The Medicare Gap: What Every U.S. Retiree in Costa Rica Discovers Eventually

Stratacr.com Blog | June 2026 | Reading time: 4 minutes

The fact most retirees learn too late

Traditional Medicare provides virtually no coverage for care received outside the United States. The exceptions are so narrow they almost never apply, rare border situations involving Canada or Mexico, or emergencies where a foreign hospital happens to be closest while you're still on U.S. soil. Living in Costa Rica? You are, in Medicare's eyes, on your own.

Many retirees keep paying their Part B premiums anyway, to preserve coverage for visits back to the States. That is often a sensible decision but it means paying monthly for insurance that covers none of your daily healthcare life here in "Pura vida land".

So what do retirees here actually do?

In practice, American retirees in Costa Rica assemble their own coverage from three pieces:

The Caja (CCSS). As a legal resident, you contribute roughly 9–11% of your reported income and gain access to Costa Rica's public health system, genuinely good care, with the trade-off of longer waits for specialists and procedures.

Private insurance. Many add INS coverage (typically $60–$250 per month depending on age and health) or an international policy, to unlock the private hospitals, CIMA, Clínica Bíblica, Hospital Metropolitano, where a specialist visit runs $100 or more, paid out of pocket or through the policy.

Cash. For everything in between: the $75 GP visit, the pharmacy, the lab work, the second opinion.

Most retirees make this work financially. The system is affordable by U.S. standards. That is not the real problem.

The real problem is the gap nobody insures: your information

The day you left the United States, your medical history stopped traveling with you.

Your cardiologist's notes from 2019. The full context behind your thyroid medication. The colonoscopy results, the allergy list, the reason your previous doctor chose this blood pressure medication and not that one. All of it lives in U.S. patient portals, in systems your Costa Rican doctors cannot see, and often in a language they don't practice in.

Meanwhile, your new life generates new records: Caja visits in Spanish, private lab results, new prescriptions. Two countries. Two languages. Two sets of files. And no single doctor, anywhere, who holds your complete story.

Every retiree who has sat in a consultation trying to summarise twenty years of medical history from memory knows exactly how this feels and how much can get lost.

Medicare Gap

Closing the gap:The financial side of the Medicare gap has solutions: the Caja, INS, international policies. The information side is what we built Strata to solve.

We gather your records from both sides of the border, discharge summaries, lab results, specialist notes, even the supplement bottles on your counter, and integrate them into one clear, coherent health narrative. Translated. Organised. Cross-referenced. A document you understand, and one you can hand to any doctor, in either country, so they finally see the whole picture.

We make sure that wherever your care happens next, your full story walks into the room with you.

Because in cross-border retirement, clarity isn't a luxury. It's the foundation of every good medical decision you'll make.

Living between two health systems and tired of being your own medical historian? Book a discovery call with Strata. Bring your questions, and we'll show you what an integrated health looks like.

This article is for educational purposes and is not medical, legal, or insurance advice. Verify your individual Medicare situation at Medicare.gov.