Foreign residents can "buy into" the Social Security system (Caja, as it's called in Costa Rica) by paying a fee from $40 to $50 a month and then going to government hospitals for treatment However, since medical care is free, it isn't surprising to find that the system is crowded, well-used. When people don't feel quite up to snuff, they traipse off to the hospital to see a doctor. Of course, for emergency treatment, there is no problem you are seen immediately but for an ordinary office visit with a govern­ment doctor, you could find yourself standing in line or sitting in the waiting room for a long while. For elective surgery, you can expect a wait of several months for your turn. However, there is a better way: choose a family doctor who is in both public and private practice. See him as your private doctor for minor problems and as a public servant for expensive treatment.

A resident of Heredia told of his strategy for choosing a family doctor. He said, "I joined the Social Security plan by paying about $40 a month. Then I visited a free clinic a few times until I found a doctor I liked. I made an appointment to see him in his private practice. Now, as my regular doctor, I can see him any time simply by making an appointment and paying for an office visit. But if something expensive ever comes up, such as a major operation, he'll check me into the government hospital for free treatment by the same doctor! "
Even if a patient chooses a private doctor and uses a private hospital, costs are ridiculously low compared to the United States. For example: In San Jose, the typical bill for a gall bladder opera­tion is $2,500, and for an appendectomy $1,200 to $1,800. The total cost of a heart bypass operation is currently $15,000 to $20,000—that's "out the door," for everything as opposed to $50,000 in the United States, just for the surgeon, plus hospital room, anes­thesiologist, medication and other medical fringe benefits.

For those with Medicare, be aware that it is not valid outside of the United States. However, for those under 70 years of age, there is a Costa Rican government insurance company, the Na­tional Insurance Institute (INS), which offers a policy for $1700 a year for adults and $1100 for dependents under 24. This policy pays 80 percent of hospitalization (private room), post-operative care, medicines, lab tests, X-rays, CAT scans, cardiograms, therapy, home care and support systems. For surgical fees, the policy pays 100 percent up to a maximum which is based on a surgical table. Doctor visits are also covered to the limit of the schedule. The limits of the policy are said to be generous, taking into account the low medical costs in Costa Rica.

All retirees we interviewed swear by the quality of Costa Rican medical care. I can tell you my personal experience: I went to a doctor with a bad case of the flu, severe back and neck pains, and a fear that I had pneumonia. The doctor decided that I was going to be okay, but he suggested that I go to the hospital for a checkup and a rest. I asked for a shared room, but since the hospital wasn't full, they didn't put another patient in with me; essentially it was a private room for a two-bed ward rate. After three days of tests, medication and tender loving care (plus great meals) I was presented a bill which made me feel even better. The entire cost of three days in the hospital, including electrocar­diogram, blood tests and X-rays, was less than if I had stayed in a moderately-priced hotel and dined in ordinary restaurants for those three days!

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