Health Care for Expats in Nicaragua

Update December 2019:
We left Nicaragua mid July 2018 because of a Civic Rebellion that continues to this day. My eye doctor from Vivian Pellas fled the country because the doctors who treated the protestors were ordered to stop treating them or be fired. Most of the ethical doctors left the country…and I don”t blame them. They treated horrendous injuries of protestors who were shot in the eye, or burned,  or tortured, raped, and mutilated for simply speaking out or marching for their human rights or fighting back with stones against armed paramilitary. Nicaragua is no longer a county I choose for retirement. It continues to be full of suffering and sadness.


One of the biggest challenges of living abroad is health care. When we opted for early retirement, we could have continued our group health insurance, but the cost of the insurance would have reduced our pension checks by half. Plus, when we retired, our health insurance was not accepted in Nicaragua. We are too young for Social Security and Medicare. Medicare is not accepted in Nicaragua either. At the time, our only option was to take a risk, self-diagnose, and live cautiously on our tropical island.

Fortunately, Hospital Metropolitano Vivian Pellas in Managua is committed to providing healthcare with international excellence. So, we made an appointment with Arlen Peres, the Medical Tourism Manager, called our faithful taxi driver, and visited the hospital to explore our insurance options.

Arlen Peres, Medical Tourism Manager

Arlen met us in the lobby of the hospital and attended to us like newborn babies. She took us on a tour of the immaculately clean and modern hospital, answered all of our questions with the honesty and professionalism of a Supreme Court Judge, and spoke fluent English. Impressive!

She explained the two insurance plans for the hospital: the Silver Plan and the Gold Plan. When we were trying to decide which plan would be the best for us, she recommended the Silver Plan because it cost less and it would meet our needs until we are 65 years old.

The Silver Plan

We filled out the health insurance application for the Silver Plan. It was three pages of general health questions..all in Spanish, which Arlen patiently translated for us. Ron’s Silver Plan is $21 a month. Mine is $18 a month. We could pay monthly or annually. We chose to pay annually and we charged $468 on our credit card for a year of health insurance for both of us!

The Silver Plan offers discounts for emergency room services, medical and physical rehabilitation, laboratory diagnosis and tests, annual preventive health check-ups, intensive care, and operations. The discounts increase after 24 hours, 90 days, and 180 days of insurance coverage. The discounts range from 15% to 70% depending on how long one has had insurance coverage.

Next, we had to have blood tests and urine samples tested for health insurance coverage. Arlen sent us to the lobby where we waited for about 10 minutes while she set up the appointments.

Ron and one of our friends

The reception desk in the lobby

Arlen returned and took us directly to the admittance booth, where we paid $25 each for all the laboratory tests. Then, she took us to the laboratory for our tests…no waiting! Top notch service! We went to the emergency room for general physicals: weight, height, blood pressure. While we were in the emergency room, Arlen toured us through the offices and operating rooms. They have a kidney dialysis room, where we heard soft music and the TV behind the closed-door. She said the kidney dialysis room is open 24 hours a day and is always busy. I don’t know why so many people in Nicaragua have kidney problems, but it is prevalent.

We met with the doctor for a few more questions and prodding and poking. Then, on to the cafeteria where we had lunch while we were waiting for the results of our lab tests. Thirty minutes later, after we had delicious cappuccinos and chicken burritos, we met Arlen in the lobby with our test results. The best news was that the test results indicated that we had no parasites. Ron had just completed a round of parasite pills because he had a bad bout with parasites the week before. I know the parasites were the result of him eating mangoes that dropped to the ground!

We were finished for the day! Our lab tests and physicals would be reviewed by the insurance director and we would be notified of our acceptance within a week. I have never encountered such personalized attention. Where in the states could one have a personal attendant, who tends to every health need? Not to mention immediate test results hand delivered the same day. Before we left, we asked Arlen how much each operation or procedure cost. She said, “Email me with the specific procedures and operations you may need and I’ll send you a list of the all-inclusive costs.” Can you believe that? No hidden costs? A list of all the costs of the procedures and operations? I’m amazed! Why can’t they do that in the states?

My expat friends from Granada went to Vivian Pellas hospital two weeks ago for their annual check-ups. While they were doing the stress test, they discovered that J had a serious heart blockage. They operated on him that evening and placed 2 stents in his heart. He did not have the hospital insurance, and he had to pay upfront for the operation. He charged $16,500 on his credit card for the total bill. His wife had the same operation seven years ago in the states. She only had 1 stent placed in her heart. Total cost for her? $50,000. What is wrong with the health care system in the states? I won’t rant here, but something is terribly wrong when the same operation costs 3 times as much in the states.

Vivian Pellas Hospital has a website, but when we checked for information, the website was outdated. I talked with Arlen about the website and she told me that someone had hacked into the website. They had to put up the old website until October when the new website will be completed. Here’s a link to the old website: Vivian Pellas

If you are an expat living in Nicaragua, or a potential expat, please feel free to contact me for more information about Vivian Pellas Hospital. Nicaragua is advancing daily in health care for expats. It is reassuring to know that excellent, affordable health care is available in Nicaragua.





44 thoughts on “Health Care for Expats in Nicaragua

  1. Pingback: Hitchhiking in Nicaragua | NicaConexiones

  2. Hi! Would you happen to know what that heart operation would have cost if your friends had bought health insurance for Nicaragua? $16,500 is still crazy expensive but much better than $50k. I’m just wondering how much better it would have been if he’d have been insured.

    • Hi Digna, I am sorry, but I don’t have the answer to that. With our discount program at Vivian Pellas, we can receive up to 70% off certain procedures and the cost of the hospital room. I don’t have a list of all the procedures that are accepted for the discount program. I’ll see if I can find out for you.

  3. Nicaragua is currently #1 on my list of places to move to from the U.S. later this year. As a seven-year cancer survivor with no further problems I anticipate having issues being covered for health care overseas. I don’t want to move to Ecuador even though I hear they have a new inexpensive coverage for expats with pre-existing conditions. I will arrive in your country at 69 years old, and have very “long livers” in my family: Dad 95, Mom 87. I expect to be around for another 20 years. Am I able to get taken care of by this wonderful sounding hospital? And what sort of costs would I expect? -jacqualine-

    • Hi Jacqualine,
      Thanks for your questions about health care in Nicaragua. I can only speak from my experience, but Vivian Pellas hospital is extremely affordable. We belong to a discount program, not actually health care coverage. We get discounts for many procedures..up to 75% off since we’ve had the discount for over a year. The costs for all procedures are generally 1/4 of the cost in the states. We have only used Vivian Pellas for our annual check-ups. However, friends of ours have gone to Vivian Pellas for a variety of procedures, such as heart stints, chemotherapy, gall bladder surgery, and they all speak highly of their care and the costs of their care. When we enrolled, we had a complete work-up..blood tests..the works. All of this included same day results. I think you would be pleased if you made an appointment to go to Vivian Pellas and talk with Arlen about the programs they offer. Our monthly plan is $26. It’s called the Silver Plan. There is a more expensive Gold Plan, but Arlen recommended we start on the Silver Plan. I hope this information helps.

      • Thank you for your quick response:) I have added Vivian Pellas to my list of important places to go when I take my look-see trip this summer. You have certainly put my concerns to rest. All this great information as I read another article today about Medicare costs increasing and services decreasing here in the U.S. It seems I am making a timely move. Most grateful. Now I just need to find a group of ladies who enjoy cards and board games. Do you know if my two little dogs will be welcomed in your part of the world?

        • It sounds like Granada may be a place to check out. They have travel groups, book clubs, and I’m sure you can find some card players there, too. Also, your dogs will be well taken care of in Granada. Now, on my little island, well…that’s another story. Our services aren’t nearly as encompassing here.

        • As your question about senior citizens was not answered directly, have you seen anything that resembles real insurance? While a discount is great, one must, at our age, think about catastrophic illnesses which require insurance. So, what is available for those of us over 65?

        • Liberty, Vivian Pellas Hospital in Managua accepts most international health insurance, for example Cigna and Blue Cross Blue Shield. I have used these two health insurance companies in the past. If you read through the comments, I think someone posted a link to a health insurance program offered in Nicaragua. Medicare is not accepted in Nicaragua, although there are some scams that will tell you it is accepted. Don’t be fooled into believing this. It is illegal. I hope this helps.

        • Thanks for the reply. However, I am aware of international insurers. What I am looking for is something originating in Nicaragua. Some countries like Ecuador offer their government schemes to expats. I do not believe Nicaragua does this. So in some countries there are other programs available to senior expats. The international insurers are very expensive by the way.

        • Liberty, there are 2 health insurance programs from Nicaragua. One is INESUR, which is the Nicaraguan health care system. I haven’t really explored this option, but I’ve heard it is very inexpensive. I believe that an expat would need residency for this. It’s something for us to think about, but for now, we are pleased with the services and the discount program offered at Vivian Pellas. We only use it for our preventative check-ups. Another thing to think about is that the cost of health care in Nicaragua is about 1/4 of that in the states. A tourist spent 13 days in Intensive Care with a traumatic head injury at VP and the total cost for everything was $13,000. Can you imagine what it would have cost in the states? My thoughts of the need for comprehensive health insurance have changed dramatically since living in Nicaragua.

        • Jacqueline,
          My wife and I are moving to Managua, Nica in Sept of this year. We have been waiting for this for over 20 years.
          My wife had two operations down there over a 3 year period. Flight, round trip, hotel, operation(female type), Hosp room w/bed for me total cost was less than $4000. Her other operation was of the bladder @ $3000 w/round trip flight, hotel, etc, etc, etc. there are three classes of hospitals down there. All three are served by the same type/educated doctors. No drop off in quality of doctors either. The newer hospital being the most expensive. My wife went to a different Hosp and was received better than in US. The doctor showed up the morning of the operation w/a cup of coffee for me. When has your stateside Doctor been so thoughtful?
          At our age the insurance, basically a you pay 20% they pay 80% payment type. That’s how it was two years ago. And let me say you have a few options along this split payment plans.
          I’d like to next address how old folks are taken care of in Nica. Usually at home by a relative or friend, or a maid & Gardner (couple that works for you). Like it used to be in the US, back in the day! LOL. You remember the 50’s, don’t you! Think how life was in the US back during the Ike administration, add modern technology and you will have a good vision of Nica. Maids are inexpensive. $10 to $20 a day. They will clean, cook, wash and iron your clothes and shop for you. Many times becoming your new best friend. Remember, these people love and respect the elderly. And especially Americans. I have never been rudely treated by a Nicaraguan in all my travels of Nica. And I’ve made more than a dozen trips to Nica since 1978. You will need to find a driver. My wife’s cousin is taxi driver, certified w/all the credentials. We use him whenever we are down there. You build trust w/people down there a little at a time. Nica’s are proud people. This doesn’t mean you won’t get ripped off down there. Let the buyer beware applies world over. But also remember Nicaragua is one of the safest countries in the Western Hemisphere. Still, keep your guard up. Just like in any city in the USA you wouldn’t walk the streets alone at night. Nor should you do that in Nica.

        • Hubie,
          Thank you so much for the long detailed comment about health care in Nicaragua. Everything you mention about the excellent care your wife received is true! We even got hugs from the docs! I love this country, mainly because of the people. Thanks for your comments.

      • Would you know the cost of gall bladder surgery? We live in Nicaragua part of the year, and part of the year in the States. Considering get it done in Nicaragua.

    • After visiting Nica every 4 years of so since 1978, my wife and I are finally doing it. I’m 64 and she is 59. We lost everything to Hurricane Katrina back in 05. After building my business back up I tried getting health ins again. Unfortunately I too am a cancer survive from1997. My wife had a stroke right after Katrina. I guess going from an upper middleclass income to 0 was too much for her. Plus we had two daughters in college at that time. My insurance premium went from$450 a mo to $1200 a month. Three years ago my wife went to Nica for a female operation. Great Doctor and Hospital in Nica. They gave us a double room so I could sleep in there with her. The doctor greeted my wife and I and gave me a cup of coffee the morning of the operation. Nicaraguans are very personable people and they LOVE Americans. My opinion after years of spending time in almost every town in the country since 78′. She paid $4000 cash for what our local hospital n the US wanted over $50,000 to do. We are moving to Nica on Oct. 3, 2015. Can’t wait. Who do I speak to and where do I go to check out the Gold and Silver plans. A name and phone number would be appreciated.

      • Hola Hubie,
        Thank you for writing such a detailed introduction and the problems you have experienced with healthcare in the U.S. It is great to “meet” you and I hope we have an opportunity to meet in person when you move to Nicaragua in October. I imagine that your lives were very stressful after Katrina, and I hope that you will experience healthy, stress-free lives in Nicaragua. I am so excited for you!
        Here is the contact information for Arlen Perez. She works at Vivian Pellas. In fact, your wife may have met her when she came to Nicaragua for her operation.
        cell phone: 505 8464-0084

        Best wishes in your move. It won’t be long now!

    • Bob, it depends on where you go to have a baby. You can go to a clinic or state run hospital and it costs little to nothing. If you go to Vivian Pellas Hospital in Managua you will have to pay. I am not sure, but a friend of mine had her baby at Vivian Pellas and I think the cost was a little over $2,000 for everything, including all the prenatal exams. I’ll see if I can find out exact prices for you.

  4. Great post, thanks for sharing. Arlen is a true gem! One consideration is that the plan mentioned that Hospital Metropolitano offers isn’t really insurance, it is more of a discount scheme.
    There are two companies that I know of that offer real health insurance, Seguros America and INISER. I went with INISER after checking out both companies. It is dirt cheap in comparison to the States, that is for sure!

  5. I think the liver problems for Nicaraguans is el guaro (slang for alcohol)… I wanna move back to Nicaragua lol …… great post Debbie

  6. I would like to know the costs for the procedures request. I know I would not be able to pay even $16,000 up front, so it would be nice to know what that procedure would have cost your friend with insurance.

    • The one troubling aspect of the health insurance at Vivian Pellas is that even with the health insurance plan, we are required to pay a deposit before a procedure or operation, and before we leave, we must pay the full amount. I wondered how a patient would pay for a major operation if his/her credit card limit was low? Arlen told us that the hospital will assist expats in transferring money from the states, but all balances must be paid before a patient leaves the hospital. So, my recommendation is to come to Nicaragua with a high credit card limit, or have
      a medical savings acct. for emergencies. There are certain things that are not covered under the insurance plan. Stents are one thing not covered. As far as the cost if he would have had insurance, I’m not sure. I think his doctor’s care and any medicines, anesthesia, and hospital room ( all private rooms) would have been covered under the insurance.
      Here is a good example: A young man was involved in a serious motorcycle accident on our island. He was transferred to Vivian Pellas with severe injuries. His mother was on a flight to Nicaragua, and the hospital called the pilot of the plane to get her permission and her credit card number so they could do surgery. He spent 13 days in the intensive care unit of the hospital with major surgeries. The total cost of his hospitalization was $13,000. Can you imagine what the cost would have been in the states?

  7. Maybe this information will help your followers:
    Insurance companies accepted by Pellas Hospital


    If you must have an international health plan go to the following sites to find a good one. They will compare most of the available plans.

    I would like to communicate directly with you as it looks like we have a lot in common.

    I really enjoy your posts and thank you for your contributions to the Nicaraguan lifestyle.

    • Glenn, thanks for the list of insurance companies. We had Cigna insurance in the states, but our type of Cigna was not considered international and would not cover us abroad. That is one thing to check into with health insurance. We would have had to buy the Cigna International health insurance which was a separate health insurance policy.

  8. I realize your question was rhetorical but health care costs are so opaque here in the US I can’t resist helping (hopefully) your understanding of the reasons for our high costs. This article was published earlier this year. We have a large (and expensive) medical community here in Charlotte and this is a list of “robber barons” that our part of the problem.

    I love your blogs!
    Steve in Charlotte

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