Medismart (Prepaid Medical Plan)

I have been trying to find the best way to use all the medical resources available to me here in Costa Rica. This country is blessed with many talented, affordable medical practitioners and several options from public to private doctors, as well as pharmacists, and independent labs. My challenge has been to piece all these parts together in the best, most affordable solution.

I first laid out my initial healthcare plan in this article.  The summary is: get healthy, use the pharmacist first for burns, rashes, bites, etc., followed by a public /private doctor followed by a public / private hospital.  Some folks feel you are “cheating” on the CAJA if you use private doctors or labs, but really each person has to make choices on what is right for them, which might include using a combination of the best of all options.

The problem I had with my initial plan was I am not keen on searching for the best doctors, gynecologists, dermatologists, nutritionists, ultrasound, etc. when I need one.   There are not many resources for finding medical resources in Costa Rica. A question on Facebook might result in plenty of doctor recommendations all over Costa Rica, many of whom would be difficult to reach without a car. One resource I found useful and would recommend is Hulihealth which lists many doctors (not all) with their bio, charges and customer ratings. You can even set up an appointment electronically if calling on the phone intimidates you.  But even using Huliheath can involve running all around Costa Rica from doctor to specialist to lab to pharmacist trying to address a medical issue. Since we do not have a car, working with doctors spread across Costa Rica is problematic, and I was hoping for a more centralized solution.

I first heard about about Medismart from “The Real Costa Rica Blog” in which the author recounted his cancer treatment in Costa Rica  Post.  I was drawn to Medismart because the program appeared to have all the doctors, tests, and specialists I might need in one place under one plan that offered a discount for using them.  For folks not familiar with Costa Rica currency, here is the trick.  In round numbers, the exchange rate is 500 colones to $1. So, below, a gynecologist’s normal price in Costa Rica of c45,000 is about $90, but through the Medismart plan you pay c9,000 or $18 and save c36,000 or $72.  The same appointment could cost $150 in the US (for reference).

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Note, Medismart is NOT an insurance program. MediSmart is a Prepaid Medical Plan that offers a wide range of medical services through the Metropolitan Hospital with discounts that will save up to 80% of your bill.  Here is an example of the specialties and the discount offered for each.  Again, using the conversion trick, General Medicine c6,940 is about $13.88.

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MediSmart is a company of Grupo Montecristo. I noticed similar programs in Nicaragua and Panama where you affiliate with a specific hospital, pay a monthly fee and get discounted services. Think of Medismart like a Costco membership. The deal is UNLIMITED usage, $12 plus $3 per dependent per month with NO restrictions, age limits, etc. I notice they offer optometrist exams, dental and veterinary service too. Since I do not have any pets, I cannot vouch for the veterinary services.  The discount by speciality is listed here.

I started my journey by sending an email to the contact address on their website. It took a week to get back to me. I figured they were searching for someone who spoke English to respond. Nancy Solis sent me an email answering my questions. We corresponded back and forth until I decided to just call her. Unfortunately, I discovered Nancy could read and write English but not speak it, so I was happy to stay with the email. After feeling satisfied that my questions had been answered, I went online and registered. Medismart charges your credit card monthly. If you want to cancel, you have to give them two months’ notice. My monthly cost is $15 ($12+3) for my wife and me.

I emailed Nancy to make my first appointment and she told me I had to call the appointment phone number. My heart was beating fast thinking, will anyone speak English? I called the appointment number and said hello in English, which caused a long silence and lots of commotion until Jeffery came on the line. Jeffery speaks great English. He noticed my wife’s details were not correct and fixed them.

One thing I like about the Medismart program is they use Hulihealth’s medical appointment software which sends me an email with the appointment details that can easily be added to my calendar so there is no confusion over dates and times.

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Of course, when you join any group plan, they assign you a number and give you a membership card. Medismart’s process to is “mail” your card. I put quotes around mail because I had never seen mail delivered in Costa Rica. I provided my “Tico address” which is based on landmarks. My address is “across from the electric company substation, 300 meters north and 50 meters east in an apartment with #1.” As fortune would have it, the motorcycle messenger came to my house while I was outside and we connected. That was a good sign.

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I started our Medismart journey with an easy test of having my wife see a general doctor about some concerns she had. Jeffery set up the appointment for Thursday at 2pm. Normally, because of the rain, I prefer to do things in the morning, but I sucked it up and accepted the time slot. We headed over at 1pm to give ourselves plenty of time since we had never been in that part of town before. Hospital Metropolitano is a little south of Parque de La Merced and not hard to find.

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The Hospital has two buildings across the street from each other. The smaller building on the east side appears to be an ER and is open 7×24. We also went there for the ultrasound. There appears to be plenty of parking around the hospital, though we take the bus and walk so cannot comment on the cost. We went through the parking lot of the west side building for our appointment. So entering the building might not be obvious to folks from the States since you go through the parking lot and then through the cafeteria to get to the receptionist’s desk. The receptionist directed us to the cashier.

The casher took our information and charged my credit card BEFORE the appointment. The discount (descuento) was clearly shown.

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We sat in the comfortable and uncrowded waiting room until the doctor came.

The appointment was at 2pm and the doctor called my wife in at 1:57, so right on time. After the appointment, the doctor came out to the clerks and helped set up appointments for some tests she wanted done. Thank God I didn’t have to call the appointment number and hope Jeffery was in the office.

We came back the next week, again pre-paid at the main building and took the appointment and receipt across the street and presented them to the receptionist. I thought it would be pretty clear what we were having done using the appointment document and the receipt, but there was slight confusion and luckily one person spoke English and got us set up. We accidentally walked into the ultrasound area. I think we were supposed to wait for our name to be called, but they took my wife anyway 20 minutes early.

The specialists and technicians were professional and friendly and spoke English. The one technician who did not still was able to give clear instructions. Unlike in the US, they gave immediate feedback and gave Jeni her x-rays and ultrasound photos before we left.

After receiving the test results, we walked back across the street to review them with the doctor. I think we should have made an appointment beforehand. The doctor saw us waiting and scheduled a follow-up appointment. We waited an hour for that time slot and the doctor reviewed all the results, gave my wife some options and a prescription. I was prepared to pay for another visit; this visit did not cost anything. We decided to use the convenient hospital pharmacy, which had all the medications the doctor prescribed, and the 7% Medismart discount was applied. Again, I am not a fan of running around town trying to fill a prescription, so I liked that convenience, though I cannot say whether or not it was a deal. Another thing I like about the comprehensive arrangement is when the pharmacist has a question, he can walk down the hall and ask the doctor.

Having accomplished test #1, we took another baby step and scheduled a dermatology appointment. I called the appointment line and got Jeffery again. He set up the appointment with the dermatologist the following week. He was very helpful and made sure we got an English-speaking doctor.  In addition, he gave me his email so I would not need to call in and could handle appointments electronically.

When I went in for the dermatology appointments and tried to prepay like previous times, the cashier directed me to the dermatologist’s office which is on the first floor directly behind the cashiers. The dermatologist’s receptionist spoke great English. We had our appointment, had our questions answered, were examined, paid our bill and left. So, very easy and inexpensive.  If you are a stickler for details and predictability, the only “glitch” was that we got the discount for the consultation as listed above, but burning off the suspect spots was extra.  Also, if you want any plastic surgery, botox, or tummy tucks, those procedures are not discounted under the Medismart plan.

So, here is what I have spent so far.  For $15 first month’s fee, I have saved $160.

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I am happy with this solution so far.  Medismart offers me all the doctors, specialists, tests, and drugs I need in one location.  The plan is a low $15 a month for my wife and I, conveniently charged to my credit card each month.  The two-month cancelation policy seems low risk. The prices and discounts are available on their website, and making an appointment is very easy by phone or email. And email confirmation makes adding appointments to my calendar easy.

I think this is a good plan for anyone who wants to take control of their healthcare where convenience (location, specialists, appointments and payment) is important.  Remember my initial plan was to get healthy and be proactive, which this plan allows me to do.  Since we do not have a car, going to one location to get everything done is perfect for us.

Here is another article on the company link

A final note.  Since we are typically at the hospital for our appointments around lunch we have been happy to find this place to get a meal and would recommend it to anyone doing the same.

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12 thoughts on “Medismart (Prepaid Medical Plan)

  1. I have some questions. Where do live in CR. How do you pay your credit card. Is it an American Credit Card? I am retiring to CR in 2017 or 18 and I need any info. Thanks

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    • Where do live in CR.

      I live in San Jose at Sabana Park. We spend our first year in San Ramon and than moved to San Jose to be closer to transportation and entertainment.

      How do you pay your credit card.
      I have two cards Capital One and USAA both of which charge no ATM or foreign transaction fees here in CR. I pay my credit card online just like when in the US.

      Is it an American Credit Card?

      Yes they are issued in the US.

      I am retiring to CR in 2017 or 18 and I need any info.

      I would be happy to help with your transition. I did a lot of research before moving here. Just send me a PM on FB with your questions.

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  2. This plan looked very attractive to me until I read through the website fairly thoroughly. From it I saw that the only real discounts offered are on appointments with doctors and an array of basic tests. These discounts do look pretty good. A patient can easily save $40 or so on an appointment with a doc, and probably as much or more on some tests. Saving $160 out of the gate doesn’t seem unreasonable to me for a couple with a couple different things they want attended to. However, that same couple is spending $180 in annual membership fees in order to save the $160.

    Now, if people are in a situation where they want or need to go through these kinds of visits and tests two or three times a year, paying $180 to save $320 or $480 makes a lot of sense, but most people aren’t in this situation. For those who are, the Caja (through EBAIS) is pretty good at getting everyone who needs basic tests at regular intervals the tests they need. Speaking only for myself (and I’m not especially sick) my EBAIS has me on a quarterly regime of blood and urine tests while throwing in an EKG and this and that once a year, all of course free and all right in my own neighborhood. Why anyone enrolled in the Caja would pay to go private for these kinds of basic tests and appointments makes no sense to me, regardless of the discount offered. Of course, for anyone not enrolled in the Caja yet needing regular tests, this Medismart makes sense.

    But for me, and I suspect most people, the only real benefit I see to Medismart is for those times when I want to make an end run around the Caja. These times exist, especially when it comes to seeing a specialist and/or having non-routine tests, but I have to ask myself: How often? Every once in awhile I pay a private specialist like $80 for an appointment and as much or more for some fancy test, mainly because the Caja gives me the runaround, and on those occasions I would really love to have Medismart. However, those occasions don’t arise very often. In fact, they’re less than once a year.

    Meanwhile, Medismart isn’t guaranteeing discounts on anything else. The reference to similar plans in Nicaragua made me laugh. I know an expat there who really talked up a similar plan–until he ended up with a kidney stone in that hospital. Then he pitched a fit about being charged $10,000 up front for his treatment. Well, what did he expect? The plan didn’t offer discounts for kidney stones, as neither did it offer members delayed billing.

    Neither is it clear that having everything in one place is worth it or exactly true. Actually, there are two different locations, not a lot of affiliated doctors, and even the affiliated doctors aren’t necessarily full time. By contrast, everything really is in one place in the Caja hospitals, where you will always be treated by a team of doctors if your situation is serious, never a lone wolf. If you’re really sick, you probably want to be in a Caja hospital (and just deal with that zoo) because everything really is in one place in them.

    Of course, for $12 a month or $15 for a couple, this isn’t a bad plan. I don’t see the hospital as being crooked or anything like that, I just don’t see it as giving anything away. The main risk of enrolling, as I see it, is to fall for the plan’s obvious intent to get you accustomed enough to going to that hospital that you go there for things that aren’t discounted when you might be better off going elsewhere. It’s, you know, more marketing than anything else, and probably not even a money saver for most people. However, if you take the plan for what it is (and are aware of what it isn’t), it’s not a bad deal. Even I am tempted to sign up, since it would be nice to be able to shoot right over to see a doc and get a test when sick or worried without having to take out a bank loan first. However, in reality I doubt I’d save any money and suspect I would lose money, although I would be able to spread out the costs monthly and that’s a convenience.

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    • Thank you for the comprehensive and detailed analysis. It shows a sharp mind.

      Since moving to CR, we are determined to be proactive with out health and get in from of any problems.

      So, we have a regime of the following each year
      2 dentist visits
      2 opthomologist visits
      1 gynecological
      2 dermatology visits
      2 physicals

      for the two of us. We are pretty healthy and have never been hospitalized nor take any medication.

      So, I figure we will save a few hundred dollars off the work we normally have done.

      We are not familiar with our EBAIS yet. It is only open two days a week and you have to get there by 5:30 to get an appointment. The bus does not run that early and it is too far to walk so it has been problematic . I understand that online scheduling may come one day.

      And you are right for non-residents, this may work. I just liked the convenience of not having to search around town to get things done. Not having a car limits how far we can travel things.

      That is the crazy thing is that I can pay a CAJA doctor after hours $50 to write out as many referrals as I need without having to stand in line at 5:30

      You are right, this is NOT an insurance plan. Just a discount plan. And a discount mainly on consultation and tests. So, when I went to the dermatologist I got a discount on the consultation but paid full price to burn off my bumps.

      I also have private insurance and so can go to CIMA or Biblica too for really bad stuff. So, if CAJA told me they could treat my cancer in two years, I would just go over to one of the private hospitals.

      I figure over time, I will line up the pharmacist, CAJA, private, public, etc. to see how to mix and match to get the best healthcare. Hopefully, we will be come more comfortable with the CAJA and use it where it fits.

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  3. There’s another nice place to have lunch nearby.
    If you walk up the street in the direction in which the traffic is going and pass the pedestrian crossing at the entrance to hospital Blanco Cervantes it is on the next corner.
    We go there after appointments at San Juan de Dios,
    For us, the CAJA works…I’ve heard similar stories to yours about the need to queue early for an appointment but our EBAIS seems a lot more civilised in that respect.

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