This article explains how Costa Rica and Panama, two Central American countries with nearly universal public healthcare programmes, have come to enjoy such broad coverage. It then describes the distinct paths each is taking towards reaching the populations still left out of healthcare coverage. Costa Rica is seeking to bring all residents under the umbrella of its ILO‐style social security plan. Panama is targeting the rural poor with a package of defined interventions aimed at maternal and child mortality. The article frames these cases within the literature on the varieties of universalism.