Expat insurance and health insurance in Costa Rica

The Costa Rican healthcare system relies on the CCSS (Caja Costarricense de Seguro Social), a public scheme funded by tripartite contributions — employer, employee and state. An employee in formal local employment contributes around 10.17% of gross salary (health-maternity insurance, basic pension scheme, Banco Popular contribution), while the employer pays around 26.67% (health-maternity, basic pension, family allowances, INA training fund, labour capitalisation fund, supplementary pension, INS insurance). According to the UFE, every insured person benefits from free care in public hospitals. CCSS registration is mandatory for every legal resident of the country, including foreigners, from acceptance of the immigration file.

For foreign residents not working locally — pensionado, rentista or inversionista statuses — registration is under the CCSS's so-called "Asegurado Voluntario" (voluntary insured) scheme, a condition for obtaining and then renewing resident status. According to the UFE, retirees or people living on investment income pay around 10% of their declared income to this scheme. A bill aiming to exempt these categories from this contribution was reviewed and then dropped, with Costa Rica maintaining the contribution requirement for pensionados, rentistas and investors.

The private sector, concentrated in San José, is known for its medical tourism (dental, ophthalmology, cosmetic surgery according to the UFE) with facilities such as Hospital CIMA, Clínica Bíblica, Hospital Metropolitano or Hospital La Católica. France Diplomatie notes that a security deposit is generally required on admission to private facilities. British authorities (GOV.UK) specify that only the first emergency response is free for an unaffiliated visitor, with any subsequent treatment billed, and that ambulance services may be more limited outside urban areas. Since May 2025, yellow fever vaccination has also been mandatory on entry for travellers arriving from certain countries (including Brazil, Colombia, Ecuador and Peru).

• Tourist stay (up to 180 days for a French passport): no health insurance legally required on entry; France Diplomatie nonetheless describes it as essential in practice, as the embassy cannot cover medical costs, and private clinics generally require a security deposit on admission.
• Stay of more than 90 days: authorisation must be requested from the Costa Rican embassy in Paris or the Dirección General de Migración y Extranjería (DGME); no specific insurance requirement could be confirmed for this authorisation alone in the texts consulted — to be checked directly before any application.
• Working holiday programme: no agreement is currently in force between France and Costa Rica, unlike Peru, Mexico, Chile, Argentina, Colombia, Brazil, Uruguay or Ecuador. Negotiations were under way according to pvtistes.net; if an agreement is reached, it would be the first French working holiday scheme in Central America. Status to be reconfirmed before any plans, with no entry-into-force date known.
• Pensionado / rentista / inversionista residency: mandatory CCSS registration as "Asegurado Voluntario" to obtain and then renew status, with a contribution based on declared income (around 10% for retirees and rentiers according to the UFE). Income or investment thresholds (law no. 9996) are around 1,000 USD/month of pension for pensionado status, 2,500 USD/month of income for rentista status, and 150,000 USD of investment for inversionista status, according to the specialised firms consulted — amounts to be confirmed with the DGME at the time of application.
• Digital nomad visa (minimum stable income of around 3,000 USD/month, 4,000 USD with dependants, according to the specialised guides consulted): private international health insurance is required for the entire stay, with minimum cover of 50,000 USD; a simple travel insurance policy is not accepted by the DGME.
• Seconded employees and employees in formal local employment: automatic CCSS registration from hiring, with an employee contribution of around 10.17% and an employer contribution of around 26.67% of gross salary.

No official fixed penalty has been identified for a simple lack of cover outside the residency statuses mentioned above; the documented risk is full billing of care in the private sector, with a security deposit required on admission.

No social security agreement has been signed between France and Costa Rica: the country does not appear in CLEISS's list of country sheets, which only covers countries that have concluded a coordination agreement with France.

• In the absence of a bilateral agreement, no totalling of insurance periods between the two countries is possible to establish pension entitlement.
• No coordination mechanism allows even partial cover of care received in Costa Rica under French affiliation, nor the reverse for care received in France under CCSS affiliation.
• CCSS registration, whether resulting from formal local employment or the "Asegurado Voluntario" scheme, provides local cover but does not replace any French social protection and is not recognised as such on returning to France.

For lack of an agreement, for any French national settling in Costa Rica — an employee registered with the CCSS, a pensionado/rentista/inversionista resident, a digital nomad or a retiree — voluntary membership of the Caisse des Français de l’étranger (CFE) or taking out international health insurance remain the only solutions for cover recognised in France, alongside any local cover.

• Before departure: take out insurance covering medical costs, hospitalisation and medical repatriation, whatever the length of stay planned, as Costa Rican private clinics generally require a security deposit on admission.
• For a stay of more than 90 days: check directly with the Costa Rican embassy in Paris or the Dirección General de Migración y Extranjería (DGME) on the applicable authorisation procedure.
• For a pensionado, rentista or inversionista residency application: gather the income or investment documentation required by law no. 9996, and plan for CCSS registration as Asegurado Voluntario, a condition for obtaining and renewing status.
• For a digital nomad visa: before filing the application, take out private international health insurance valid for the entire stay with minimum cover of 50,000 USD, as standard travel insurance is not accepted.
• From formal hiring in Costa Rica: check CCSS registration with the employer.
• Within 6 months of arrival: register with the roll of French nationals living abroad at the consulate general in San José (free, valid 5 years, recommended).
• In the absence of a bilateral agreement: voluntary membership of the CFE or taking out international health insurance from settlement.