Health care costs and Medicare

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.

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6 Responses to Health care costs and Medicare

  1. George and Kathy Ernst says:

    Arden, thanks for changing my mind. First for CAJA, everything about price is determined by the guy sitting behind the desk. We filled out the forms, went with Randi. We did the whole thing in Spanish (which helps, I think). In the end he asked Randi what she pays and she said 20,000 colones. He said that sounded good so that’s what we pay. Not scientific to be sure, just a number out of the blue.

    We think like you. Caja Emergency is good, but for regular stuff, the typical American ( read me) is not going to stand on line at 7:00AM to see the “free” doctor. We go to a mixed practice doctor, pay a few bucks with an appointment and then expensive meds like Kathy’s COPD inhaler stuff goes through Caja for free Vs several hundred $$ en la farmacia here. For something like chest pains or Xrays, it is off to Cima. Those things are still cheap here as compared to the cost of US insurance premiums. Now here’s where you just affecred my thinking. I was going to go to the embassy to cancel my Medicare part B that will be $115/month next year. I am 71, almost middle-aged. What if I need a procedure like Louise? Big bucks here. If I keep my part B, I can take a $100 flight to Miami and see the best surgeons in the world basically for free. I am going to keep it!

    • arden says:

      Yeah, I actually think keeping medicare as an option just as you describe is smart here. Until the grandbaby came along, that’s what we’d been thinking, but now with other more pressing reasons to move back, access to medicare counts as just another really good factor for making the move. I’m always glad when something I’ve written has served to help someone, so I’m glad you told me!

  2. Sharon Rochester says:

    By joining ARCR you and David would just pay $49. a month and your mom would also just pay $49.00 a month. The membership fee is just $60 a year for a husband and wife. Another $50 for your mom. You could save $1314.00 per year or almost $110.00 a month by doing this. I know you are leaving, but new people need to know about this.

    • arden says:

      Hi, Sharon,

      Yep, but you know what it would be like to schlep mom down to San Jose for the change-over process?!? ;-) Plus there’s there’s the dues to ARCR themselves. (Not a lot, but have to be factored in.)

      Long-term, if we were to be staying, we might eventually switch over to the ARCR CAJA program, but in the short-term it just doesn’t work. It IS a very good thing for others to be aware of though, so thank you very much for mentioning it. For us, all other things considered, compared to utilizing mom’s and David’s medicare, it’s no contest.

      Glad to have you reading and hope you’ll comment often. That’s what makes a great blog!

  3. Tom Duffy says:

    Hi Arden, great finally meeting you on George’s tour in November.

    How much does an INS policy cost. I am 62 and my wife is 58. We are both in good health. I understand that if you buy it through ARCR you can get a better group rate.

    • arden says:

      Hi, Tom,

      Yes, always fun to finally put a “real person” with a previous email exchange! ;-) I’m not sure I could make any terribly intelligent guess as to the cost of the INS policy for you specifically. We know relatively few people who have the insurance and the few we do know have not have very good luck getting them to pay out on things. (From what we’ve seen with other folks, INS seems to be very good at establishing that whatever you need to have done is somehow connected to a pre-existing condition, which they exclude.) One friend, who is in his 50s, I think pays around $1200 a year (and I think that includes a bit of discount for paying annually) and it seems once I’d seen some kind of “rate chart” and it got up to $160 to $180 a month or so as you got older. I’ve understood that it’s nearly impossible to get if you don’t *start* the policy before you’re 65 (although once you’re enrolled it can continue past that age) so your age would be on your side, which is good. We’re not ARCR members, so I can’t speak to that, but it seems possible. You do get a “group rate” on the CAJA through ARCR. How soon are you all thinking of coming down?

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