HEALTHCARE AND INSURANCE IN PORTUGAL
Portugal offers a comprehensive healthcare system that combines universal public coverage with optional private insurance, making it an attractive destination for residents, expats, and visitors. Whether you’re planning to move to Portugal, work there temporarily, or simply visit, understanding the healthcare landscape is essential for ensuring proper medical coverage.
Overview of Portugal’s Healthcare System
Portugal’s healthcare system is built on three main pillars: the national public system (SNS), special subsystems for certain professions, and voluntary private healthcare. This multi-tiered approach ensures that residents have access to quality medical care while providing flexibility for those seeking additional services.
The Serviço Nacional de Saúde (SNS) Explained
The Serviço Nacional de Saúde (SNS) forms the backbone of Portuguese healthcare. Established as a national, universal, and free system, the SNS provides comprehensive health insurance coverage to all legal residents, regardless of their financial situation or employment status. The system is primarily funded through general taxation and contributions from workers paying into the social security system.
Who Regulates and Oversees Healthcare?
Portuguese healthcare operates under the supervision of the Ministério de Saúde (Ministry of Health), which guarantees public health insurance to all residents. The independent regulatory body Health Regulatory Entity (ERS) oversees the system, ensuring high standards of care and focusing on preventative medicine, including cancer screenings.
Mainland vs. Islands: Coverage Differences
While the SNS covers mainland Portugal comprehensively, the Azores and Madeira islands operate separate healthcare systems. Residents of these autonomous regions have their own regional health services, though they maintain similar standards and coverage to the mainland system.
Funding and Structure of the SNS
The SNS is funded through a combination of general taxation and social security contributions from workers. This funding model ensures universal access while maintaining the system’s sustainability. Additionally, Portugal features a special social healthcare initiative called the health subsystem program for members of certain professions, such as ADSE, which covers over 1.3 million public servants.
Who Needs Health Insurance in Portugal?
Understanding your health insurance requirements in Portugal depends on your residency status, nationality, and length of stay. The system is designed to ensure comprehensive coverage for residents while maintaining specific requirements for visitors and temporary residents.
Health Insurance for Residents vs. Tourists
Legal residents who contribute to social security are automatically entitled to public health insurance through the SNS. International residents living and working in Portugal enjoy the same healthcare rights as Portuguese nationals. However, tourists and non-residents must secure their own health insurance coverage, as they don’t qualify for SNS benefits.
EU, EEA, and UK Visitors: EHIC and GHIC Use
EU and EEA citizens can use their European Health Insurance Card (EHIC) for necessary medical treatment during temporary stays in Portugal. Following Brexit, UK individuals can use their UK Global Health Insurance Card (GHIC), which provides similar coverage to the previous EHIC system. These cards cover emergency and necessary medical treatment but don’t replace the need for comprehensive travel insurance.
Bilateral Agreements and Access to Care
Portugal maintains bilateral healthcare agreements with several countries, allowing their citizens to access medical care using their home country insurance. These agreements include countries such as Andorra, Brazil, Canada (Quebec only), Cape Verde, Morocco, and Tunisia. Citizens from countries not covered by these bilateral agreements must obtain private travel health insurance.
Health Insurance Requirements for Visa Holders
Visa requirements vary depending on your country of origin and intended length of stay. Short-stay visitors with a Schengen visa must have minimum health insurance coverage of at least €30,000. Travel insurance is mandatory for visits lasting less than 181 days. Long-term visa applicants, including those applying for Golden Visa or D7 Visa programs, must provide proof of medical coverage as part of their application process.
Public Health Insurance in Portugal (SNS)
The SNS represents one of Europe’s most comprehensive public healthcare systems, providing extensive coverage to all legal residents. Understanding eligibility, coverage, and registration processes is crucial for anyone planning to live in Portugal.
Eligibility for Public Healthcare
Everyone who legally resides in Portugal for more than 90 days qualifies for public health insurance through the SNS. Legal residents are automatically entitled to access the system once they complete the registration process and obtain the necessary documentation.
What’s Covered by the SNS?
The SNS provides comprehensive coverage including doctor consultations, specialist care (usually requiring referrals), medical emergencies, mental healthcare (when referred by a general practitioner), maternity care, hospital stays, preventative care, and eye exams. The system focuses on preventive, curative, and rehabilitative care, ensuring comprehensive medical support for residents.
What’s Not Covered Under the SNS?
While the SNS is comprehensive, certain services are typically excluded. Dental care is only covered for vulnerable groups through dental vouchers. Optical care, including glasses and contact lenses, is not covered. Cosmetic surgery, alternative therapies, and elective procedures are generally excluded from public coverage.
Costs, Co-Payments, and Fee Exemptions
Public health insurance in Portugal is almost completely free at the point of use. In 2022, user fees and co-payments for most medical treatments under the public scheme were abolished. However, a limited co-payment system still exists for certain treatments, with amounts varying by income level. Small contributions may apply to doctor visits, specialist consultations, hospital care, and prescriptions.
Pharmacy and Prescription Medication Coverage
Pharmacy costs under the SNS are generally affordable, with prescription medications being partially or fully subsidized. The amount you pay depends on the medication’s classification, whether it’s for a serious illness, and your demographic status. Older adults, disabled individuals, and low-income residents may receive additional financial assistance with pharmaceutical costs. Patients with chronic illnesses can access regular medications for free through online applications.
How to Register for Public Health Insurance
To access SNS benefits, you must first establish legal residency in Portugal. The registration process involves obtaining a social security number (NISS), which is typically required for employment. You’ll need to register at your local health center (centro de saúde) with proper identification, proof of residency, your Social Security number, and tax identification number (NIF). Upon successful registration, you’ll receive a health user card (cartão de utente) and be assigned to a primary care doctor.
Temporary Access While Awaiting Residency
If you’re waiting for your residence permit but have lived in Portugal for 90 days, you can obtain a certificate from your local parish (freguesia). This certificate can be presented to your health center to obtain your SNS user number, providing temporary access to healthcare services while your residency application is processed.
Pros and Cons of Public Healthcare
The SNS offers significant advantages including universal coverage, comprehensive services, and affordability for all residents regardless of income. However, the system has limitations such as potentially long waiting times for non-urgent treatments and elective surgeries, limited dental coverage for most residents, and exclusion of optical care. Additionally, short-term visitors generally don’t qualify for SNS benefits.
Private Health Insurance in Portugal
Private health insurance serves as a valuable complement to the SNS, offering additional services, faster access to care, and greater provider choice. Approximately 25% of Portugal’s population maintains private health insurance coverage.
Why Choose Private Health Insurance?
Many residents and expats opt for private insurance to access services not included in the public system, such as dental and vision care. Private insurance helps avoid potentially long waiting times in the public system, provides access to private hospitals and clinics, and offers greater choice of healthcare providers.
Advantages of Private Coverage
Private health insurance offers numerous benefits including wider choice of healthcare providers, faster access to appointments and specialists, easier access to English-speaking providers (especially outside major cities), comprehensive coverage for additional services like dental care and alternative therapies, customizable plans to meet individual needs, potential international coverage, and benefits such as repatriation and direct payment for treatments.
Who Commonly Uses Private Insurance?
Private insurance is popular among expats, especially short-term residents who are typically required to have private coverage when first arriving. Many Portuguese citizens also maintain additional private coverage for services not included in the SNS. Self-employed individuals, Golden Visa holders, and those in specialized professions often choose private insurance for enhanced coverage and flexibility.
Costs and Coverage Options
Private health insurance in Portugal is generally affordable, with monthly premiums ranging from €20 to €150 or more, depending on coverage level, age, and pre-existing conditions. Annual costs average around €400 for basic plans and up to €1,000 for comprehensive coverage. Most schemes include a deductible, and costs increase with age and pre-existing medical conditions.
How to Choose a Private Insurance Provider
When selecting a private insurance provider, research reputable hospitals, clinics, and medical centers in your area. Check accreditation and licensing of providers, review coverage options to match your specific needs and budget, investigate the provider’s network of medical professionals, compare costs across different insurers, and seek recommendations from other expats or residents. Be aware of policy clauses that may change coverage at certain ages, as obtaining new policies after retirement age can be more expensive or difficult.
Well-Known Private Health Insurers
Portugal’s private insurance market includes both international and local companies. Major providers include Allianz Care, Cigna Global, Médis, Multicare, AdvanceCare, Fidelidade, AXA, and Bupa. Each offers different coverage levels, network sizes, and pricing structures to meet various needs and budgets.
Payment and Reimbursement Process
When using private healthcare services, you typically need to pay upfront for treatments and later apply for reimbursement from your insurance provider. Private insurance generally covers the full costs of specialist treatments and hospital care, with higher premiums providing greater choice of doctors, hospitals, and specialists.
Potential Downsides of Private Insurance
The main disadvantage of private insurance is the upfront payment requirement, which can be expensive for major treatments. Additionally, policies may become more costly or difficult to obtain as you age, and coverage limitations or exclusions may apply to pre-existing conditions.
Healthcare for Specific Groups in Portugal
Portugal’s healthcare system accommodates various demographic groups with specific needs and circumstances, ensuring comprehensive coverage across different life situations.
Seniors and Retirees
Older people staying in Portugal for more than 90 days are covered by public health insurance through the SNS. Pensioners receive subsidized prescriptions and contributions toward additional healthcare services like dental and eye care. EU citizens who retire early may qualify for free or subsidized healthcare for up to two years using form S1. Many seniors choose supplementary private insurance for more extensive services and faster access to care. Portugal ranks 4th globally in healthcare quality for retirees, making it an attractive retirement destination.
Unemployed and Low-Income Residents
The SNS provides nearly free healthcare for all residents, with unemployed and low-earning individuals potentially exempt from all fees through a user fee waiver (isenção de taxa moderadora) managed by the Tax and Customs Authority. Low-income families may receive additional healthcare assistance through social welfare programs, and unemployed individuals who previously contributed to Social Security may retain access to benefits. State-sponsored health subsidies may cover co-payments for medications and services.
Students (EU and Non-EU)
Students with legal residency rights in Portugal are covered under the SNS. Non-EU students requiring visas must provide proof of valid health insurance. EU students staying less than 90 days can use their EHIC cards, while those staying longer need health insurance (public or private). Non-EU students may need to purchase private health insurance if their educational institution doesn’t provide SNS coverage.
Self-Employed Individuals
Self-employed residents must register directly with the Social Security Institute and are entitled to public healthcare if they pay social contributions (approximately 21.4% of income), which include health insurance, pension, and unemployment benefits. Many self-employed expats also purchase additional private insurance for enhanced coverage and flexibility.
Foreign Workers and Expats
Foreign workers employed by Portuguese companies are automatically enrolled in the social security system, qualifying for public health insurance once payments begin. They need to obtain a NISS (Social Security number) and register at a local health center to receive their SNS user number (número de utente). International workers enjoy the same healthcare rights as Portuguese nationals.
Golden Visa and D7 Visa Applicants
Golden Visa applicants must purchase private health/travel insurance before obtaining their visa. Once granted, they’re eligible for the SNS but must register first. Golden Visa holders not living in Portugal full-time are required to maintain private healthcare insurance covering their time in the country. D7 Visa applicants must purchase travel insurance covering health for one year when applying, which covers them until their residence permit is issued. After receiving their D7 Residence Permit, they can access public healthcare by registering with the SNS.
Types of Medical Services in Portugal
Portugal offers comprehensive medical services through both public and private sectors, ensuring residents have access to quality healthcare across various specialties and circumstances.
General Practitioners and Specialist Care
Primary care through general practitioners is covered by public health insurance and accessed through local health centers. Specialist care usually requires referrals from primary doctors, though wait times can be lengthy in the public system. Private insurance often provides faster access to specialists without referral requirements.
Emergency Medical Services and Hotlines
Emergency services are available 24/7 regardless of insurance status. Call 112 for ambulances in critical emergencies, with treatment for medical emergencies provided free under the SNS. The SNS24 hotline (808 24 24 24) offers 24/7 health advice and referrals. However, using emergency services without proper referrals and not being admitted may result in fees.
Mental Health Services
Mental healthcare is covered under the public system when referred by a general practitioner. The SNS provides a free 24/7 psychological support hotline (808 24 24 24, press 4). Wait times for appointments can be long due to limited psychiatric professionals, making private health insurance an attractive option for faster access to mental health services.
Maternity and Prenatal Care
Comprehensive maternity care is provided free under public health insurance, including all checkups and emergency medical attention. Routine care takes place at local hospitals or health centers, with pregnant individuals receiving a Pregnancy Booklet (Boletim de Saúde da Grávida). Prenatal care and midwife services are available through the hospital system.
Dental Services
The SNS only covers dental care for vulnerable groups through dental vouchers. Most residents must seek private dental care or include dental coverage in their private insurance plans. Dental coverage can be purchased as part of comprehensive health insurance or as a separate add-on policy.
Eye Care and Optical Services
Eye care professionals can be accessed through the public system via local health centers, though wait times may be lengthy for non-urgent issues. The SNS covers eye exams and some vision-related services but doesn’t include optical care such as glasses or contact lenses. Separate vision insurance is available privately for comprehensive eye care coverage.
Pharmacies and Medication Access
Portuguese pharmacies (farmácias) typically operate Monday through Friday with lunch breaks and Saturday mornings. Larger towns provide Sunday availability, and 24-hour service pharmacies (farmácias de serviço) operate in each area for urgent medication needs. Prescription medications are affordable and often subsidized under the SNS.
Other Key Aspects of Portuguese Healthcare
Understanding additional aspects of Portugal’s healthcare system helps ensure optimal access to medical services and successful navigation of the system.
Quality of Healthcare in Portugal
Healthcare quality in Portugal is strong and continuously improving. The country ranks 23rd globally and 14th in Europe according to Numbeo’s Health Care Index for 2025, scoring higher than the UK, Spain, Italy, and Ireland in the Euro Health Consumer Index. Portugal provides high-level care through both public and private sectors, with modern facilities in larger cities and high satisfaction rates among expats.
Language and Communication in Medical Settings
Many medical professionals are sensitive to language barriers and accommodate international patients. Virtually all doctors in the private system speak English, while English-speaking doctors in the public system are easily found in major cities but less common in smaller towns. The vast majority of healthcare professionals have English language capabilities, making medical communication accessible for international residents.
Publicly Subsidized “Social Hospitals”
Social hospitals, historically operated by charitable institutions (misericórdias), now have agreements with the SNS and are publicly subsidized. These hospitals offer services similar to public hospitals while maintaining their traditional charitable mission, providing additional healthcare capacity within the public system.
Emergency Numbers and Support Lines
Essential emergency contacts include 112 for medical, fire, and police emergencies, and 808 24 24 24 for the SNS24 health advice line. These services are available 24/7 and provide crucial support for both emergency situations and general health inquiries.
Healthcare for Non-Habitual Tax Residents (NHR)
Non-Habitual Tax Residents who contribute to social security can access the public SNS system. Those not contributing to social security must invest in private healthcare coverage to ensure proper medical protection during their residency in Portugal.
Portugal’s healthcare system successfully combines universal public coverage with flexible private options, creating a comprehensive medical environment that serves residents, expats, and visitors effectively. Whether relying on the SNS or supplementing with private insurance, individuals can access quality healthcare that meets international standards while remaining affordable and accessible.
- See also: Finding Medical Care in Portugal