Health Insurance For Old Expats

By Pat Werner

When I retired from the university in San Marcos after working there for 20 years, I  was eligible for Cobra at $600 per month, for health insurance for my wife Chilo and myself.  Pretty pricey.  So I started looking around, and compared notes with Darrell Bushnell in Granada, who was in sort of the same situation.   Some sobering facts:

1.       All national health insurance plans, of which there are several with good coverage,  Mapfre, and Iniser being two,  would not grant new coverage to anyone, citizen or legal resident,  or continuing tourist card holders, at the age of 62 years.

2.      Medicare coverage, as it is currently written,  absolutely does not work in Nicaragua; a Nicaraguan doctor tried to do this and is now in jail in Miami.

3.      There are several international insurance organizations who offer coverage, Cigna being one, but they tend to be pricey; the quotes I got hovered around $800 per month for my wife Chilo and I.

There are a couple of alternatives.  I found the Silver program at the Hospital Bautista, the oldest international hospital in Managua and a good hospital, that offered a sizeable reduction of costs, in some cases up to 90%,  for $100 per month.  The Vivian Pellas also has a discount plan, though not as generous as that of the Bautista.

For emergency care, the social security hospitals give free service, though you may have to furnish food, and bed sheets, if you are going to stay over night.  In Diriamba the Teacher´s Hospital is new, clean, and surprisingly good.  Several of the residents of Reparto Regina, who do not have social security coverage, have used it and are satisfied with the service, which cost nothing.

Another alternative is to use and directly pay for services from the medical community.  You have to be able to speak enough Spanish to describe symptoms, but there really are out there qualified specialists, you just have to look for them, and expats are not always the best source to find medical services. Some speak English most do not, and the ability to speak English does not mean they are a competent doc.  Many doctors over the age of 50 are very good trauma doctors as most of them served in the Contra war and are good with bullet wounds and ugly trauma like traffic accidents; all of them I have met, including  my personal physician,  Bismarck Perez, do not speak any English at all.  Best to learn the national language here. I have always found doctors with a Cuban accent to be very good, and my personal physician for years was Dr.Claudio, a Cuban, until he got hired away.

Many of us have raised families here, and had a sick kid wake up in the middle of the night with a high fever or with stomach pains.  The answer has been to know a doctor in advance who you could call and have him make a house call. The last time I did this it cost me an extra $10,which I could afford.

The best alternative for getting coverage is the Nicaraguan social security system, something I almost never see discussed in expat blogs.  To be eligible you need:

1.      To be a legal resident with the right to work stated on the residence cedula.  Multiple tourist cards do not work, and being a rentista or pensionista, just won´t work, and bootlegging a work situation, something I suspect exists in places like SJDS, does not work either.  If you can get a job, no matter how low the pay, that will allow you to sign up.  Social security gives 100% coverage, like nasty old socialized medicine.  They also pay for all medication, and at my age they give me a big bag of pills, free, every month. I also get a monthly checkup, and specialist checkup if I request it.

2.      All that costs $35 per month, and to be eligible you have to be a wage earner and under the age of 55, though there may be some flexibility in this.  Presently, there is no provision to buy into the service, as in Costa Rica.  And there are questions about the financial condition of Social Security, here called INSS.  Most of the financial issues are fixable, and I suspect they will get fixed. An added advantage to getting on INSS is that you are eligible for a pension after 15 years of contributions, to a máximum of 1500$ per month, exclusive of any other pension, like American social security. Living here on extended tourist cards when you could be accumulating weeks that accrue to your Nicaraguan retirement pension, is nuts.

3.      If you are an expat working on Nicaragua it makes sense to get inscribed as soon as you can.  You can start making contribution with every paycheck, and when you leave work, which may provide health insurance coverage, you just continue with INSS regardless of your age of separation.  Why more foreign companies do not do this I do not understand.

I still see my private physicians for specific purposes, and to visit, as they are my friends.  Old Bismarck Perez has given me various EKGs, at 25$ per EKG.  I still see Dr. Hermann Schaefer for skin lesions due to the Sun.  He has been slicing and dicing them, freezing them,  and cauterizing them with an electric spark for 15 years, and he will continue to do so.  I hate the dentist, but Chilo twists my arm so I go, once every couple of years. He charges 10$ to clean teeth and about that for cavities.

Lastly, there are a couple of things that can be done that may help out the growing number of expats living in Nicaragua.

1.      Lobby with INSS to allow expats to buy into the system.  This is apparently what they can do in Costa Rica, and it would be very helpful to aging expats here. The director of INSS is approachable, and something may be able to be done, especially if expats organize and do something other than complain about the lack of this or that.

2.      Lobby to extend Medicare benefits to expats.  Actually, this is not very hard to do, and could opérate if a few sentences in the Medicare law were amended.  This is how insurers like Aetna now opérate to insure expats, and it works fine.  The insured asks for permission to get health service from a foreign source; the insurer approves this, and the insured submits the bill for reimbursement.  This would reduce te cost of medical care for Medicare recipients,  as the cost of medical services in Nicaragua are usually a fraction of  the cost for the same services in the US, less than half sometimes much less than half, than US costs.

As the number of expats in Nicaragua increases the possibility exists to be able to lobby for things of common interest within Nicaragua and with the American national  government.  Maybe time to start moving.

Addendum by Darrell Bushnell

Pat and I along with many other expats discussed the major medical options available to us. Obviously, and to the great advantage to the United States, Medicare should offer their services to the countries where the expat resides since medical care is much cheaper almost anywhere than the states. In fact, Medicare should send many of its patients to other countries when possible to save money and in many cases, receive superior care.

Amy and I believe the medical care in Nicaragua is sufficient for most of our needs and our Granada doctor has been the best doctor we have ever had. Still, after Amy’s father went through a long painful ordeal with cancer, all costs being covered by his medical policy, we realized that even with greatly discounted costs here we probably could not afford a protracted disease or injury. We eventually decided to get catastrophic coverage with a high deductible that would at least cover the major possibilities.

We searched the world for a insurance company that would simply cover our costs in Nicaragua since the costs here are radically lower. Alas, none to be found and in Nicaragua, as Pat explains, you must be a legitimate working person and under 62 to to apply. Pellas and Bautista offer the discount plans but it is a discount off of an unknown amount. Amy is 61 and I am 67.

We narrowed our search to just catastrophic costs with a high deductible of $5,000 and were able to find several companies that fit the bill with various issues. Finally we found an agent that was familiar with all of the international plans and understood our needs and is located in strangely enough, Taiwan. Her contact info is below.


Regional Senior Advisor USA

Pacific Prime

T   +1 800 670 2574 (toll free US)

      Sun-Thurs 8pm-6am EST


+86 21 2426 6500
+86 21 6467 0328


After several long conversations of our needs she led us to Best Doctors Insurance located in the United States but with international offices. We decided on their Ultimate Care plan for our needs which essentially covers our catastrophic needs (with $5,000 deductible per incident) and below shows a short synopsis.

Maximum Benefit $1.000.000 per Insured per Policy Year
Eligibility to Apply Up to age 70
Renewal Lifetime guarantee
Coverage • Outside the USA:Free choice of Hospitals and physicians
• Inside the USA: Through the ULTIMATECARE™ Network If medical care is performed outside the ULTIMATECARE™ Network 60% of covered medical costs will be paid with a maximum daily rate of USD$600 for a room and USD$1,200 for intensive care unit
• Emergency medical treatment will be covered 100% up to the Policy limits

Preconditions are essentially not covered – for example, Amy has high blood pressure so heart issues are not covered for her. But our policy premium comes out to around $2100 a year to cover both of us. Everyone’s needs and priorities are different but this was the best fit to our limited budget. You can cover these preconditions but it would affect the policy price.

For full details go to  and download the PDF. They have other policies you can look at. You have to apply before the age of 70. But this policy also covers us in the states though doubt we would use that possibility.

Medical insurance is such a complicated and costly issue and the medical companies of the USA have ensured it remains complicated and costly with the USA one of a few countries not offering universal health coverage. Current legislation will probably make it worse. I am not a medical expert and you should do your own extensive investigation. If you have questions, you should contact directly Deanne. She is one of the most knowledgeable people on medical care costs we have ever met.

As for Amy and I, if the policy does not cover our needs we would probably just jump into a volcano since we have no heirs. Let others fight over our empire and meager possessions.

For another expat’s viewpoint go to:

A friend was looking at the same time and went with Costa Rica’s Blue Cross Shield. Here is her writeup.

Part One: Let’s Get Real about Health Insurance in Nicaragua

Part Two: Let’s Get Real About Expat Health Insurance

One Comment

  1. R. Trembley

    July 9, 2017 at 12:24 pm

    I have used pacific prime for many years with a high deductible and it costs around 1000 per year per person. Excellent service.