What you need to know about expatriate health insurance in Portugal
In Portugal, health coverage is universal and provided to all permanent residents. Although all public facilities offer access to healthcare, it is not completely free; and some specialized services are available only in the private sector and therefore must be paid for. It is essential to have private health insurance in Portugal, which has the highest percentage of out-of-pocket expenses in the EU. And given the peculiarities of local insurance companies, expatriate health insurance is an ideal choice for covering all your health expenses.
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The Portuguese constitution provides that anyone can receive healthcare in Portugual. The Portuguese National Health Service, or Servicio National de Saude (SNS), was created in 1979 and is based on the English NHS model, with the distinctive feature of being a public health service that is co-financed by the patient. This means that healthcare costs are not completely free and that there will be a "co-payment," which applies according to the care received.
With its mixed public-private system, Portugal ranks high among European health systems (in 12th place according to the OECD), although Portugal's per capita health expenditure is one-third lower than the European average. In 2019, health expenditures accounted for 9.5% of the GDP compared to the European average of 9.9%.
This result is due in particular to the economic program which was in place between 2010 and 2013. But the trend has been reversing in recent years, with many investments (such as better chronic disease management since 2019), and most recently, the 2020 COVID crisis. The new economic plan provides for an 8% increase in the budget allocated to health and for the hiring of 8,400 more healthcare professionals.
Finally, solutions are being studied for the various patient out-of-pocket expenses. While this helps to finance healthcare costs in addition to the state budget and taxes, Portugal has the highest out-of-pocket expenses in Europe: 30% on average compared to 15% in the EU.
For the time being, the current system encourages a many people to use private insurance (in order to limit out-of-pocket expenses), when their budget allows it.
In Portugal, health services and the quality of the health infrastructure vary according to their location. Most are located on the coast between Lisbon and Porto, and according to the most popular tourist websites, some areas are considered to be a medical desert.
The quality of healthcare in the public sector is similar to the healthcare provided in the private sector. However, there are significant differences in waiting times, the number of available healthcare personnel, the services offered and the cost of care.
It is best to be patient when seeking healthcare in the public sector, because health services are usually crowded in the morning. With endless waiting lists (even with an appointment), healthcare providers forgetting or cancelling appointments, and numerous strikes by healthcare staff, some facilities are beginning to lose their reputation. There can be a wait of several months for a specialist consultation. For example, the average waiting time for a cataract operation is four months.
Beyond the lack of staff and long waiting times, some special services are not available in the public sector. You will need to pay close attention to your care pathway, as you may be redirected to private practitioners and facilities which are not "sponsored" by the state. Similarly, if when you are hospitalized, you wish to avoid the lack of privacy of a common room and you request a private room instead, you will have to pay all the costs for this room, instead of being completely covered.
Finally, receiving care in the public sector does not guarantee that you will receive free care, because there will be a co-payment/taxa moderadora in most cases (except for exemptions or exempted categories, such as pregnant women, children, retired persons, etc.). But the cost is still lower than in the private sector.
The private sector is well developed, with modern, high-quality, state-of-the-art facilities and a larger staff. Portugal has 107 private hospitals, the most well-known of which are the CUF, Lusiadas and Hopital da Luz. It will be easier to find English or French-speaking physicians in the private sector. However, the cost will be higher than in the public sector and it is recommended to have private health insurance to cover your expenses.
Using the public sector for your healthcare means that you must follow the customs of the country.
In Portugal, your general practitioner is designated when you register at the health center near your home. The health center (centro de saùde) provides non-urgent primary care. This is where routine consultations, routine vaccinations and nursing care are performed; specialists will be at the hospital.
The family doctor is always consulted first, who then refers you to the necessary specialist, such as a dermatologist, a pediatrician, a cardiologist or even a gynecologist. The co-payment for a general practitioner consultation is €4.50, it will be €7 for a specialist, and the fee for emergencies is about €18 (2020 figures).
If you choose a doctor from the private sector, you will have to choose a doctor in your healthcare network if you have a local insurance policy or card. And depending on which of these you choose, you will benefit from a negotiated rate, a discount, or a partial or total refund.
With an expatriate health insurance policy, you can select the doctor of your choice. The average cost of a consultation with a general practitioner is between €40 and €70. Specialist fees will depend on the location and the doctor, as it is often the case in private practice. It is best to select a plan with an intermediate level of reimbursement to have the least amount of out-of-pocket expenses or to be completely reimbursed.
For comparison puposes, local insurance companies offer reimbursement packages starting at €15 for general practitioner consultations, while international insurance companies offer packages starting at €30-€40 for general practitioner consultations.
Due to the long waiting times for (public sector) consultations, many Portuguese go directly to the emergency room (Serviço de Atendimento Permanente or hospital). These emergency rooms are very efficient, but the waiting time depends on the strict screening done when you arrive. It is best to call 808 24 24 24 (SNS24) for a referral for minor emergencies. A mobile app, "MySNSTempos," is also available. Otherwise, as in all Europe, 112 is the usual number to call (where you can also speak to someone in another language than Portuguese).
If you need to be hospitalized, you will be also referred by your family physician, unless it is an emergency.
Drugs are prescription-only, and like other healthcare services, they will not be free. Depending on the disease treated, the State's participation varies between 15% and 90% for the listed drugs. An exception is made for retired persons and certain categories of vulnerable people, for whom the State covers 100% of generic drugs. Generic drugs are generally covered by an additional 10% reimbursement.
For dental care, you generally choose your dentist from among the specialists in the private sector (the cost is between €30 and €60 for a basic consultation). The only people who are covered are retired persons (depending on their specific needs), children up to 16 years old and certain categories of vulnerable people (disabled, etc.). The government has set up a scale to regulate certain types of care and a system of "dental vouchers" that allows access to care from approved dentists.
There is also a scale for prostheses (including optics, for example, €75 for an ophthalmic consultation) and for therapeutic devices. In these cases, the State subsidy varies according to specific ceilings and conditions of coverage.
Because of the out-of-pocket expenses, delays or services which are lacking in the public sector, about 25% of the population in Portugal uses private insurance (2.34 million people in 2017).
The SNS provides comprehensive coverage for maternity-related health costs for all women. The SNS also offers an exemption from co-payment up to 60 days after birth and coverage of healthcare costs for newborns (and coverage up to the child's 16th-18th birthday). The few expenses which are not free are, for example, childbirth preparation courses.
The family doctor will monitor the entire pregnancy, if it is going well. Occasionally, certain examinations, such as an ultrasound or a periodic check-up can be provided by the health center's maternity ward. The follow-up is not very extended. If you want a closely supervised pregnancy, with counseling and education, it is preferable to be followed-up privately; and to have insurance that covers the costs.
You are free to choose the mother-child center in which you would like to have the delivery take place. You have access to all public centers. In fact, public hospitals may have better neonatal facilities than some private hospitals and clinics.
Local insurance or international insurance?
Social protection in Portugal is based on three distinct systems:
Although the Portuguese National Health Service (SNS) is universal, it is an agency of the Ministry of Health and provides healthcare through local health units, health center groups, and public hospitals. The main healthcare providers are the Health Centers and their local branches. The SNS is managed at the regional level, where each of the five jurisdictions is responsible for the roles of insurer, purchaser, and provider of care and the regulation of all aspects of these roles.
Any permanent resident in Portugal can register at the secretariat of the Centro de Saùde, as soon as they are in possession of a passport, proof of residence (Cartão de Cidadão) and/or a tax identification number (NIF). The resident will receive a public health service user number (número de utente) and a user card for the provision of healthcare in the public sector.
Depending on the resident's status, registration in the SNS can either be temporary (renewed every year) or long term. In general, EU citizens do not need to renew their applications.
Workplace injury insurance is mandatory in Portugal. This is managed by private insurance companies and supervised by the Ministry of Finance.
Health insurance covers the following health benefits in full or in part:
Employees are also compulsorily covered for sickness and maternity, disability, old age, death, workplace injuries / occupational diseases and unemployment under the benefit system. These benefits are financed by social security contributions. Whereas health and maternity insurance benefits in kind and family benefits are financed by taxes
Self-employed persons, or those who perform non-salaried professional activities, are compulsorily covered under the general social security system for self-employed persons after 12 months of activity, regardless of their income. It is possible to request coverage before 12 months. The risks covered are: sickness-maternity, occupational diseases, disability, old age, death, and unemployment for certain categories of non-salaried workers.
Employees (via their employer) and self-employed persons must be insured by private insurance companies to cover the risk of workplace injuries and occupational diseases.
Two types of benefits are covered:
Retirement insurance is compulsory for employees. To be eligible, you must have contributed for at least 15 years in Portugal, including at least 120 days per year of earnings.
The legal retirement age has been adjusted over time. In 2021, it was set at 66 years and 6 months. After you retire, you cannot receive unemployment benefits or daily allowances.
Residents who cannot prove that they have contributed for 15 years may be entitled to a social pension if their monthly income does not exceed €175.52/month or €263.29/month for couples.
The self-employed are compulsorily covered by pension insurance for disability, old age and survivor/death benefits. The calculation and conditions of this pension are the same as those for the general employee regime.
Employees are covered by unemployment insurance, provided that they have been employed for at least 360 days during the 24 months preceding unemployment.
To be eligible, you must also be a resident of Portugal, be able to and available for work, be registered with the local employment center, be actively seeking work and not be retired.
The benefit paid is 65% of your average daily remuneration of the last 12 months preceding the two months before loss of employment. The monthly allowance cannot exceed 2.5 times the IAS (reference index for social benefits). In 2020, this amount was €1,097.03. And the minimum amount is the IAS, which is €438.81.
How long payment continues depends on the age of the insured and the length of the contribution period.
Self-employed persons cannot voluntarily contribute to unemployment insurance. However, some self-employed persons may receive benefits in the event of cessation of professional activity, provided they have contributed for at least 720 days during the 48 months preceding the cessation of activity (which must be involuntary).
This includes workers or owners of sole proprietorships and assisting spouses; who contribute 25.2%. How long compensation is received depends on the age of the applicant and the length of the contribution period.
Partial severance pay is also provided in some cases.
Family and maternity cash benefits are also provided. For more detailed information on these social benefits, please visit the CLEISS website, which offers extensive documentation.
Depending on your needs, there are several types of private insurance in Portugal. Private insurance allows you to reduce waiting times, give you access to more personalized service (such as English or French-speaking doctors) and offers a wider range of services and benefits.
Local insurers generally offer hospitalization and medical coverage, with rather limited coverage limits that apply within an agreed network (mainly with private establishments).
For example: there is a ceiling of €1,200 per year for all medical expenses, with a maximum reimbursement of €15 for a consultation.
Extended plans are available for adding coverage for dental and optical expenses. Waiting periods will apply (sometimes up to 12 months for chronic conditions, and about 90 days for hospitalization or dental care), depending on the coverage chosen and whether you were previously covered. The rate depends on your age and the level of reimbursement desired, and you may need to complete a health questionnaire when you apply for coverage.
A first option is to purchase hospitalization-only insurance, with or without a deductible. These policies will generally be open to as many people as possible and sometimes have no age limits.
A second option is to use a discount card for use within a partner network, such as EDP, for example. This card system, which has been highly developed in recent years, offers a 40% to 50% discount on the rates advertised in the private sector, depending on the network you select. These health cards can be without entry requirements and are quite economical.
A third alternative is to use a mixed insurance product that allows you to benefit from the network rates and be reimbursed for your health expenses. The basis and amount of reimbursement varies according to the level of coverage you choose. For example, a 90% reimbursement for medical expenses incurred in the network. The reimbursement is lower if you go outside the network (more than 50% for example). There may be also be deductibles. The more you pay, the less out-of-pocket expenses you have to pay. These insurers are, for example, Medis or Multicare.
Regardless of the local insurance company you choose, it is important to understand that these insurers operate within a private network and will not be able to cover your out-of-pocket expenses for care received in the public sector. Insurance is still a necessity if you do not want to depend on the public sector.
And even if you have to take out private insurance, an expatriate insurance policy is a viable solution which will free you from having to obtain care from within the network, will offer more comprehensible and complete benefits, and will continue to cover you in your country of origin, which will allow you more freedom in your healthcare follow-up.
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Health insurance is compulsory when applying for a residence permit and a visa for Portugal. Not all health care costs are covered and co-payments are applicable in the public sector. Aprivate insurance is often necessary to cover both of these costs.
Even if you have to pay for private insurance, an expatriate insurance policy will give you valuable freedom of choice, a good level of reimbursement for all the benefits you want to cover (including pharmacy, optical/dental, alternative medicine, private rooms and more), and the peace of mind knowing that you are covered in your home country if you keep certain doctors and procedures there.
You can take out expatriate insurance at any time, whether you are departing within three months, have just arrived or have been a resident for several years.
International insurance offers are flexible, and you can choose only the options that interest you. The benefits are similar to those you are familiar with, which avoids uncertainties about how local reimbursements work. In terms of your budget, expatriate insurance could be a little higher than local Portugese private insurance, but it would also offer more advantages and greater flexibility.
In addition to the benefits mentioned above, your expatriate insurance policy also guarantees emergency international health coverage for your personal or professional travel.
Expatriate insurance is also complementary to the Caisse des Français de l'Etranger, the social security fund for French nationals and Europeans living abroad. If you choose to join, the CFE's health coverage is only a first basis for reimbursement. With expatriate insurance, you get reimbursement rates that are in line with the rates available in your host country.
Finally, travel insurance is not enough: many expatriates think they can save money on expatriate health insurance by using their travel insurance/CB or the European Health Insurance Card (EHIC).
However, in the event of a problem, the travel insurance company will ask you to provide proof of your travel conditions, return ticket, type of accommodation and Social Security reimbursement. If they find out that you are staying for more than 90 days, and are not on a short trip, they will deny coverage.
As with Social Security in Europe, the EHIC allows you to benefit from your home coverage in EU countries, for emergency expenses during temporary travel, and not for expatriation/residence abroad; and not for scheduled care. Youmay be reimbursed on the basis of your own country basis (EU), if you are not covered directly by the local health insurance. This basis will sometimes be lower than the rates charged in Portugal. You may be surprised by the amount of out-of-pocket expenses you have to pay.
The procedures for enrolling in expatriate coverage are more complex than for traditional insurance, so it is recommended that you enroll at least 30 days before your departure.
All expatriate insurance companies require you to complete a health questionnaire. Depending on your medical history, discussions with the medical department may take some time. You may need to gather additional documents, consider a specific proposal, or have your doctor complete a specific questionnaire.
Our website allows you to get quotes online and to compare coverage.
An advisor will be available to help you review the proposals, assist you in choosing a policy and accompany you through the enrollment process.
Your advisor can also verify that the plan you have selected has been accepted/recognized by the administration.
Because universal health coverage is available to all permanent residents (employed or self-employed), the biggest risks will be covered locally by the public sector (hospitalization and doctors).
If you wish to benefit from private sector healthcare services and to be able to select the doctors and medical facilities you prefer, you should choose an expatriate hospitalization and medical plan.
This type of coverage will allow you to consult your usual doctors when you are in France, and will cover any health expenses that you would prefer to continue to incur there.
If you can afford to spend more on your health budget, and if you have a regular need for it, choose a plan that also reimburses optical/dental expenses; although more accessible than in France, you are generally responsible for these healthcare costs.
If you are insured by the local social security system, you are responsible for the co-payment and various other expenses, unless you are in a category that exempts you from paying for these expenses.
If you have local private insurance, you will have to pay in advance and then request reimbursement, often by mail. It is recommended that you confirm any procedures with your insurer, especially for hospitalization.
With expatriate insurance, for hospitalization of more than 24 hours, the insurer organizes coverage with the hospital/clinic. You must pay in advance for routine medical and optical/dental expenses.
Nowadays, reimbursements can easily be requested online (no more sending requests by mail); insurers all offer customer portals or mobile apps for submitting your reimbursement requests and tracking them.
In general, invoices up to €1,000 can be transmitted digitally. Invoices for amounts over €1,000 (which is more rare) must still be sent by mail.
The quality of care and the local facilities mean that there is little risk that you will have to be repatriated for health reasons. However, repatriation assistance may be useful abroad in the event of an accident or illness that occurs during a trip/vacation or business trip (depending on how often you travel and for how long).
It also offers services that can be considered as "comfort" but which will be welcome in the event of a serious problem, such as paying for the trip of a relative to come to your bedside, arranging for the care or transport of children, receiving medical advice and guidance, repatriation of the body in case of death, etc.