Finding private health insurance for expats in Portugal is literally as easy as walking into your bank. One of the benefits of moving overseas is that healthcare itself is much more affordable. Private insurance is too.
First off, in order to qualify for a D7 residency visa, you need to have a year of health insurance in place. I bought a policy for about $350 which basically would do nothing except possibly ship my body home if I died in Portugal. I considered it just another fee in the process of getting my visa. So, technically I had health insurance. But if I had to actually count on it, I’d be out of luck.
The Portuguese Health Care System
Once here, I started hearing (reading, really) people talk about utente numbers and SNS (the National Health Service) and asking which company was best for health care. The expat groups on Facebook are a treasure trove of information. Americans & Friends PT in particular has a series of files that cover just about every question you have on moving to and getting set up in Portugal. If you are serious about moving to Portugal, join this group.
Anyone in Portugal, resident or not, can seek service through the SNS. There may be a small fee for non-residents, but you will never be denied care. In case you are worried about the quality of care you receive, Portugal’s health care system is ranked #12 in the world; the US is sitting at #37, just ahead of Slovenia and Cuba. Once you have your Residency Permit, you can register with your local health center (Saude) and if necessary, access that care.
Because residency appointments have been delayed due to the pandemic, the government is now issuing a temporary Nὐmero de Utente to those who have a Residency Visa, but not their Residency Permit. My appointment was postponed from April to September which left me in vaccine limbo—without the Residency Permit, I couldn’t get a Nὐmero de Utente and was not in the queue for the vaccine. The issuing of temporary numbers is my path to the vaccine. Once I found out I could get a temporary number and got the correct email address to do so, the entire process took under two hours. (About 30 minutes of that was painstakingly translating my request and necessary data into Portuguese using Google translate.)
Researching Private Health Insurance for Expats in Portugal
Now that I have a permanent address in Portugal and I am settled in, it was time to see about getting private health insurance. I know that private pay medical expenses (no insurance) are ridiculously low compared to the US. This is a typical post in groups when people ask about health care costs:
“I had my annual checkup with cardiologist Dec 2020, 70€ total cost with no insurance coverage (plus 7€ for an echocardiogram for which I got a script from Saude; covered by the public health system. If no script, echo was going to cost 50€.”
I don’t know what an echocardiogram costs in the US, but I’m betting it’s more than $60. I also know that it cost over $200 to walk into my local “doc in a box” in Florida before he even did anything. With no insurance, if I needed anything short of major medical care in Portugal, I could most likely afford it out of pocket.
However, I had read in the glossy expat magazine how senior couples were paying less than $100 a month for health insurance and I figured it would be worth getting.
There are several private health insurance companies to choose from. The two I heard the most about were Allianz and Médis. I know how difficult it is to navigate plans in the US, and I figured with the language barrier, I would take the path of least resistance. I could walk into my bank (Millennium) and sign up for Médis health insurance. People said it was a little more expensive through the bank. Some people claimed Allianz was better, but others said it depended on your personal health situation.
Frankly, I could spend days comparing all the plans and talking to three different people to get the best deal on the best plan. Or I could spend 90 minutes with Virginia at my local branch, get a solid plan at a price fractionally above what three days of shopping would have got me. Yeah, no contest.
Médis has three standard plans that are fairly straightforward (base, medium, highest, cleverly marketed as Option 1, Option 2, and Option 3). They also have two “Vintage” plans, a base plan and an upgraded plan. First of all, I love the use of Vintage as opposed to Senior. That works for me. The base Vintage plan is about €35 a month and the upgraded Vintage plan is just under €50 a month. These are the plans people talk about when they say health insurance for a retired couple is under $100 a month. The plans cover up to €2,500 and €5,000 in hospitalization fees respectively, give you one check up a year, 5 or 10 doctor visits, and a few other services, including two ambulance transports a year. The Medicare co-pay on ambulance transport in the US if you don’t have a MediGap plan is around $90, so I see value there. But to me, the Vintage plans were skimpy and I’m sure the people who get it know that the SNS will come in to cover any additional major costs.
I haven’t paid any Portuguese taxes yet. I haven’t paid into their system. I’m not putting hundreds of thousands of dollars into their economy. I’m a newcomer and at this point, a guest. I looked at the three standard options and of course, chose the middle one. It covers hospitalizations, outpatient care, and doctors’ visits. My co-pays average between €17 and €20. My hospitalization copay is 10% of my stay up to a maximum of €500. My MRI copay is €65. Oncology is covered sort of separately here. My upgraded policy has coverage for treatment and chemotherapy.
I am paying €130 a month for this. In a couple of years, I will need to move to the next level of plans, which will still be under €200 a month. As a comparison, my premiums for a similar plan in the US, with a $3,500 deductible and 20% copay, was $900 a month in 2019.
Oh, no physical and I don’t have any pre-existing conditions (that I know of). I think major pre-existing conditions may be excluded for the first year. But I will also point out that treatment here is inexpensive and the SNS is a safety net.
So, I got a little crazy and splurged. I got a dental plan that, unlike American standalone dental plans, actually provides coverage. For €10 a month I have unlimited dental appointments (because people love going to the dentist…), annual X-rays, twice a year cleanings, two restorations annually for damaged teeth (great for those bar fights I get in), fluoride treatment twice a year, special sealants every two years, and one root canal with follow up per year. There are also extractions and a few other things. It doesn’t cover implants, but it does cover the pre-study to determine if you need an implant. A conversation in a Facebook group centered on the cost of implants here. The average seems to be between €1,000 and €1,200 per tooth. That’s about a quarter to one-fifth the cost in the US. (If you can’t make it to Portugal, plenty of people recommended Mexico and Costa Rica.) And Portugal developed the leading implant procedure in the world.
The dental care in Portugal is excellent and frankly, with medical tourism becoming more accepted, I think it will become a center for international dental care.
My Final Analysis
So, this is not a comprehensive analysis of the private health care industry in Portugal, just my experience. I have a health care plan that is comparable (actually slightly better) to what I had in the States for roughly $175 a month. I haven’t paid a monthly premium that small since the 1990s when I first started buying my own healthcare coverage. While the standalone dental plan is comparable to what I paid in the States, it actually covers services. The problem I ran into in Florida was finding a dentist who would take my standalone Blue Cross insurance. There are several dentists right near me who take the Médis plan and if I want to venture farther out, there are more.
Before I moved here, I heard a joke that went something like, “For the cost of a hip replacement in the US, you can fly to Portugal, get your hip replaced, live well for a year, and fly back.” This past week I discovered it’s not a joke.
Set the cost of the American healthcare system aside for a minute or two and please really ponder this statement from a British physician: “You cannot ethically have a for-profit health care system.”
Think about it and let me know your thoughts.