Moving to a new country comes with lots of questions and worries. Healthcare sits high on the list of concerns, along with schools, where to live, and lifestyle.

We’ve been in Portugal as American expats for nearly three years now, and we’ve been navigating these things along the way. Thankfully, Portugal has excellent health care. It ranks high in Europe, with the Euro Health Consumer Index ranking Portugal number 13 (out of 50 European countries). That is higher than Spain, the UK, and Ireland! Portuguese also enjoy a long life expectancy, currently around 81 years.

Healthcare is readily available to expats with an SNS number, both in the public and private sectors.

Our experiences have been very positive when using the Portuguese healthcare system.

How To Get Health Insurance In Portugal

Once you are residing in Portugal with a visa in hand, you’ll work to convert your visa into a residency card with the SEF office.

As part of your residency card requirements, you’ll need to purchase private health insurance. While travel insurance gets you into Portugal, once you are living there, you need to get private insurance to show to SEF (foreigner services) to get your residency cards.

• The biggest private healthcare companies for Portugal are Allianz Care, Médis, and Cigna Global.
• We have a private plan with Cigna. It has a higher deductible, so we pay out of pocket 1000€ per person and then get reimbursements. It costs our family of seven about 500€ per month. An ER visit costs around 400-600€ (with several tests involved), so we usually pay for the first 1-2 visits out of pocket and start to get reimbursements.
• I’ve seen other expats pay as low as 20-40€ per month for private insurance. It depends greatly on the coverage you want, including deductibles, maximum coverage, and more.
• Some private plans for individuals can be as low as 10€ a month. The more services you want, the more you will pay with the bigger networks.

Once you have your residency card (usually 3-6 months after arriving, depending on appointment availability), head to your local Centro da Saude to get a family doctor and health card. Most family doctors have wait lists years long, but getting on the list for one is an important step, especially with kids. Together with your private insurance, you can face any medical issues that pop up.

What Is Portuguese Healthcare Really Like?

What are the realities of healthcare in Portugal? 

Picture this: a healthcare system that’s like a nice visit to your favorite Portuguese beach – easy to get to, functions very well, and only has the occasional hiccup.  Whether you’re fretting about finding a doctor who speaks your language, curious about the cost of fixing that surfing injury, or wondering if you can still get your go-to meds, we’ve got the inside scoop.  Healthcare in Portugal is NOT healthcare in the USA.  Some of it you might like better, and some you’ll not like as much.  However, you will get excellent care in Portugal.

Here are some important points to understanding healthcare as an expat in Portugal:

Public Healthcare System

• Portugal has a universal healthcare system known as the Serviço Nacional de Saúde (SNS). It provides healthcare services to all legal residents, including citizens and foreign residents. Tourists can also gain coverage, but they must pay for services.
• SNS, or the public healthcare system, covers various medical services, including doctor consultations, hospital care, surgeries, and emergency services.
• Access to public healthcare is typically free or involves a nominal fee, and services are heavily subsidized by the government. Prescriptions are NOT covered, but they come at reduced prices compared to the USA.
• As of 2022, the public system has no user fees or copayments for almost all services. Only prescriptions cost money, and these are much more affordable than in the USA.  One eyedrop (name brand) that I’ve bought several times in the US for $250 per bottle has cost me $25 at a local pharmacy in Portugal.  This makes public healthcare nearly free in Portugal!
  • Several groups are exempt from any fees at all, including pregnant patients, new mothers, children under 12, disabled patients, blood donors, organ and tissue donors, transplant patients, firefighters, active military, and households under a certain income (making less than 654€ per month).
  • Public hospitals in Portugal treat everyone who needs emergency care, regardless of insurance status.

Private Healthcare

• In addition to the public system, Portugal has a well-developed private healthcare sector. 
• Private healthcare providers offer quicker access to medical care and a higher level of comfort and privacy.
• Many expats mix and match public and private care. It’s quicker, often cushier, and perfect for those specialized needs.

Ever heard of AFPOP? It’s like a club for expats in Portugal if you are a property owner, and they’ve got a sweet deal on health insurance that’ll make your wallet happy!

AFPOP (Association of Foreign Property Owners in Portugal) has teamed up with Medal Insurance to offer members some pretty nifty health insurance options. Here’s the scoop:

• They’ve got plans with Allianz Worldwide Care – a big player in the international insurance game.
• You can choose from three levels of coverage: Essential, Classic, and Comprehensive. There’s something for every taste and budget!
• The best part? If you have pre-existing conditions, don’t sweat it! They offer full medical underwriting, which means you might get coverage for those issues.
• Oh, and did I mention there’s no age limit? 

You’ll need to be an AFPOP member to participate. But trust me, with benefits like these (plus all the other perks of membership), it’s worth considering!

Hospitals and Medical Facilities

• Portugal has modern hospitals and medical facilities equipped with state-of-the-art technology and staffed by highly qualified healthcare professionals.
• Public hospitals are spread nationwide, with larger facilities in major cities like Lisbon and Porto.
• Private hospitals and clinics are also widely available, especially in urban areas.

Pharmacies (farmácias)

• Pharmacies are widely available throughout Portugal, easily identifiable by their green cross signs. You’ll find them in city centers, residential areas, and even small villages.  Most apartment complexes in Lisbon have a pharmacy on their bottom level.
• Most pharmacies are open Monday to Friday, typically from 9am to 7pm, with a midday break. For after-hours needs, there’s always a pharmacy on duty (farmácia de serviço) in each area. Look for posted schedules on pharmacy doors or check online for the nearest open pharmacy.  You can find 24-hour pharmacies in large cities, but they are rare.  Drive-throughs are also rare.
• Beyond prescription medications, pharmacies provide over-the-counter drugs, skin care products, baby supplies, pet medications, and some natural remedies. They’re a one-stop shop for many health and wellness needs.
• In tourist areas and larger cities, you’ll often find English-speaking staff. This can be particularly helpful for expats still learning Portuguese.
• Some medications that require prescriptions in other countries may be available over the counter in Portugal. However, certain drugs still require a prescription from a Portuguese doctor.  If you are traveling in Portugal, showing a picture of your prescription or even the prescription bottle can get you some medication if you are in a pinch!

Emergency Services (Quick Response When You Need It Most)

When it comes to emergencies, Portugal takes healthcare seriously. Here’s what you need to know about emergency services in this beautiful country:

• In any emergency situation, dial 112. This number works throughout Portugal and the European Union. It’s free to call from any phone, including mobiles.
• When you call 112, operators can usually assist you in English, French, or Spanish if you’re uncomfortable with Portuguese.
• The 112 number connects you to all emergency services, including medical, fire, and police. The operator will direct your call to the appropriate service.  However, take note that the fire department can sometimes be all volunteers, and they are NOT trained as ENTs like in the US.  They are only there for fires.
• Ambulance services are readily available in Portugal, but in a busy city, you might not be able to get one on rare occasions. Either they are all occupied, or there might be a strike. If this is the case, take a taxi!
• Most larger hospitals in Portugal have emergency departments (Serviço de Urgência) that operate 24/7. These are equipped to handle a wide range of medical emergencies.
• Portugal has a modern fleet of ambulances staffed by trained paramedics. Response times are generally quick in urban areas.
• The National Institute of Medical Emergency (INEM) coordinates emergency medical services in Portugal. They operate ambulances, rapid response vehicles, and even helicopters for critical cases.
• Many emergency departments use a color-coded triage system to prioritize patients. Don’t be surprised if non-life-threatening cases have longer wait times.
• While emergency services are available to everyone, non-residents may be charged for treatment. It’s always wise to have travel insurance when visiting Portugal.
• For less urgent medical needs at night or on weekends, there’s always a pharmacy on duty (farmácia de serviço) in each area.
• Some private hospitals also offer 24/7 emergency care, which can be a good option if you have private health insurance.

Waiting Times (Navigating Public vs. Private Healthcare)

Public Healthcare System

• For routine check-ups with your assigned family doctor, wait times for an appointment are usually reasonable, often within a few weeks.
• Depending on the specialty and urgency, waiting times for specialist consultations in the public system can range from a few months to over a year.
• Be prepared for potentially long waits for elective procedures. For non-urgent surgeries, it’s not uncommon to wait several months or even a year.
• Waiting times for tests like MRIs or CT scans can also be lengthy in the public system, sometimes several months.
• The emergency room wait times in the public system can skyrocket to 10-14 hours or more. Since Portugal does not have urgent care facilities like the US and the ER is free to all in Portugal, there can be a lot of people.  

Private Healthcare System

• This is the primary advantage of private healthcare: you can often get appointments with specialists within days or weeks.
• Diagnostic tests are usually available much faster, often within a week or two.
• Non-emergency surgeries can typically be scheduled much sooner than in the public system.

3 Factors Influencing Wait Times

1. Location: Urban areas, especially Lisbon and Porto, tend to have shorter wait times due to a higher concentration of healthcare facilities.
2. Specialty: Some medical specialties have longer wait times than others. For example, orthopedics and ophthalmology often have longer queues.
3. Time of Year: Wait times can increase during holiday seasons or flu outbreaks.

3 Strategies for Managing Wait Times

1. Consider a Mix: Many expats use a combination of public and private healthcare to balance costs and wait times.
2. Using the MySNS app allows you to check wait times at different facilities for certain procedures.
3. Be Proactive: Don’t wait until the last minute for routine check-ups or to address developing health concerns.

Family Doctors

Getting a family doctor who will provide comprehensive care throughout your life is popular in Portugal. You’ll head to your local health clinic or Centro da Saude to request one to be assigned to you. 

Once registered, this doctor will be your primary point of contact for all healthcare needs, offering comprehensive care from routine check-ups to managing chronic conditions. The availability of family doctors can vary, so it might take some time to be assigned one, but rest assured, the system is designed to ensure you have consistent and reliable care.

Maternity Care

For expectant families, Portugal offers a comprehensive and caring approach to maternity services. Here’s what you need to know:

Public Healthcare System

• Cost: Prenatal care and delivery are free in public hospitals for residents registered with the National Health Service (SNS).
• Prenatal Visits: Expect regular check-ups throughout your pregnancy, typically starting around 8-12 weeks. These include blood tests, ultrasounds, and health assessments.
• The “Pregnancy Booklet”: You’ll receive a “Boletim de Saúde da Grávida” (Pregnant Woman’s Health Booklet) to track your pregnancy progress.
• Birthing Options: Most public hospitals offer both natural and medicated births. Water births are available in some facilities.

Private Healthcare

• Quicker Access: Private care often means shorter appointment wait times and more scheduling flexibility.
• Choice of Doctor: You can usually choose your obstetrician and keep the same doctor throughout your pregnancy and delivery.
• Additional Services: Private hospitals may offer extra amenities like private rooms and more personalized care.

Hospital Luz and Other Facilities

• Hospital Luz: Known for its excellent maternity care, it offers a 24-hour maternity emergency unit in Lisbon, providing peace of mind for expectant mothers.
• Other Notable Hospitals: CUF hospitals in various cities and Hospital da Luz Arrábida in Porto are also popular choices for maternity care.

Tips for Expat Families

1. Start Early: Begin your prenatal care as soon as possible after confirming your pregnancy.
2. Language Preparation: Learn key Portuguese terms related to pregnancy and childbirth.
3. Tour Facilities: Many hospitals offer tours of their maternity wards – take advantage of this!
4. Understand Your Coverage: Whether using public or private care, know what’s included in your health plan.
5. Connect with Other Expat Parents: Join local expat groups for shared experiences and advice.

Welcoming a new family member in Portugal can be a wonderful experience. The country’s blend of modern medical practices and a family-oriented culture creates a supportive environment for growing families. Whether you choose the public or private route, you’ll find that Portugal takes maternal and infant care seriously, ensuring a positive start to your family’s Portuguese adventure.

Diabetes Care

For those managing diabetes, Portugal offers a robust and supportive healthcare environment. At the forefront of this is the Association for the Protection of Diabetics in Portugal (APDP), but the care extends beyond just this organization.

Diabetes Care Beyond APDP

• Public Healthcare System: The SNS (National Health Service) provides diabetes care through local health centers and hospitals.
• Medication Coverage: Many diabetes medications and supplies are heavily subsidized or free under the public health system.
• Specialist Care: Endocrinologists and diabetes specialists are available in both public and private settings across the country.
• Technology Access: Advanced diabetes management tools like continuous glucose monitors and insulin pumps are available, though access may vary.

Portugal’s approach to diabetes care, exemplified by organizations like APDP, offers a reassuring environment for those managing this condition. With a combination of advanced medical care, affordable services, and a lifestyle conducive to health, Portugal provides excellent support for individuals and families dealing with diabetes. As you settle into your Portuguese life, you’ll find that managing diabetes here can be a smooth and well-supported process.

Finding New Healthcare Providers In Portugal

Switching over your healthcare needs to new providers can be stressful, but a few things can make it easier.

• Ask for recommendations. If you’re going for private services, you’ll be able to pick your provider and ask for recommendations. Use expat communities, such as Facebook groups, Internations, or Expats in Portugal, to ask for recommendations in your area. 
• Bring copies of your medical records, especially vaccination records, with you. When you leave a medical practice, you have every right to ask for your records. It may cost a small fee to get it printed, but it’s a good idea when transferring care to a new place.
• Head to your local Centro da Saude as soon as you are settled and have your residency card. You’ll be able to ask for a family doctor and familiarize yourself with your local clinic.

What If You Don’t Want To Transfer Treatment From Your US Provider?

I’ll be upfront: I keep treating some things for our family in the US.

We are blessed to still have a house in the States (we rent out the basement), and we regularly visit at least twice a year.

I’ve kept a few medical treatments still going for my kids in the US, including:

• Orthodontia 
• Yearly Well-Checks
• ENT treatments

Why have I not switched these services? There isn’t a great answer. We carry a Christian Healthshare Plan in the US as another failsafe for when we are traveling or in the US. This allows us to seek medical care in both places.

ENT Treatment

Additionally, sometimes, providers in Portugal are more conservative than US providers. A recent example was when our US-based ENT told me our two youngest should probably have tonsils removed. We have a long history with the ENT with multiple ear tube surgeries, some hearing loss, and more.

Due to the recovery and intensity of tonsil removal surgery, I visited an ENT in Portugal to see if we could have the surgery there. However, this provider didn’t think their tonsils needed to be removed at all.

This left me in a conundrum. After sitting on it for over a year and monitoring the kids, I opted this last summer to fly to the US for tonsil removal. I’m glad we did it!

Orthodontia

Orthodontia isn’t impossible to find in Portugal, but its popularity is still small compared to the US. Many adults have been exploring this in the last few years for themselves, having never had it as children.  It’s also expensive and not possible for many locals.

There are many qualified orthodontic providers in Portugal, and it simply comes down to me and my comfort level with our US provider. I really enjoy the practice, and they are willing to work with us on a reduced schedule with more aggressive treatment.

Palatal expanders are available in Portugal, and the entire process costs about 500 to 1000 euros.

Other Important Things To Know About Portuguese Healthcare

• Treatment for medical emergencies is free in Portugal, but there is one exception. If a patient uses emergency services without a referral from the SNS and is not admitted to the hospital, they will have to pay medical fees.
• Mental health can be treated free of charge in Portugal with a referral from your general doctor.  You can also access a free, 24/7 psychological support hotline. Call the SNS24 main line at 808 24 24 24 and press 4.
• Maternity care is free for pregnant patients under public health insurance. You’ll get a “green book” to track all your progress, aka Boletim de Saúde da Grávida. The Portuguese take pregnancy very seriously, and the care is wonderful, although at a different pace than in the US.
  • My pregnant friends tell me you don’t get your due date for a while and really won’t be seen by a doctor for a certain number of weeks.
• Dental care is not nearly as popular in Portugal (or Europe) as in the US. Regular check-ups are not as common. Dental care is also not free under the national healthcare system unless you are a vulnerable group.
• Similarly, optical care is not covered under public care, but private vision insurance is available.
• Many doctors work in both the private and the public sectors to supplement their income.
• Coverage when visiting the US. SafetyWing offers coverage for US citizens visiting the US for up to 15 days.
• Chronic condition management. Some expats note that managing chronic conditions can be challenging due to communication issues and differences in healthcare approaches.

Overall, American expats in Portugal can generally expect to access high-quality, affordable healthcare through the country’s universal healthcare system.

Additional Reading

Moving to Portugal Checklist

How To Obtain A Portuguese D7 Visa For Your Family: Everything You Need To Know

Obtaining a Portuguese Health Number, SNS Number, or Número de Utente de Saúde, As An American Expat