CAJA vs. Private Insurance in Costa Rica: What’s the Best Choice for Expats in 2025?

Thinking about healthcare in Costa Rica can feel like stepping into a maze—especially for newcomers. Should you rely on the public system, CAJA? Or spring for private insurance? As we roll through 2025, here’s the down-to-earth, up-to-date guide to help you make the right call.

First Things First: What Is CAJA and Why Do Expats Need It?

If you’re applying for residency in Costa Rica—whether as a retiree, investor, or digital nomad—you’ll need to register with CAJA, Costa Rica’s public health system, run by the Costa Rican Social Security Fund (CCSS).

Here’s the deal: once your residency is approved, you’re required to join CAJA and start making monthly payments. These contributions are based on the income you reported when applying for residency.

Your payment includes two parts:

• SEM: Health insurance
• IVM: Pension fund contribution

Let’s break it down.

What You’ll Pay to CAJA in 2025

Your monthly payment to CAJA depends on how much income you told immigration you’d have. Here’s what some typical contributions look like in 2025:

CAJA Contribution Examples (2024-2025)

Most expats will fall somewhere between $100 to $350 per month, though higher-income residents may pay significantly more. The rates are adjusted each year, so always check with CAJA or a legal advisor to get the current numbers.

Still Living as a Perpetual Tourist? Read This

In the past, some expats avoided CAJA entirely by doing regular “border runs”—leaving the country every 90 days and re-entering to renew their tourist visa.

But that strategy is getting more difficult.

As of June 2025, immigration authorities have tightened up:

• You’ll usually get 90 days at the border, not 180.
• Immigration officers can shorten your stay if they see red flags (like a return ticket that’s too soon).
• Your right to drive is only valid for the length of your visa stamp—so if you get 90 days, your driver’s license is only good for 90 days.

Bottom line: Living as a perpetual tourist is less predictable and riskier than ever. Consider starting your residency process.

How About Private Insurance? Let’s Talk Options

Private health insurance is optional—but for many expats, it’s a lifesaver. Literally and figuratively.

Here’s what’s available in 2025:

So… CAJA or Private Insurance? Or Both?

Let’s compare the two side by side:

CAJA vs Private Insurance, Pros and Cons

Why Many Expats Choose Private Plans:

• Appointments in private clinics are fast—sometimes same-day.
• You can choose English-speaking doctors and specialists.
• Many plans include extras like dental, eye care, and annual checkups.

Most expats use both systems:

• CAJA as the legal requirement and backup for emergencies.
• Private insurance for faster care and choice of doctors.

What Changed in 2025?

• CAJA premiums became a little more stable after previous spikes, but they’re still based on your declared income.
• Tourist border runs are now a gamble due to stricter entry enforcement.
• Private insurance plans are growing in number, but also getting more expensive, especially those that offer care outside Costa Rica.

What’s the Best Setup for You?

• If you’re a legal resident: CAJA is non-negotiable, but don’t stop there. Add a private plan if you value speed, choice, or international access.
• If you’re still a tourist: Relying on border runs is becoming unsustainable. You might not be able to drive, and healthcare without insurance is expensive.
• The winning combo? Use CAJA for peace of mind and private insurance for convenience and speed.

Final Thoughts

Living in Costa Rica is an incredible experience—but it’s not carefree when it comes to health. The best path forward for most expats is to embrace the benefits of both systems. That way, you’re covered whether you need emergency surgery or a quick check-up with an English-speaking doctor.

And remember: Good health coverage isn’t just a legal requirement—it’s part of your peace of mind in paradise.