Quick answer
- Costa Rica does not require travel insurance for tourists. The pandemic-era insurance rule was removed on April 1, 2022.
- Long-stay visas (digital nomad, rentista, pensionado) do require proof of health coverage.
- Tourists are billed directly at both public (CCSS) and private hospitals, and private hospitals expect insurance or payment.
- Rental cars come with a mandatory third-party liability charge at the counter that your credit card and US auto policy cannot replace.
Costa Rica is built for adventure: zip lines, white-water rafting, surfing, volcano hikes and long drives on rough roads. That makes it one of the destinations where travel insurance pays out most often, even though nobody checks for it at the airport. Here is what is required, what is not, and where travelers get caught.
Is travel insurance required for Costa Rica?
No. Costa Rica briefly made insurance a condition of entry during the pandemic, but that requirement and the related health pass were removed on April 1, 2022. US citizens enter visa-free as tourists, and immigration does not ask for a policy. You may be asked for proof of onward travel.
Some older blog posts still say insurance is mandatory. They are out of date.
When insurance is required: long-stay visas
If you apply for a Costa Rican residency or long-stay permit, health coverage is part of the application. The digital nomad visa, rentista and pensionado categories all ask for proof of medical insurance valid in Costa Rica for the length of the stay. A short-term travel medical plan may or may not satisfy the specific category, so confirm with Costa Rican immigration (Migración) before buying.
Medical care costs for tourists
Costa Rica’s private hospitals in the San José area (such as CIMA, ClÃnica BÃblica and Hospital Metropolitano) are widely used by tourists and expats and offer care comparable to US standards. They bill privately, at rates that assume insurance or self-payment, and usually want a guarantee before admission. Public CCSS hospitals treat emergencies but also bill uninsured visitors.
The bigger issue is geography. Popular areas such as the Osa Peninsula, Tortuguero and parts of Guanacaste are hours from a major hospital. Ground or air transfer to San José is expensive, and serious cases may need a flight back to the US.
Adventure activities: check your policy
- Zip-lining and canopy tours: covered by many standard plans, but not all.
- White-water rafting: often limited to lower river classes on basic plans.
- Surfing: usually covered recreationally; surf competitions are not.
- Scuba diving: check depth limits and certification requirements.
- ATV and motorbike tours: frequently excluded or covered only with a valid license and helmet.
If your trip is built around these activities, look for an adventure sports rider.
Recommended coverage
| Benefit | Suggested minimum |
|---|---|
| Emergency medical | $50,000 to $100,000 |
| Emergency evacuation | $100,000 or more (more for remote areas) |
| Trip cancellation | Your prepaid, non-refundable costs |
| Trip delay | Useful in rainy season, roughly May to November |
Rental car insurance in Costa Rica
This catches more visitors than anything else. Costa Rican law requires third-party liability insurance on rental cars, and rental companies add it at the counter, often as a daily charge not included in the online price. Your US auto policy does not apply in Costa Rica, and credit card rental benefits usually cover only damage to the rental car (collision damage waiver), not liability. If you plan to rely on card coverage for collision, bring a letter from your card issuer confirming it, because agencies often ask for one before they will let you decline their own collision coverage.
Medicare and US plans in Costa Rica
Original Medicare generally pays nothing in Costa Rica. Medigap plans with a foreign travel emergency benefit pay 80% after a $250 deductible, up to $50,000 lifetime, and do not cover evacuation. Employer plans often treat care as out-of-network: you pay first and claim later.
Sources
- US Department of State, Costa Rica country information.
- Costa Rican Tourism Board (ICT) announcements on the end of pandemic entry requirements (April 2022).
- Dirección General de Migración y ExtranjerÃa, digital nomad and residency requirements.
- Medicare.gov, coverage outside the US.
Frequently asked questions
Is travel insurance mandatory for Costa Rica?
No. Costa Rica removed its pandemic-era insurance requirement on April 1, 2022. It is still recommended because tourists are billed directly for medical care.
Does my credit card cover rental cars in Costa Rica?
Usually only damage to the rental car. Costa Rica requires third-party liability insurance, which rental companies sell at the counter and which card benefits generally do not include.
Do I need insurance for a Costa Rica digital nomad visa?
Yes. Long-stay categories, including the digital nomad visa, require proof of health insurance valid in Costa Rica for the whole stay.