Do you need health insurance as an expat in Portugal? Find out if you can register for state healthcare to get free or discounted treatment, or if you’ll need to take out an additional private health insurance policy.
This guide on health insurance in Portugal covers the following topics:
- The healthcare system and health insurance in Portugal
- Who needs health insurance in Portugal?
- Public health insurance in Portugal
- How to apply for public health insurance
- Private health insurance in Portugal
- Health insurance costs and reimbursements
Bupa Global is one of the world’s largest international health insurers. They offer direct access to over 1.3m medical providers worldwide, and provide direct settlements, so no up-front healthcare payment for the client is required. They provide access to leading specialists without the need to see a family doctor first, and ensure the same level of cover, whether at home or away.
The healthcare system and health insurance in Portugal
The Portuguese health insurance system can be complicated, but it has improved considerably in recent years. It is currently ranked as the world’s 12th best by the World Health Organisation.
The 2019 Health Care Index lists Portugal’s system as 22nd best out of 89 countries, with a high score for quality of infrastructure.
Who needs health insurance in Portugal?
All foreign residents or employees in Portugal typically gain the same healthcare rights as Portuguese nationals.
Expats receive health insurance in Portugal from the state. Not all types of treatment are available for free, with many requiring a patient contribution.
Public health insurance in Portugal
The SNS title covers numerous initiatives and healthcare centers, involving a number of complicated and sometimes contradictory schemes.
State healthcare is considered to provide a relatively good, albeit not uniformly consistent, standard of care. Unfortunately, waiting times can be long due to over-subscription.
Portugal’s health insurance typically only covers a percentage of treatment costs. For those with ongoing health issues or expensive medicine, private health insurance in Portugal may provide greater coverage.
Who does public health insurance in Portugal cover?
- Employees and their dependents: Portugal’s state system is open to those who pay Portuguese social security (seguranca social) and their dependent family members.
- Retirees: subsidized prescriptions and contributions towards additional healthcare such as dental and optical treatment are provided. EU citizens who retire early may qualify for free or subsidized healthcare for up to two years of residence, with form S1. Alternatively, early retirees can pay voluntary social security contributions or get private health insurance in Portugal.
- Short-term visitors: short-term visitors can access the Portuguese healthcare system. They will typically have to pay unless they are covered by travel insurance or medical insurance (a typical visa requirement).
- EU/EEA citizens: travellers from the European Union, European Economic Area or Switzerland who are visiting Portugal can be covered by their European Health Insurance Card (EHIC Portugal), which allows access to subsidized healthcare on the same conditions as local residents.
- Students: EU, EEA and Swiss students are entitled to the same healthcare benefits as Portuguese citizens using their European Health Insurance Card.
What does Portuguese public health insurance cover?
- Visits to the doctor: after registering with your local health center, you can book appointments over the phone, in person, or online. When visiting the doctor, Portugal’s health insurance scheme covers most costs. However, you may need to pay the consultation costs, depending on your coverage. As an example, low-income earners and pensioners often pay less or nothing.
- Hospital treatment: Portugal boasts around 200 hospitals, around half of which are private. Unless it’s an emergency, a visit to a specialist at a hospital requires a doctor’s referral; otherwise, it may not be covered by your health insurance. How soon you get an appointment and where you will be treated can often depend on whether you’re covered by private insurance in Portugal or are using the state system, which has long waiting times for some services.
- Medical emergencies: If you require an ambulance for a medical emergency, you should call 112. If you use an ambulance you’ll often need to make a small contribution towards the service that is not necessarily covered by health insurance in Portugal. Alternatively, if you can make your own way to the hospital, you should be able to visit an around-the-clock emergency department.
- Maternity cover: most maternity care is provided by your local hospital. Medical examinations are free under health insurance in Portugal, but pre-natal care classes aren’t. Pregnant women receive a Pregnancy Booklet (Boletim de Saude de Gravida), where parents can track their baby’s progress. On maternity leave, mothers receive 100% of their salary for 120 days and 80% for the following 30 days. Fathers, meanwhile, have five days of paternity leave after the birth.
- Sick pay: sick pay is available to those who pay social security contributions. If you’re absent through illness or injury, you are eligible to receive sick pay for a total of 1,095 days. The amount of sick pay operates on a sliding scale of between 55% and 75% of your salary. This figure also varies based on whether you receive benefits, earn a very low wage, or have several dependents.
- Dental treatment: SNS doesn’t cover dental care unless you’re part of a vulnerable group. In this case, you may receive dental vouchers to cover dental costs. Otherwise, some private health insurance companies offer dental insurance; they offer this either as a comprehensive health insurance plan or as an optional add-on.
- Eye care: eye care works slightly differently. If you want to see an optician under the state system, your local health centre books appointments with specialists. Waiting times are often long if your problem isn’t urgent. SNS doesn’t cover optical care; you’ll need to pay for glasses and contact lenses yourself or consider vision insurance in Portugal.
How to apply for public health insurance
If you are working in Portugal, your employer should automatically enrol you and arrange payments into the social security system in Portugal, after which you can get health insurance.
Self-employed people, however, will need to register with the Social Security Institute (Instituto da Solidariedade e da Segurança Social) themselves before apply for health insurance in Portugal.
Once you’re registered, you then need to visit your local health centre (centros de saude), where you’ll be assigned to a doctor (read more about registration at a health centre, or see the SNS’s site in Portuguese). You will need to register with a doctor before making an appointment.
When registering at the health centre, you’ll need to take your social security card and passport and residence permit. You’ll then be given a temporary registration certificate, before being sent a healthcare card (cartão do utente), which you should carry at all times and allows you to receive discounted healthcare.
If you haven’t yet received your residence permit, you can get a certificate from your local Junta de Freguesia confirming more than 90 days of residence in Portugal.
Show this, along with the necessary paperwork, to your local health center to get your healthcare number (numero utente).
Private health insurance in Portugal
If you don’t qualify for the state healthcare system, you’ll instead need private health insurance in Portugal.
Regardless of eligibility, some expats choose to take out a private plan anyway to avoid the long waiting lists often seen in the state system.
Private health insurance in Portugal is growing in popularity, with some expats also opting for supplementary private insurances, such as dental or vision.
Your company might offer you a private insurance plan when you start working in Portugal. If you change employers, it typically ceases and you may lose coverage for certain factors if you change companies.
The advantages of getting private health insurance coverage in Portugal
Private healthcare typically offers shorter waiting times, better facilities, wider choice, and less language barriers.
Although many English-speaking doctors are available in major cities and resort towns, this isn’t always the case if you live in a more remote areas.
Expat health insurance typically offers more flexibility to access healthcare in a number of countries. It provides benefits such as repatriation or evacuation, coverage for non-urgent issues abroad and direct payment for your treatment in any country.
How to choose a health insurance provider
Private health insurance in Portugal is widely available from well-known international private insurers and local private insurance companies.
Use comparison websites to search the range of health insurance companies in Portugal.
Quotes vary wildly depending on the level of coverage; most providers can’t provide an accurate policy quote until you fill out a health questionnaire or undergo a health check.
Before signing up for private health insurance in Portugal, check your policy to note any clauses giving insurers the right to cancel or increase your rates once you reach a certain age.
Changing a policy or taking out a new policy after retirement age is considerably more difficult and expensive. Additionally, many Portuguese private insurers only offer policies for people aged under 55. If you’re older, you may need to get cover from an international insurer.
It’s possible to get advice from English-speaking insurance specialists who compare private health insurance products on your behalf. If you already have private insurance in another country, you could consider extending your plan to include coverage for Portugal.
You can read more in our guides on the differences between local and international health insurance and how to choose the best expat health insurance
Some of the largest private health insurance companies in Portugal include:
Health insurance costs and reimbursements
Portugal’s health insurance scheme allows for residents to access healthcare services for free or at discounted costs.
However, you’ll need to pay higher fees for some treatments and services unless you fit into one of the following groups: low-income earners, students, children, patients with diabetes, people over 65 and pregnant women.
If you take out private health insurance in Portugal, costs range from several hundred euros per year to thousands.
Most schemes also come with an excess fee; you’ll have to pay this before making an insurance claim. In addition to individual policies, it is also possible to get private healthcare packages to cover your whole family.
The cost of private health insurance varies depending on the level of coverage you choose and for where, and families can usually get competitive rates.
Many private insurance policies don’t cover outpatient costs, for example, family doctor visits or certain medicines, although you can increase your coverage to incorporate such factors.
Most private insurance in Portugal will, however, typically cover the full costs of specialist or hospital treatments. Typically the higher the cost of private insurance, the more features and choice of doctors and hospitals will be available.
Pharmacy costs under Portuguese health insurance
You’ll be able to access many medicines over the counter at your local pharmacy (farmacia de servico); some require prescriptions from your doctor.
Under state health insurance in Portugal, you’ll typically need to contribute a percentage of the cost of your medicine, with different grades of medicine subsidized by the following percentages: Class A (90%), Class B (69%), Class C (37%) and Class D (15%).
Pharmacies are usually open all day from Monday to Friday (although some close at lunch times) and on Saturday mornings; in larger towns, some pharmacies open on Sundays.
In any case, there are always 24-hour facilities in each area for urgent medical issues.