The Structure of the CCSS
- First level — EBAIS (Equipos Básicos de Atención Integral en Salud): community clinics, each serving a geographic area of approximately 4,000–6,000 residents. They provide general medicine, prenatal care, vaccinations, essential medications, and preventive care. It is mandatory to visit these clinics before being referred elsewhere.
- Second level — regional clinics and hospitals: basic medical specialties (pediatrics, gynecology, general surgery, internal medicine) and complex emergencies — for example, Hospital San Vicente de Paúl (Heredia) or Hospital Max Peralta (Cartago).
- Third level — specialized national hospitals: reserved for highly complex cases, major surgeries, and high-tech treatments — Hospital México, Hospital San Juan de Dios, Hospital Rafael Ángel Calderón Guardia, plus specialized centers such as the National Children’s Hospital or the National Hospital of Geriatrics and Gerontology.
Funding—it is not free; it is contributory and tripartite
- Employers — pay a percentage of their employees’ payroll
- Employees/Professionals — automatic monthly deduction from salary (employees), or a monthly contribution calculated based on income (self-employed)
- The government — general funds for people without income, the unemployed, or those in extreme vulnerability
What You Actually Receive
- Medications are free—all prescriptions approved on the official CCSS list are provided to the patient at no additional cost
- Very high-cost treatments are covered 100%, with no copayment—chemotherapy, transplants, antiretrovirals, open-heart surgery
- Universal coverage—any citizen or legal resident, regardless of socioeconomic status, pre-existing conditions, or age
- True geographic coverage—EBAISs reach rural and indigenous areas, with medical staff and essential medications constantly available
- Emergency departments respond quickly to critical cases—providing either treatment or hospitalization
How the System Works
The first point of contact is always the EBAIS corresponding to your address. The doctor there assesses your case and, if a specialist, complex tests, or a procedure is needed, issues a referral to the next level. Appointments are made by phone or through the EDUS (Expediente Digital Único en Salud) platform, where you have access to your complete medical history, vaccinations, and previous test results.
CCSS Strategy 2026–2030
For scheduled procedures (surgery, specialist appointments, certain complex tests), wait times may be longer than in the private sector—a well-known aspect of any public system with universal coverage.
In response, the CCSS Board of Directors has launched a Comprehensive Plan to Reduce Waiting Lists, valid for 2026–2030, which moves away from a fragmented, center-by-center approach in favor of centralized coordination—budget reallocation, expanded surgical schedules on weekends and in the evenings, and the decentralization of resources to rural areas.
The private healthcare system offers four options for access
Private healthcare is not centralized under a single entity; it operates in parallel with the CCSS through three channels:
- Direct payment—the patient covers 100% of the cost directly at a private clinic or pharmacy
- Private health insurance—policies issued by companies regulated by SUGESE (Superintendencia General de Seguros). The state is the pioneer through the INS (Instituto Nacional de Seguros), but it competes with international firms such as Pan-American Life, PALIG, or ASSA
- Mixed healthcare — a CCSS-insured patient pays for a private consultation to receive a rapid diagnosis, and the doctor can issue prescriptions valid within the CCSS system, allowing the patient to pick up medications free of charge from their local EBAIS pharmacy
Private healthcare infrastructure is concentrated primarily in the metropolitan area (GAM), with JCI international accreditation: Hospital CIMA (San Rafael de Escazú), Clínica Bíblica, Hospital Metropolitano, and Hospital La Católica (Goicoechea).
A fourth option, which is growing in popularity: “prepaid medical” plans. These are not traditional insurance plans—they are not regulated by SUGESE—but rather function as a benefits club: you pay a small monthly fee and receive discounts of up to 80% on consultations, lab tests, X-rays, ultrasounds, or CT scans within a wide network of healthcare professionals and specialties. The best-known example is MediSmart, which is particularly widespread in the northern part of the country—it costs between $5.65 and $14.51 per month, with no age restrictions or pre-existing condition requirements, and activation within 24 hours. The main advantage: test results come back quickly, often within 1–2 hours, and are sent directly via email—especially useful for diagnostic purposes, where CCSS can be slower.
How the Two Systems Coexist
The public and private systems aren’t separate worlds—they constantly overlap:
- Many specialists work at the CCSS in the morning and in the private sector in the afternoon—at Clínica Bíblica or CIMA, for example—so you often see the same doctor in both systems
The
CCSS remains the ultimate safety net—even Costa Ricans with the best private insurance, or foreigners with comprehensive international insurance, still end up at CCSS hospitals in catastrophic cases (serious accidents, heart attacks on the street), because Cruz Roja ambulances prioritize transport to CCSS trauma centers, due to their capacity to respond to critical emergencies
Family Benefits Through the CCSS
In addition to your own insurance, the CCSS offers extensive benefits to your family, which are often unknown to newly arrived foreigners:
Children are insured free of charge as dependents of the insured parent, with no additional premium—up to:
- 18 years of age, unconditionally
- age 22, if they are enrolled in secondary or technical school
- age 25, if they are pursuing higher education/university studies (and are not self-employed)
Maternity leave totals 4 months (one month before birth (prenatal) + 3 months after), fully paid (100% of salary)—half covered by the CCSS, half by the employer.
National retirees (Costa Ricans who have contributed to the CCSS their entire lives through the standard IVM system) receive free health care upon retirement — with no additional health insurance deductions, as a reward for their contributions throughout their careers.
This differs from the situation of foreign residents with retiree status (the “pensionado” category in Migración), who continue to pay a monthly premium, but only for the health portion (SEM), not for the IVM, since their pension does not come from the Costa Rican system. In practice, this differentiated treatment for seniors reflects a clear philosophy of the system—an emphasis on prevention and ongoing care for the elderly, not just treating problems as they arise.
What a foreigner needs to know from a legal standpoint
Here, the rules are strictly regulated to prevent the misuse of public funds by individuals who do not contribute:
- Enrollment in the CCSS requires active legal immigration status—permanent resident, temporary resident, pensioner, investor, or retiree—issued by Migración.
- CCSS enrollment is mandatory for DIMEX — you cannot obtain a residence card unless you are enrolled and up to date with your CCSS payments. The monthly cost is calculated on a progressive scale (6%–11% of declared monthly income) and fully covers the policyholder plus immediate dependents (spouse, children).
- Tourists do not have access to CCSS—they cannot enroll and cannot receive scheduled consultations, whether for general or specialty care.
- Exception: critical emergencies—by constitutional and humanitarian obligation, CCSS hospitals treat any foreigner (tourist or even undocumented) if their life is in imminent danger (serious accidents, cardiac arrest, active labor). Once the patient’s condition has stabilized, however, the CCSS issues an invoice for the services provided, which is paid by the patient or their travel insurance.
Medical tourism—a thriving industry, among the world’s best
Costa Rica ranks in the world’s top 10 on the Medical Tourism Index—it is no longer just a beach destination, but a major exporter of premium medical services.
2026 Figures:
- Medical tourism accounts for approximately 13.4% of the country’s total visitors
- ~70,000 foreign patients per year, with an economic impact of over $465 million
- 80% of medical tourists come from the U.S., 10% from Canada
- Average spending: $6,600 per visit (compared to ~$1,200 for a typical tourist)
- Savings of 50–70% compared to the U.S./Canada, with identical safety and technology standards
Most popular procedures: dental implants/smile design (highest volume), plastic and reconstructive surgery, complex orthopedic procedures (hip, knee, shoulder), plus wellness tourism—detox centers, mental health, and longevity retreats in the Blue Zones (Nicoya Peninsula)
One final note
This article is for general informational purposes only. Rules, costs, and processing times within the healthcare system are subject to change, so we recommend checking directly with the CCSS or your chosen private provider before making any concrete decisions. This article is for informational purposes only and is not intended as medical advice—that is not our area of expertise.
Behind OpenZone are two people: a Costa Rican native with deep roots in the local history, and an expat who has been settled here for over two decades. Together, we combine native knowledge of the system with firsthand experience of the very process you’re going through right now.
