How CAJA Healthcare Works
for Expat Retirees in Costa Rica (2026)

What Is CAJA — And Why It Matters to You

The Caja Costarricense de Seguro Social — known universally as CAJA — is Costa Rica's national public healthcare and social security system, established in 1941. It is the backbone of healthcare for the entire Costa Rican population, including legal foreign residents, and it is one of the primary reasons Costa Rica consistently ranks among the healthiest countries in Latin America.

All legal residents of Costa Rica — including Pensionado and Rentista visa holders — are enrolled in CAJA and contribute monthly. In exchange, they receive access to a comprehensive system of clinics, hospitals, specialist care, surgeries, emergency treatment, lab work, and prescription medications at essentially no additional cost at point of care.

For retirees coming from the U.S. — where healthcare costs represent one of the largest monthly expenses — the CAJA enrollment cost is one of the most welcome surprises of life in Costa Rica. See our hub for the full picture: Healthcare in Costa Rica for American Retirees: The Complete Guide.

What CAJA Covers — The Full List

• Primary care visits — at your assigned EBAIS clinic (basic integrated health team)
• Specialist referrals — cardiology, orthopedics, neurology, oncology, and more
• Surgeries — elective and emergency, fully covered
• Hospitalizations — room, nursing care, medications, and procedures included
• Emergency care — at any CAJA hospital, without prior authorization
• Prescription medications — from the CAJA formulary, dispensed at no charge
• Laboratory work — blood panels, urinalysis, pathology
• Diagnostic imaging — X-rays, ultrasounds, and in major centers, MRI and CT
• Maternity care — for residents of all ages where applicable
• Mental health services — via referral through your EBAIS

What It Costs — Your Monthly CAJA Contribution

CAJA contributions are calculated as a percentage of your declared monthly income. For Pensionado visa holders, the contribution rate is approximately 11% to 14% of declared income, up to a maximum. For most American retirees declaring a monthly Social Security income of $1,500 to $3,000, this works out to $70 to $130 per month.

This contribution covers you and your legal dependents on the same application. It is paid monthly and is typically coordinated through your immigration attorney or directly at any CAJA office. At Magnolia Reserve, our team assists all new residents with CAJA enrollment as part of the onboarding process.

How to Use CAJA — Your First Steps

Once enrolled, you are assigned to an EBAIS — Equipo Básico de Atención Integral de Salud — the community primary care clinic closest to your registered address. This is your first point of contact for all non-emergency healthcare needs. Your EBAIS physician manages referrals to specialists and coordinates your care within the CAJA network.

For emergency care, go directly to the nearest CAJA hospital emergency room — no referral or prior authorization is required. The Hospital Dr. Rafael Ángel Calderón Guardia in San José and the regional Hospital Tony Facio Castro in Limón are the primary CAJA facilities serving residents of the Puerto Viejo area.

Bring your DIMEX card (Costa Rican resident ID) to all CAJA appointments. If you do not yet have your DIMEX while your residency application is processing, your attorney can provide documentation of your pending status.