Costa Rica Health Requirements 2026 — No Immigration Medical; CCSS Enrolment and Yellow-Fever Rules Instead

No. DGME's published requirements for every residence category — pensionado, rentista, inversionista, work, family, permanent residence — contain no medical examination, no medical certificate, no HIV test, no TB screening and no vaccination schedule. There is no panel-physician system because there is nothing for one to examine. The health obligations that do exist are different in kind: mandatory CCSS enrolment once your residency is approved (checked at DIMEX issuance and renewal), a yellow-fever vaccination certificate if you arrive from a risk country, and a full-stay private medical policy if you apply under the Ley 10008 remote-worker estancia.

There is no mechanism for it to do so at the admissibility stage: since no medical screening exists in DGME's requirements, decisions turn on financial proof, civil documents and criminal records — not health status. Nor does the CCSS price you on risk; contributions are assessed on declared income, not medical history. The practical planning point is different: think about continuity of care — bring medical records (with official Spanish translations if you'll need them for treatment), check medication availability with Costa Rican pharmacies or the CCSS, and decide whether you want private cover alongside the Caja for speed of access.

After your residency is approved and before your DIMEX issues — proof of CCSS affiliation is a precondition the card channel checks at first issue and at every renewal. You affiliate as a salaried employee (your employer enrols you), as an independent worker, or as a voluntary insured under the asegurado voluntario regulations. Contributions are calculated on your declared income — pension, rental or remote earnings — so bring income documentation to the affiliation interview. The Caja publishes its contribution scales; verify the current percentages with CCSS directly rather than relying on forum figures, which age badly.

Only if you are arriving from a yellow-fever risk country. Under Decree 39997-S-G-SP-RE, foreigners arriving from risk zones who cannot present the International Certificate of Vaccination to the migration authority are refused entry, and carriers are obliged to check before selling passage. The Ministry of Health's 2025–2026 updates kept vaccination obligatory for risk zones — South American risk countries such as Colombia, Brazil and Peru and African risk zones feature in the current scheme — while allowing vaccinated travellers to enter without completing the former 10-day post-vaccination wait. Check the Ministry's current risk-zone list against your exact routing, including layovers.

A medical-services policy covering you — and every dependent on the application — for the entire period of authorised legal stay, filed as part of the Ley 10008 application through DGME's digital platform (application fee US$100 or colón equivalent). Match the policy term to the full authorised stay: a 12-month visa with a 6-month policy is a refusal waiting to happen, and extensions need cover too. Minimum coverage amounts and qualifying-policy conditions come from the regulations to Ley 10008, so verify current figures on DGME's Nómadas Digitales page before purchasing rather than assuming last year's numbers still apply.

Not legally — CCSS affiliation is the only health obligation attached to residence, and no DGME process asks residents for private cover. Whether you add it is a service-level decision: the public system provides universal coverage through EBAIS clinics and public hospitals, while private hospitals offer faster elective access for those who pay or insure privately. Immigration-wise the only people who must hold private policies are Ley 10008 remote workers, whose estancia depends on a policy spanning the full authorised stay. If you later switch from the estancia to residency, the obligation flips from private policy to CCSS enrolment.