The essentials on expatriate health insurance in Brazil
Brazil provides universal health coverage for all its citizens and residents, including expatriates. However, disparities in the allocation of resources have seriously tarnished this beautiful image. The system, which is meant for all, is in reality ill-equipped and overcrowded. Meanwhile, the intensive privatization of the health care sector has led to a race for high-end care, which comes at “exclusive” prices. In Brazil, expatriate health insurance ensures access to the best care without it costing you an arm and a leg.
| Health care expenditure per capita | €1081 |
| Annual indexing of health care expenses | 12,5% |
| CFE hospitalization reimbursement rate | 31% |
| Number of insurance companies providing services | 15 |
| Cost of hospital coverage for people 30 years old/year | €789 |
| Cost of hospital coverage for people 50 years old/year | €1264 |
Brazil, the world's 8th largest economy, is experiencing a growing demand for health care services from its population. This demand is reflected in the number of people insured by the private sector, which reached 48 million in 2019.
Brazil is the largest health care market in Latin America. It has the fourth largest population of physicians in the world (454,000 registered practitioners) and is second only to the USA in the number of cosmetic surgery procedures.
Intense competition in the private health care sector has led to continuous innovation and improvement in terms of quality of service and “hospitality” in health care facilities. Over 60% of Brazilian hospitals are private establishments.
More and more “luxury” health care facilities are being opened, with the primary goal of providing the best “customer experience.” It goes without saying that the fees are equally extravagant.
However, behind the glitter of the high-end facilities lies a multi-speed health care system. The modest number of public facilities and their lack of equipment is a stark contrast to the investments made in the private sector.
There is a free, universal health care system in Brazil, the Sistema Unico de Saude (SUS), which guarantees full coverage of health care costs for citizens and residents. Nonetheless, the population that can afford to pay systematically chooses the private sector to avoid extensive wait times and to be treated in good conditions.
The decentralization of the Brazilian health care system has caused multiple disparities in the distribution of health care facilities and the equipment they have available. This has led to “medical tourism” in the big cities, while more rural areas remain poorly equipped and in difficult situations. The hospitals and medical facilities in major cities are overcrowded, and some treatments and operations have wait times of up to 2 years.
With these shortcomings in quality of care, the long wait times (in public and government-approved private facilities), and the enormous cost of health care in the private sector, nearly 25% of the population is covered by private health insurance. Expatriate health insurance is a logical choice to protect your health.
Health conditions in Brazil are satisfactory, especially for the wealthy classes, and they are improving over time. There are significant disparities according to geographic area.
In general, avoid raw or undercooked food, and choose bottled water if you have any doubts about potability. Ice cubes and opened drinks are not recommended.
There are no mandatory vaccinations, but the following are recommended: hepatitis A, hepatitis B, rabies, measles, typhoid and yellow fever.
Yellow fever is a serious risk in some regions. It’s a good idea to get vaccinated before you go, just in case. Proof of vaccination is not required for travelers entering Brazil. Speak with a health professional about your situation. Vaccination is strongly recommended for all central, western and northwestern states, including Brasilia. The risk isn’t as great in other states, but it remains widespread outside the cities of Rio de Janeiro, Recife, Fortaleza, Salvador and Sao Paulo.
You’ll also need to protect yourself from insect bites to lower the risk of dengue fever and malaria in certain regions.
The symptoms of dengue fever are similar to those of malaria, but they don’t last as long (usually 10 to 15 days) and generally do not present complications. However, no preventive treatment currently exists.
Given the high cost of health care in Brazil, we recommend getting a check-up before you go.
The price of a consultation varies according to the region and the reputation and/or specialty of the physician, as well as several other factors:
- In Brasilia, it can range from 120 to 500 BRL.
- In Sao Paulo, medical care is less expensive: a consultation with a general practitioner costs 210 BRL on average, and a consultation with a specialist is 280 BRL.
- In Rio, a general practitioner in the private sector charges between 200 and 250 BRL. Fees in the private sector are negotiable.
Dentists' fees are usually over 150 BRL in Brasilia and Sao Paulo. They are high, but not excessive. The quality of care is excellent, and the cost of dentures and orthodontics can be lower than in many European and Asian countries.
The cost of vision care is significantly lower than in Europe, and the equipment used is of the same quality.
In general, insurers classify Brazil as a country with high medical costs for expatriates, globally ranking between 6th and 20th alongside countries such as Australia and the United Arab Emirates.
Considering the prices, if you are on a budget we recommend having a dental check-up and handling all necessary preventive care before you go. That way, you may not have to choose a health insurance plan that includes dental care, at least not for your first two years in Brazil.
The public sector suffers from a noticeable lack of materials and equipment and chronic overcrowding, and wait times are extremely long. English-speaking physicians are rare.
Despite the fact that some public hospitals have a good reputation for certain specialties, the vast majority of expatriates choose the private sector for their health care.
60% of hospitals in Brazil are concentrated in the South and Southeast, so health clinics (Posto Saude) are overcrowded throughout the country.
The quality of health care in the private sector also varies from one region to another. It is not uncommon for certain specialties to be unavailable in rural areas.
In Rio, for example, the quality of health care is on par with that of the most developed countries, thanks to the high technical level of the practitioners. This is also the case in Sao Paulo, where there are extremely high-quality hospitals (such as the Albert Einstein Hospital) whose prices are equally high, almost equivalent to those in the United States.
In the private sector, significant price differences can exist without a corresponding difference in the quality of care. These differences may be related to the reputation of a physician or the comfort of the facilities, rather than the quality of the equipment or level of care.
Only private supplementary insurances allow the insured to choose their physician and hospital. In the public sector, you must contact your specific dispensary, health care center or “family health unit” to be directed to the appropriate specialized service or hospital.
You’ll usually need your general practitioner to provide a referral before seeing a specialist.
It’s difficult to find physicians that speak English or French in public establishments. It’s easier to find one at private practices. Your consulate can provide a list of recommended physicians and health care centers for expatriates.
International health insurance provides online consultation services for common ailments, which can be very helpful. Medical assistance services can help answer your questions in case of emergency.
As a reminder, in the event of a medical emergency, it is not the responsibility of your embassy or consulate to arrange or pay for medical repatriation.
If you don’t want to cover the cost (up to several thousand euros) on your own, repatriation coverage is strongly recommended, especially if you live or travel regularly outside of major cities.
French social security only covers French tourists, not temporary or permanent residents in Brazil. There is, however, a social security agreement between France and Brazil that covers secondment contracts of up to 24 months.
The Brazilian social security system covers:
- Social welfare: This concerns maintaining the income of insured persons who are unable to work. It includes coverage for illness, maternity, disability, old age, death and involuntary unemployment. This first form of Social Security coverage is managed by the National Institute of Social Security or INSS (Instituto Nacional do Seguro Social), which falls under the supervision of the Ministry of Social Security.
- Health (sickness/maternity): This is funded by the state and falls under the supervision of the Ministry of Health
- Social assistance: This is for those who do not qualify for insurance services (the elderly, the disabled, those unable to work, etc.).
- Unemployment risk for employees: This is managed by the FGTS (Fundo de Garantia do Tempo de Servicio). Employers pay the FGTS 8% of earnings on employees’ individual accounts.
- Retirement: This functions on a pay-as-you-go basis, and there are two types of plans (one for civil servants and one for private sector employees).
The Unique Security System, SUS, is a public entity that facilitates access to health care services in public and private contract hospitals.
The SUS covers the following health care services: hospitalization and surgery in public or government-approved private institutions, consultations with approved general practitioners and specialists, lab tests, and certain prescription drugs (most drugs are not covered). These health services are coded, priced and listed by the SUS.
“Convênio” is the Brazilian private health insurance system. It is regulated by the health agency (ANS), and exists in various forms:
- Self-managed: a company that has a contract with certain physicians/hospitals.
- Group medicine/Planos de Saude: offered by approved health care facilities.
- Medical cooperatives: the physicians own the hospital to which insured persons pay their contributions.
- Private insurances: there are around 15. They are more expensive than Planos de Saude, but subscribers aren’t limited to receiving care only in approved facilities.
If you choose a local private health insurance, the higher the level of "convenio", the better the reimbursement rate. Private insurance plans have dedicated health care networks, and the practitioner and health care facility you choose must be in-network. You will generally need a supplementary plan for vision/dental coverage. Premiums are high, and each health plan functions according to locality, state or country, depending on the coverage selected. Waiting periods may apply.
The CFE is available to all EU citizens. It will cover your expenses incurred in Brazil, but it will only provide partial reimbursement. For example, for a consultation with a physician, the CFE reimburses a lump sum of €17.50, based on the French social security reimbursement.
The same principle applies for all treatments, including hospitalizations. CFE reimbursement is based on the reimbursement percentages for zone 4 (CFE). If you are hospitalized, the CFE will cover 31% of the bill. Pharmacy bills are covered at 45%, and blood tests at 20%. These numbers are interesting because they show that, according to CFE statistics, prices in Brazil are between three and four times as high as rates in France.
As you can see, CFE coverage won’t be enough to ensure that you are properly taken care of in an emergency. You’ll need to subscribe to supplementary insurance as well, to ensure adequate coverage for the high cost of Brazilian health care expenses.
Based on your situation and preferences, our advisors can help you decide whether to subscribe to the CFE plus a supplementary expat plan or just an expatriate insurance plan.
The high cost of health care in Brazil makes purchasing expat health insurance essential, even for those who have already chosen to join the CFE (as explained above).
Expatriate health insurance will allow you to choose your own physician, and will ensure 100% reimbursement for all expenses incurred in case of hospitalization. Most private hospitals require you to pay a deposit or present proof of insurance before providing treatment. They want to make sure that they will be paid before treating you.
With an international insurance policy, your coverage will apply worldwide, both in Brazil and on a getaway to Argentina or Uruguay, for example.
If necessary, your expatriate health insurance will assist with repatriation, which can help you avoid complications in case of serious illness. It will also provide assistance with any legal or medical procedures.
If you are on a tight budget, find an insurance that just covers hospitalization, which is the absolute minimum. Choose a plan with an annual coverage limit of at least 500,000 EUR.
If you can spend a little more on your health care, choose a plan that covers other health care expenses in addition to hospitalization. This can be particularly useful for pharmacy services and exams.
For more information, compare global health care insurance offers online.
If you are hospitalized for over 24 hours, your expatriate insurance provider will see to it that the hospital/clinic is paid directly.
Regular medical and vision/dental expenses must be paid up front. Claims can be filed easily online (no need to send anything by mail). All insurance companies provide online customer support via their websites, and sometimes apps, to manage your reimbursements.
In general, invoices for €1,000 or less can be submitted digitally. Invoices for over €1,000 (which are rare) still have to be sent by mail.
Apply around 30 days before your departure, since the procedure for taking out expatriate coverage is more complicated than for traditional insurance.
Use our website to compare coverage and get price quotes online.
Then one of our advisors can help you through the whole subscription process.
In Brazil’s major cities, the quality of care is good, and you won’t need to be repatriated to receive proper treatment.
The situation is different in the central, western and northern regions, where repatriation assistance can be extremely helpful. It may also be useful if you intend to take advantage of your time in Brazil to explore other parts of America.
Repatriation assistance may also be able to help you find a physician or health care center, or even reduce the cost of medical expenses by taking advantage of special agreements.
It may also provide services that can be qualified as “for your comfort" but are very welcome in case of a serious event: paying for a relative’s trip so they can come to your bedside, organizing child care or transportation, access to medical advice and guidance, etc.
In a country where the police and judicial systems may seem completely different from what you’re used to, civil liability and legal protection insurance is a must.
It covers all material and immaterial damage that an expat or a member of their family may cause to a third party, and provides valuable assistance with all the legal ramifications.
In case of a medical leave of absence or disability, neither the local social security nor French social security will provide income continuation.
Subscribing to a private insurance, or to one of the CFE options, is essential in order to be covered.
You may receive a replacement income that will be paid until you reach retirement age.
Unless your status requires your employer to make contributions to a pension fund, you will need to take out a capital-funded pension plan.
There is no coverage in case of death, so you’ll also need to take out coverage to protect your spouse and children.
The phenomenon receives less media attention now than it did in the 90's. Nonetheless, in Brazil, the risk of kidnapping cannot be ignored.
Special insurance policies cover the ransom payment in case of kidnapping, as well as the services of highly specialized crisis management agencies.
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