Before you start

DIMEX or a pending residence file
Declared income, on which the contribution is assessed
Registration at a CCSS branch or through an approved association
Private insurance details, if you carry them

Step-by-step

1
Register with the CCSS as part of the residence process
You cannot collect the DIMEX without it. Employees are enrolled by their employer; everyone else registers as a voluntary or independent contributor, individually or through an approved association that negotiates the assessment.
In personWho: You
2
Understand how the contribution is calculated
It is a percentage of declared income rather than a fixed premium, so the figure you used to qualify for rentista or pensionado status is the figure you are assessed on. Ask for the calculation in writing before you commit to a category.
In personWho: You
3
Register with your assigned EBAIS clinic
The CAJA assigns you to a local primary-care clinic based on where you live, and that clinic is the entry point to the system for referrals and prescriptions. Find yours and register in person early rather than at the point of need.
In personWho: You
4
Decide about private cover on top
The INS national insurer and international providers both sell policies here, and many residents simply pay privately for consultations. Private specialist appointments and diagnostics are inexpensive relative to North America; a private hospital admission is not.
OnlineWho: You
5
Keep contributions current — it is a residence condition
Arrears at the CCSS will stall a residence renewal. It is the single most common administrative reason a straightforward renewal goes wrong, and it is entirely avoidable.
OnlineWho: You
6
Use the pharmacies for routine matters
Costa Rican pharmacists can advise and dispense a wider range without prescription than in much of Europe or North America, and there is a pharmacy in every district. For minor issues it is the fastest route by a wide margin.
In personWho: You

Documents you’ll need

DIMEX or residence file receipt
CCSS registration and carné
Declared income documentation
Private insurance policy, where applicable
Vaccination records

Things most newcomers don’t know

The CAJA is a residence condition first and a health plan second, and the assessment follows your visa income.

Because contributions are calculated on declared income, the USD 2,500 a month you evidenced to qualify as a rentista becomes the basis of your monthly assessment. Retirees who compared Costa Rica against neighbours on visa thresholds alone consistently underestimate this, and it is the difference between the country looking cheap and looking mid-priced. Ask the CCSS for the calculation before you file, not after.

Source: Caja Costarricense de Seguro Social

CAJA arrears will stop a residence renewal even when everything else is perfect.

The DGME checks your CCSS standing at renewal. A lapsed direct debit or a disputed assessment turns into a residence problem months later, and unwinding it requires clearing the CCSS first and then returning to Migración. It is the most common avoidable failure in an otherwise routine renewal, and the fix is simply to check the account balance twice a year.

Source: Dirección General de Migración y Extranjería

Most residents run both systems, and that is the honest description of Costa Rican healthcare.

The CAJA delivers comprehensive care with real waiting lists for non-urgent specialist and elective treatment. The private hospitals in Escazú and central San José deliver quickly and at prices well below North American equivalents. The practical pattern among long-term residents is CAJA for chronic care, prescriptions and anything catastrophic, private for speed. Budgeting for only one of the two is the mistake.

Source: community-reported

Altitude and dengue are the two health facts specific to living in the Central Valley.

San José sits at about 1,150 metres, which is comfortable rather than problematic, but it does mean the sun is stronger than the mild temperature suggests and sunburn happens on days that feel cool. Separately, dengue is endemic in the lowlands and outbreaks occur in the coastal provinces; the Central Valley's altitude suppresses the mosquito substantially, which is one of the quieter reasons families settle here rather than on the coast.

Source: Ministerio de Salud

Common mistakes to avoid

Budgeting for residence without the recurring CAJA contribution on declared income.
Letting CAJA payments lapse and discovering it at a residence renewal.
Assuming CAJA cover means you never need private care, or the reverse.
Not registering at your assigned EBAIS clinic until you are ill.
Underestimating the sun at altitude because the temperature is mild.

Some of this may be out of date. Spotted something inaccurate? Help us keep it right for the next newcomer.