So far I’ve talked mostly about our moving back to be near our family (very true) and our growing realization that selling our house was a necessary financial decision (also very true). I’ve hinted that backing up those significant issues were some less significant “issues” with Costa Rica, and one of those is very simple: medical costs.
Like almost everyone who moves here, we’d read all about the amazing national health care system in Costa Rica. Essentially free, said everyone. Medicines would be free. Doctors and health care would be free. Hallelujah!
Well, we’ve had very good experiences overall with the quality of medical care here but the whole “free” thing has not turned out to be accurate at all. First, there are indeed monthly premiums and while they’re not all that high, they can still add up. Now, we’re admittedly, not the typical “family” in that we have our own (David’s and my) policy, which is nearly ¢40,000 or $80 a month, Mom’s policy which is almost ¢70,000 or $140, and we have to pay for our housekeeper’s policy, another ¢34,000 or almost ¢70 each month.
Now as side-notes, we’ve never known exactly why Mom’s is so high, although our best guess is her age. Her income (social security) is no higher than many other folks we know here, so that puts age as the only other variable. And technically Carmen, as an employee, is supposed to pay a portion of that premium herself, but that would come down to taking a few dollars a week from her pay, which seems both petty and a huge pain-in-the-butt to deal with, so we just pay it all and call it good.
So, we’re paying almost $300 a month for our “free” care.
Even so, of course, if it really were adequate medical care, that wouldn’t be too bad. But the challenge we’ve come to more fully understand after being here five years is that with a few exceptions, it’s woefully inadequate care. Again, not speaking of the actual quality of doctors and nurses, but simply of availability.
If you have an actual emergency here, you’re in pretty good shape. The “Urgencia” or Emergency Room/Department might well be overcrowded, as is likely to be true almost anywhere, but we’ve seen some very decent care in true emergencies.
In fact, these are the situations that are so typically written about, giving us all the mis-impression of this wonderful, nearly-free medical system. The mis-impression comes not from any untruths in the glowing story of the marvelous emergency care, it comes from mentally extending that out and thinking it applies to all medical care.
No, this is where reality sets it. It it’s NOT an emergency, then it is very unlikely that you’ll find the CAJA system to work well for you. There are exceptions, to be sure, and our friend Gloria, for instance, has had consistently good experiences with the CAJA. But they truly are the exception, not the rule.
Louise’s experience is more typical. She was having some chest pain and shortness of breath with exertion and, understandably, it really worried her. She went to the doctor — a “private” doctor who also worked for the CAJA, as is very common here — and it was determined that an angioplasty would be the answer. An appointment at the CAJA hospital was obtained and she was all set, right?
Well, only if she were willing to live with the pain and fear for nine months, since that’s how far into the future her appointment was.
They opted, as almost everyone who can possibly afford it does, to go the private route and she had her procedure a week later. Luckily it turned out that she only needed to have an angiogram for around $8,000 not the actual angioplasty which was supposed to cost about $15,000.
Note that the prices for those procedures were far less than they would have been in the U.S. Far less. So that’s good. If you have to pay for it yourself, then getting a better price is a much better way to go. And, ironically, that’s one reason that some folks who are not old enough to be eligible yet for Medicare find that medical care here is still a bargain. If they were going to be uninsured in the States, or be paying a fortune for private insurance, then the costs of private-pay medical care here can still work out to their financial advantage.
But, for folks like us where 2/3 of our family (that is, my husband and mom) have Medicare in the States, that advantage is pretty much lost.
It was pretty eye-opening for us, no pun intended, to waltz into a world-class eye center in Salt Lake City this past spring, flash David’s Medicare card, and waltz out again with new eyes after cataract surgery.
So for us, being back in the land of Medicare is definitely another factor in our decision to return to the U.S. It’s a considerable comfort knowing that Mom and David will be able to get care they might need for something much closer to “free” than what we have here.