Costa Rica insurance for nomads

Costa Rica runs two parallel systems and nomads end up using both.

The public side is the Caja Costarricense de Seguro Social, known locally as the Caja: universal, mandatory for legal residents, and well regarded across Latin America. It is also slow for anything non-urgent, with long waits for specialists and elective procedures. For day-to-day care most foreigners go private, where the experience is closer to what Americans and Europeans expect and the prices are a fraction of US ones.

Private hospitals worth knowing

The private hospitals worth knowing sit in and around San José. Hospital CIMA in Escazú is the one expats name first, and it is the only hospital in Central America accredited by the US Department of Veterans Affairs. Hospital Clínica Bíblica and Hospital Clínica Católica in the capital, along with Hospital Metropolitano, round out the private tier. English-speaking, US or European-trained doctors are common at all of them, which is why San José doubles as a medical-tourism hub. Outside the private tier and the main tourist towns, Spanish becomes the working language.

Pharmacies and emergencies

Pharmacies are easy to find and pharmacists handle minor issues directly. Antibiotics legally require a prescription, though enforcement varies, and many maintenance medicines are sold over the counter. A foreign prescription is not automatically valid, so bring enough of anything essential and plan to see a local doctor to continue it. The emergency number is 911, with bilingual operators, and the Red Cross ambulance is on 128.

Most nomads arrive as tourists. US, Canadian, UK, EU, and Australian passport holders get up to 180 days visa-free, though the exact length is set by the officer on arrival and is not guaranteed. You need to show an onward or return ticket, and officials can ask for proof of funds. Insurance is not a legal entry requirement for tourists. It was during the pandemic, but that rule ended on 1 April 2022.

The Estancia digital nomad visa

To stay longer and work remotely on the books, the route is the Estancia, the digital nomad visa created by Law 10008. It is aimed at people who earn from outside Costa Rica. The income bar is an average of at least $3,000 a month over the prior year, rising to $4,000 if you bring family. The official tourism site lists $5,000 for families, but the law itself says $4,000, so plan to the lower figure and confirm at application. The visa runs one year and renews once for a second, provided you spend at least 180 days in the country during the first year. The draw is tax: foreign income is exempt from Costa Rican income tax, and you can import the equipment you work with free of import duty.

The insurance condition

The condition that trips people up is insurance. The Estancia requires proof of at least $50,000 in medical cover for the entire stay, and every family member needs their own policy. An international plan or one from a Costa Rica-licensed insurer, regulated by SUGESE, are both accepted. On a tourist entry you have no claim on the public system and rely entirely on private cover; once you hold the visa, the $50,000 floor is the paperwork minimum rather than a sensible ceiling.

• The $50,000 is a floor, not a target. It sits well below what a serious admission or an evacuation actually costs, so insure above it rather than buying the cheapest policy that prints the number.
• Scooter and motorbike exclusions. Costa Rica is an outdoor country with a road-accident rate several times Europe's; the World Health Organization puts road deaths at about 15.5 per 100,000. Many policies exclude two-wheelers unless you hold a recognised motorcycle licence, so check before you ride.
• Dengue. Mosquito-borne and year-round, with a heavy 2024 outbreak of more than 30,000 cases before a sharp 2025 decline. Repellent and screened accommodation matter more than they sound.
• The Caja is slow for foreigners. It will treat a genuine emergency, but it is not a practical primary system for a visitor, which is exactly why private cover pays for itself.
• Prescriptions and paperwork. A foreign prescription is not automatically honoured at the pharmacy, and the official tourism site's $5,000 family-income figure contradicts the law's $4,000. Trust the law and confirm at application.