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Healthcare is one of the essential factors when relocating abroad. Regardless of the weather or quality of living, you need to know that you can seek medical help in an emergency, to manage an ongoing condition, or if you have any health concerns that need support.
Post-Brexit, British expats have seen significant changes to their rights and access to state healthcare services in Europe.
Read this article for an overlook at the difference between expat healthcare and the NHS.
Now that the UK is no longer part of the EU/EEA, it’s vital to assess whether you are entitled to healthcare and what sort of insurance is required if not.
Portugal ranks high in the top destinations in Europe for expats, but you need to make sure you are covered for your health.
In this guide, we’ll explain how the public healthcare system works in Portugal, who is entitled to medical treatment and what your options are as an expat.
Table of contents
Public Healthcare In Portugal
The state healthcare service in Portugal was set up in 1979 and is called the Serviço Nacional de Saúde (SNS), inspired by the NHS in the UK.
The Portuguese system varies because treatment on the SNS isn’t universal, and it isn’t always free. Most residents need to make a financial contribution towards each treatment required.
Certain essential medical services are provided for free, with a co-payment system in place for anything considered non-essential.
Some residents are exempt from SNS healthcare charges, including:
- Pregnant women
- Children under 12
- Citizens on a low income
- Retirees over 60
- Disabled residents
- Unemployed people
These exemptions apply to Portuguese residents, domiciles, and citizens and not necessarily to foreign national expats.
As in the UK, the SNS is tax-funded, so expats who are not tax-resident in Portugal or who don’t pay social security contributions will not be eligible for subsidised treatments or free medical care if they fall into an exemption group.
However, expats who are residents, pay taxes and contribute social security payments will be eligible.
Alongside the SNS, there are also many private practitioners offering a high level of medical care. Private healthcare is undoubtedly more expensive but does mean avoiding long waiting times and having more flexibility in treatment or medication options.
It is essential to take out health insurance if you do not qualify for SNS state healthcare treatments or to cover the costs of private healthcare should the need arise.
Expat Healthcare In Portugal
Access to state healthcare in Portugal will depend on:
- Whether you are a resident of Portugal.
- If you are employed and pay taxes.
- Which country you are a national of.
Given that Britain is no longer a European member, the old European Health Insurance Card (EHIC) system no longer applies.
That means that expats must be legal residents to be eligible, including non-working residents who fall into one of the above categories.
Residents pay contributions through employment made to the Instituto da Solidariedade e da Segurança Social. These contributions work in a similar way to National Insurance and give you entitlement to state healthcare.
You can also make voluntary contributions as a self-employed person or non-working resident if you wish to be eligible for state healthcare.
Some residents supplement their healthcare provisions with private insurance on top of their social security contributions – the SNS does not cover every treatment and will require a co-pay contribution for non-essential treatments.
There are also considerations around accessibility, with most hospitals and clinics in the cities and far fewer medical centres in rural Portugal.
These also tend to have few English-speaking doctors or pharmacists. A private healthcare provider might be advantageous, as they will always have medical professionals available to explain treatment options in English.
Pharmacies can dispense medication, and if the SNS covers this, it is heavily subsidised – but non-essential medicines can still be expensive.
Expats should also be cautious about travelling with prescription drugs since they will need to demonstrate that a medical professional has prescribed this. It is advisable to bring a copy of the prescription and ensure any medicines are in their original packaging.
In Portugal, residents can buy many medications over the counter without a prescription, but this will be far more expensive than obtaining a prescription from a GP.
Registering For Healthcare In Portugal
Registering for public healthcare as a Portuguese resident means you’ll need to register as a taxpayer to get your tax reference number and then register with your local health centre.
- First, you register with the Seguranca Social (social security office), who will assign you an NIF number (taxpayer reference).
- If you are in employment, your employer will usually arrange this on your behalf, but you will need to register directly if you are self-employed.
- Next, you will need to visit your local centros de saude (health centre) and bring ID documents, your social security card and your residence permit.
- The SNS will then send you a cartao do utente (healthcare card), which you need to show each time you attend a public clinic or hospital.
- Residents can also register with the SNS online and use their account to make appointments or find information about local services.
Remember that this only applies to residents, and you will need to have a residency permit or permanent residency status to register with the SNS for public healthcare.
Non-residents will need to take out private healthcare insurance to cover the costs of care.
Costs of Healthcare in Portugal
Healthcare costs will depend on whether you are registered as a resident with the SNS, whether you have insurance, and whether you are treated at a public or private clinic or hospital.
State healthcare services are subsidised, so you will usually pay a nominal fee for an appointment.
Emergency services are excluded and are provided to everybody, regardless of whether they are a resident or not – although you may need to cover the costs once recovered.
Examples of SNS co-pays include:
|Treatment||Average cost €||Average cost £|
|Home doctor’s visit||€9||£7.75|
|Hospital treatment||€4.50 a day||£3.90 a day|
|Treatment at a local health centre||€3.50 a treatment||£3 a treatment|
There are caps on the co-pay required for SNS treatment, set at €40 per exam.
Prescription costs depend on the category of medication. These are classed as follows:
- Class A medicines – 90% subsidy
- Class B medicines – 69% subsidy
- Class C medicines – 37% subsidy
- Class D medicines – 15% subsidy
Private healthcare costs are higher, and although the SNS provides high-quality medical care, private doctors or hospitals usually have faster treatment times.
However, even private medical care costs remain competitive and substantially lower than in nations such as America with example averages of:
|Treatment||Average cost €||Average cost £|
|Hip replacement||€4,000 – €20,000||£3,400 – £17,200|
Portugal Private Medical Insurance for British Expats
UK nationals living in Portugal as non-residents or those who wish to have private health cover will need to take out an international or local healthcare policy.
Costs vary considerably, depending on:
- How many family members are covered.
- Whether you have an employment insurance package.
- Preferred payment method – whether monthly, quarterly or annually.
- The extent of the cover and any specific exemptions.
Some private insurers offer a reimbursement basis cover, whereby you pay for medical treatment upfront and then claim back the costs. More often, you need to contact your insurance provider for approval before seeking treatment.
Many healthcare providers have a network of hospitals, doctors and clinics they work with. You should check whether there are any local healthcare facilities you can access, covered by your selected insurer.
Average costs tend to be low, with most expats paying between €20 (£17) and €50 (£43) a month per person. The average annual price is up to €1,000 (£860) a year.
However, there are limitations, with some insurers offering plans that only accept applicants below the age of 55 and others with automatic cancellation clauses once you reach a certain age.
There are two primary options – international policies usually cover expats of any age, although they may be more expensive. Local private health insurers are often a little cheaper, although they tend to cap insurance up to a maximum age.
Some of the most popular Portuguese health insurance providers include:
It’s vital to assess what is and isn’t included in your healthcare insurance. Plans will usually have caps on the maximum benefit available and restrictions on what outpatient services are included.
Dental care is not free on the SNS for Portuguese residents but is heavily subsidised. Private dental care can be costly, so it’s wise to opt for an international health insurance policy that covers this.
Many expats become permanent resident through buying a property in Portugal and gaining a residency visa.
Expat Healthcare In Portugal FAQ
Yes, if you apply for a visa to live in Portugal, you will need to prove that you have taken out suitable medical insurance before your visa or residence permit will be granted.
This requirement is mandatory to obtain a visa. It will usually need to be maintained for a certain number of years to avoid reliance on the SNS, depending on your visa category.
If you are eligible for SNS healthcare, insurance is not mandatory but may be advisable. For example, an international policy will enable you to seek treatment in any country and avoid long waiting lists.
You can also usually choose your hospital or doctor through a private insurer, although that might be restricted to medical facilities included in their network. The Portuguese government will typically provide SNS state healthcare at the nearest hospital to you, and you may be transferred to another facility if you need specialist care.
State healthcare in Portugal isn’t entirely free, but it is heavily subsidised for residents. For example, you might be charged €5 (£4.30) for a GP appointment.
If you are a legal resident and eligible for SNS treatment but fall into one of the below categories, you will usually be exempt from paying any contributions:
Retirees – receive free or low-cost healthcare, including prescriptions, eye care and dental treatments.
Vulnerable groups – disabled, elderly or children, pregnant women.
Note that if you are eligible for free treatment, you must bring your healthcare card and will not be able to choose which doctor you visit.
Although many expats opt for private health cover, the SNS is ranked highly and above the UK, Spain, and Italy as the 12th best country for international healthcare.
Medical treatments are considered an excellent standard, with the public system covering GPs, mental health services, hospitals, outpatient treatments and emergency care.
Yes, as in the UK, some drugs are only available from a pharmacist with a prescription, although there are more comprehensive ranges of medications available over the counter. Pharmacies are often open until 7 pm and are identified by the recognisable green cross symbol.
Expats travelling to Portugal can bring prescription medicines but will need a GP’s letter, the original packaging (with labels identifying the contents) and ideally a copy of the original prescription.
Limits apply, with most foreign nationals permitted to bring a supply of up to three months. GPs are available throughout Portugal and can dispense prescriptions just as in the UK.
If you become unwell or have an accident, you will always be treated, whether or not you are a resident, and regardless of whether you are eligible for free SNS treatment.
Suppose you do not have insurance and are not eligible for SNS subsidies. In that case, you may end up with a substantial bill, so it’s highly advisable to take out appropriate insurance cover.
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