and elective surgeries.
- Hospital assigned by zone — you don't choose.
- Uneven hospitality quality depending on the hospital.
Ideal for: Everyone. It's the safety net that covers catastrophic events without ruining you. Those who underestimate it are the ones crying when a US$80,000 private bill arrives.
INS Medical
US$80 – US$250 / monthPros
- Private hospitals in the INS network (CIMA, Clínica Bíblica, Hospital Metropolitano).
- Specialist appointments in 1–3 days.
- Reasonable coverage limit (US$1M – US$3M depending on plan).
- Operated by a public entity (INS), regulated, stable.
Limitations
- Pre-existing conditions excluded for the first 1–3 years.
- Coverage only within CR.
- Some specialized treatments are covered by CAJA, not INS.
Ideal for: Young families and healthy adults who want quick access to private care without paying international premiums. CAJA + INS is the most common combination.
International private insurance
US$200 – US$700 / monthPros
- Global or regional coverage (Cigna Global, GeoBlue, IMG, Bupa).
- Access to private hospitals in CR + USA / Europe depending on plan.
- Useful for complex chronic conditions or overseas treatments.
- Medical repatriation included in many plans.
Limitations
- Expensive. Rises sharply after age 55.
- Pre-existing condition bureaucracy.
- May stop covering CR if you choose a global plan without local riders.
Ideal for: Older adults, complex medical cases, or people who travel frequently between CR and other countries.
Combinations that make sense
Instead of choosing 'one,' most well-settled expats combine:
Profile
Healthy adult, 30–45, no children
CAJA covers day-to-day. The 'catastrophic' private plan covers surgeries and major hospitalization with high deductible but low premium.
→ CAJA + major medical / catastrophic private plan
Total cost
~US$130/month
Profile
Family with young children
CAJA for vaccines, well-child visits, and emergencies. INS for quick access to a private pediatrician and clinic care.
→ CAJA + INS Medical family plan
Total cost
~US$280–US$420/month (family of 4)
Profile
Older adult (60+) with conditions
CAJA is essential — private insurers may deny treatments for pre-existing conditions. International covers what national private insurance won't accept.
→ CAJA + international insurance with CR coverage + repatriation
Total cost
~US$450–US$700/month
Mistakes we see every month
- Paying three insurance plans 'for safety.' CAJA + INS + full international coverage = US$1,000/month in redundancy. If you have international insurance covering CR, INS is unnecessary for most.
- Not using CAJA because 'I already have private.' CAJA is mandatory and you're already paying for it. Use it for check-ups, vaccines, major hospitalization. It's not a punishment.
- Waiting for an emergency to understand the timelines. Request your first appointment at your assigned CAJA hospital in the first 3 months. Have an open file before you need it.
Extended version with detailed figures and real cases: the blog post →
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