Dear A.M. Costa Rica:
To Caja or not to Caja . . . that is not the question, because if you are a permanent resident, then you join, period.
But is it necessarily a bad deal . . . for either side? Elderly residents are likely to need more services, true, but they are also more likely to be able to pay for them privately. And will, if they can.
I’m one of the poorer cases. I moved here in 2000 and joined, voluntarily, because I thought it was a good deal. No matter what they tell you about the Instituto Nacional de Seguros and other private insurers, every last single one of them is looking for a way to avoid paying if you have even so much as a hint of a prior medical condition. Go ahead, take your time, but find me an elderly retiree who has never had a prior medical condition.
The Caja Costarricense de Seguro Social is great for routine needs as well as emergencies. My son slashed his cheek on a sharp cactus one time, and I fell on a sharp piece of concrete and ripped a gash in my arm another time. Both were sewn up in short order, no charge for that or the follow-up meds. Earlier, I fell down two flights of concrete steps and wound up spending 10 days in the Caja hospital while they evaluated my condition, admitted to the emergency room after a long ambulance ride. I had an MRI in Hospital México, where I was transported to and from by ambulance, back to San Carlos, where a cardiologist ran a treadmill stress test. And ran a Holter test, as well.
The cost of those things in the United States would have been astronomical. The cost, via INS, would have been significant, and I would have been in their office arguing over everything for months, even after my deductible. My out-of-pocket cost for all of this on the Caja? Zero.
The problem with the Caja can be boiled down to one thing, from my point of view: the time it takes to get a non-emergency appointment. And, at least here in our clinica, the lack of specialists. Our local doctor, who has dual practice, recommended an ultrasound for something recently. He said that he could prescribe it on the Caja but it might take several years to get an appointment. Otherwise, it could be done in his office the next week, but I’d have to pay for it. At a price which was a small fraction of what it would be in the U.S.
So, since medical insurance is supposed to be for the unexpected, not the anticipated, we make use of both systems. We use the Caja when it makes sense to do that, and we pay our private doctor when we need something else.
We don’t pay for a private insurance policy because (1) they cost a lot, (2) they have significant deductibles, and (3) they are almost always going to find a prior condition at our ages. Besides, who needs the grief of dealing with them?
Insurance is the price you pay for something you hope you will never have to need. It isn’t a way to cut your expected medical expenses. When you think of it that way, then the Caja is a good deal.
Also, for us it provides several medications we require on a continuing basis (We are old folks, after all) which are included in our premium and lower in cost than on the open market. They do not carry the latest and newest drugs that we need, true, but what else is perfect?
Enjoy the good while not worrying about the perfect.