The Most Important Healthcare Decision You Will Make
Before making the move to Costa Rica, every American senior needs to clearly understand one non-negotiable fact: U.S. Medicare does not cover medical expenses outside the United States. Not partially. Not with a copay. Not at all, with very limited emergency exceptions that do not apply to routine care abroad.
This is not a reason to stay in the U.S. — it is a reason to understand your healthcare situation clearly before you go, and to make informed decisions about Medicare, CAJA, and supplemental coverage. The good news: for most retirees, the Costa Rican healthcare equation turns out to be better than what they had at home. Let us explain why.
Side by Side — Medicare vs. CAJA
| Feature | U.S. Medicare (Parts A+B+D) | Costa Rica CAJA |
|---|---|---|
| Monthly cost | $174.70+ (Part B) + Part D + Medigap | $70–$130/month total |
| Annual deductible | $1,632 (Part A) + $240 (Part B) | None |
| Copays at doctor visits | 20% after deductible | None |
| Prescription drugs | Covered under Part D (with gaps) | Covered from CAJA formulary at no charge |
| Specialist visits | Referral required, 20% copay | Referral required, no copay |
| Hospital stays | Covered with deductible & copays | Covered at no additional cost |
| Dental | Not covered (original Medicare) | Basic dental at CAJA clinics |
| Vision | Not covered (original Medicare) | Basic vision at CAJA clinics |
| Coverage outside country | None (with very limited exceptions) | Within Costa Rica — full coverage |
| Wait times | Generally prompt for most services | Longer for non-emergency specialists |
Most American retirees in Costa Rica pay less per month for CAJA than they paid for Medicare Part B alone — with no deductibles, no copays, and broader coverage for hospitalizations and medications. The primary tradeoff is longer wait times for non-emergency specialist care, which most expats solve by supplementing with affordable private care.
What to Do About Your Medicare — Three Options
Option 1 — Suspend Part B, Keep Part A
Medicare Part A (hospital insurance) is free for most Americans who paid Medicare taxes and has no premium. Most expats choose to keep Part A active even while living abroad — it costs nothing and provides a safety net if you return to the U.S. for extended periods. Part B (medical insurance) carries a monthly premium of $174.70 or more. Many full-time expats suspend Part B to stop paying the premium.
If you suspend Medicare Part B and later want to re-enroll, you will face a permanent 10% premium penalty for each full 12-month period you were not enrolled. If you think you may return to the U.S. for significant periods of time, consult a Medicare specialist before making any changes to your coverage.
Option 2 — Maintain Medicare and Add International Insurance
If you plan to spend significant time in the U.S. annually, maintaining Medicare makes sense. Add a supplemental international health insurance policy from providers like Cigna Global or AXA to cover your Costa Rica care. These plans typically run $150 to $350 per month depending on age and coverage level.
Option 3 — Full Transition to CAJA + Private
For retirees who are making a permanent move and plan to return to the U.S. only briefly for visits, the full transition — suspend Part B, rely entirely on CAJA and Costa Rican private care — typically results in the lowest monthly healthcare cost and the simplest administrative situation. This is the path most full-time Magnolia Reserve residents choose.
Affordable living, without compromise, is within reach. Explore The Complete Guide for American Seniors (2026) for clear, practical insight—then discover the lifestyle that awaits at Magnolia Reserve.
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