Expat Healthcare in Nicaragua: The Surprising Reality

Living in paradise doesn’t mean you should ignore your healthcare. Whether you’re a digital nomad, long-term traveler, or new retiree enjoying the good life in San Juan del Sur, understanding how expat healthcare in Nicaragua works can save you stress—and possibly a trip to the capital when it matters most.

A Mixed Bag: What Expats Can Expect

When it comes to expat healthcare in Nicaragua, the system is best described as a patchwork. Routine and preventive care can be easy to access, affordable, and even pleasant. But more serious conditions? Those still tend to require travel—usually to Managua.

In towns like San Juan del Sur, expats will find several small private clinics with English-speaking staff. These are ideal for common issues: minor injuries, basic prescriptions, check-ups, or dental visits. If you’re lucky, you might also catch specialists who rotate through during busier seasons.

However, local “hospitals” in San Juan del Sur are better thought of as extended clinics. They’re a solid option for stabilizing an emergency, but anything requiring surgery, advanced imaging, or specialist treatment will likely involve a drive.

The Rivas Advantage

Just 45 minutes north, Rivas offers a slightly more comprehensive picture of expat healthcare in Nicaragua. The public hospital there handles X-rays, more complex outpatient needs, and has more staff and equipment than what you’ll find in San Juan. Still, it doesn’t quite meet the standards most expats from North America or Europe are used to.

So while Rivas is an upgrade from San Juan, it’s not the final destination if things get complicated.

Heading to Managua: Where Healthcare Gets Serious

For anything beyond basic care, expat healthcare in Nicaragua really centers on the capital. Managua is home to the country’s top hospitals—Hospital Militar and Vivian Pellas—and both offer services at international standards.

  • Hospital Militar: Despite its name, it’s open to civilians. It’s clean, organized, and provides emergency care, surgeries, diagnostics, and more. The prices are reasonable, and staff often speak some English. They also offer an affordable private insurance plan, which many expats take advantage of.

  • Vivian Pellas Hospital: Arguably the best private hospital in the country. English-speaking staff, modern equipment, and specialists across every major field. The experience is more comparable to what you’d expect in North America, though the cost is also higher—especially if you’re uninsured.

Both hospitals are around 2.5 to 3 hours away from San Juan del Sur by car. That can feel long during an emergency, but it’s the price of quality care in Nicaragua.

Insurance: Do You Need It?

Yes—if you’re serious about living here long-term. Many expats opt for local insurance plans through Hospital Militar, which can cover most essential needs. A family plan can cost as little as $90/month. Alternatively, international insurance is a smart choice if you want broader coverage, especially for evacuation or treatment outside Nicaragua.

To enroll in a local plan, you’ll typically need your residency card or passport, any family documentation (like marriage or birth certificates), and a small payment upfront.

Tips for Managing Expat Healthcare in Nicaragua

  • Have a plan for emergencies. Whether it’s a taxi, private shuttle, or friend on standby, know how you’d get to Managua quickly.

  • Save important numbers. This includes your local clinic, the Rivas hospital, and both Managua hospitals.

  • Ask about clinic hours. Many operate on reduced or irregular schedules.

  • Use the Nica Seeker Directory to find trusted providers across the country by typing “hospital,” “clinic,” or other keywords in the Health & Wellness category.

Final Thoughts

Expat healthcare in Nicaragua isn’t perfect—but it’s manageable. For everyday needs, towns like San Juan del Sur and Rivas are generally sufficient. When it comes to emergencies, surgery, or specialist care, Managua steps in as the country’s medical hub.

By taking the time to understand your options, signing up for the right insurance, and building a local support network, you can enjoy Nicaragua’s laid-back lifestyle with confidence and peace of mind.