Romania – Health Insurance

Is health insurance mandatory for expats in Romania?

Whether you are required to hold health insurance in Romania depends primarily on your residency status and how you earn your living. Foreign nationals who have secured the legal right to reside in Romania are entitled to healthcare under the same conditions that apply to Romanian citizens. In other words, the legal framework governing health coverage treats expats and locals equally — and for the vast majority of people living lawfully in Romania, participation in the national health insurance system is obligatory.

Citizens of third countries who come to Romania on a temporary residence basis are required to arrange private health insurance before they enter the country. Once they take up employment under a contract of employment on Romanian territory, they automatically acquire insured status and enjoy the same entitlements as Romanian citizens. This distinction is significant: prior to securing employment, non-EU nationals must ordinarily hold private coverage.

Demonstration of medical coverage is a prerequisite for non-EU nationals seeking resident status. This means you must show that health insurance is already in place even before you can apply to become a long-term resident. EU citizens, by contrast, benefit from freedom of movement provisions and have a more straightforward route to accessing the public healthcare system.

Once a residence permit has been granted by the General Inspectorate for Immigration, all third-country nationals may enrol in the health insurance scheme and pay contributions to the health fund, thereby gaining access to medical services. Those who are not in employment must make voluntary contributions to remain covered. It is advisable to check the latest requirements directly with the General Inspectorate for Immigration (IGI) and the National Health Insurance House (CNAS), since regulations may be updated.

How does the public health system in Romania work?

Romania’s healthcare structure rests on two principal pillars: the state-run social insurance system overseen by CNAS, and private health insurance. The public component operates as a contributory social insurance model, meaning that entitlement to healthcare benefits is directly tied to paying into the system. This is conceptually similar to France’s Sécurité Sociale or Germany’s statutory health insurance (GKV), rather than a contribution-independent universal model like the United Kingdom’s NHS, where access is broadly available regardless of one’s payment history.

The public system provides broad coverage financed by social security contributions from all working individuals in Romania, along with annual payments from others — such as pensioners and the self-employed — unless they qualify for an exemption. Care is organised across three tiers: primary care delivered by family doctors and GPs, secondary care encompassing specialist consultations and diagnostics, and tertiary care covering hospital treatment and complex medical procedures.

The National Health Insurance House (CNAS) oversees the system at a national level, managing fund distribution and contracting with both public and private healthcare providers. CNAS operates through regional county-level offices known as CAS offices. You can find contact information and official resources at cnas.ro.

The system’s financing depends on mandatory social contributions from employers and employees, which in turn grants access to essential services in public hospitals. Nevertheless, the public system faces well-known structural difficulties, including extended waiting times and a shortage of specialists in certain fields. Romania trains a large number of doctors each year, yet many choose to practise abroad in wealthier EU countries, driven by the chronic underfunding of domestic healthcare services.

Healthcare resources are concentrated in cities, while rural and more remote areas frequently suffer from inadequate staffing and ageing medical equipment. Expats based in Bucharest, Cluj-Napoca, or Timișoara will typically find a higher standard of both public and private facilities than those living in smaller towns or the countryside.

How do expats register for public health coverage in Romania?

Before you can access healthcare as an insured person in Romania, you must contact the relevant county Health Insurance House (CAS) and register with a family physician. The process involves several stages and some administrative paperwork, but it is entirely achievable. The following step-by-step guide outlines how expats can enrol in Romania’s public health system.

1. Obtain your residence permit. Anyone intending to stay in Romania for more than three months must secure legal resident status. EU citizens register with local municipal authorities to obtain a residence certificate; non-EU nationals must apply to the General Inspectorate for Immigration (IGI) for a formal residence permit. Non-EU nationals will ordinarily be required to present proof of private health insurance at this point.
2. Obtain a tax identification number (CIF/NIF). Contributing directly to CNAS requires a Romanian tax identification number. This is issued by the national tax authority, ANAF (Agenția Națională de Administrare Fiscală). Applications can be submitted in person at your nearest ANAF office. Further details are available at anaf.ro.
3. Register with your local CNAS office (CAS). Enrolment in the health insurance system is handled through the local CNAS county office. Documents typically required include a valid passport or national identity card, proof of address in Romania, an employment contract, and your tax identification number. Foreign nationals may additionally need to present a residence permit or visa, depending on their circumstances.
4. Arrange your health contributions. If you are employed, your employer will deduct and remit monthly contributions together with other social insurance payments such as pension and unemployment contributions. If you are self-employed or have no income, you must organise voluntary contributions independently — see the costs section below for further detail. Self-employed individuals are required to file a tax declaration with ANAF and manage their social security obligations accordingly.
5. Register with a family doctor (medic de familie). Selecting a GP as your primary care provider is essential, since the family doctor serves as the entry point to specialist and hospital services within the public system. Lists of GPs contracted with your local CAS can be found on the CNAS website or by contacting your county CAS office directly. You will need to present proof of insurance — such as a letter from your employer or a CAS-issued certificate — when registering.
6. Receive your proof of insurance. Following registration, you will be issued a health insurance card, which must be presented when using healthcare services. Some expats have experienced delays in receiving the physical card; in the meantime, an adeverință (an official certificate of insurance from your employer or CAS office) is accepted at most healthcare facilities.

The full process may take several weeks, depending on your employment situation and the workload of your local CAS office. Common difficulties for foreign nationals include a lack of clear information about the registration process, bureaucratic complexity, and language barriers. It is advisable to verify current requirements directly with CNAS or to seek guidance from a local relocation specialist, as procedures can differ from one county to another.

What costs are involved in the public health system in Romania?

For employees in formal employment, the health insurance contribution — known as CASS — is deducted automatically each month by the employer and forwarded to the state. Romania’s system operates via payroll deductions rather than requiring a separate premium payment, which makes things straightforward for those working under a standard employment contract. The contribution rate stands at 10% of gross salary as of 2025 — always confirm the current rate with ANAF or CNAS, as it is subject to legislative revision.

If you are self-employed or receive income from freelance activities, royalties, rental income, or investments, you are required to pay health insurance contributions if your total annual earnings exceed a threshold equivalent to six times the national gross minimum wage per year, which is revised annually. For 2025, the gross national minimum wage is 4,050 RON per month, in accordance with Government Decision no. 1505/2024. The contribution base therefore amounts to 6 × 4,050 = 24,300 RON. Applying the 10% contribution rate produces a total annual payment of 2,430 RON, which provides coverage for 12 months once paid.

For those who are not employed and have no regular income, voluntary contributions may be paid covering a six-month period, amounting to 1,338 RON, and this entitles the individual to health insurance coverage for 12 months. This route offers a practical option for expats who have not yet entered the Romanian labour market. These figures are adjusted annually in line with changes to the national minimum wage, so always verify the amounts currently in force with ANAF or CNAS.

While GP consultations and emergency care are provided free at the point of use, various other services and medicines involve co-payments. The level of co-payment varies according to the treatment type and the medication concerned. For outpatient prescriptions, the public insurance system covers varying proportions of drug costs, with the patient potentially responsible for up to 80% of the price of certain medicines — a significant out-of-pocket expense for some treatments. The current co-payment schedule is set jointly by the Ministry of Health and CNAS; consult the CNAS website for up-to-date information.

What does public health cover in Romania include and exclude?

The range of services covered through CNAS encompasses specialist outpatient care, inpatient hospital treatment, prescription medicines, maternity services, primary care, medical devices, and a number of additional services. On paper, the public system offers reasonably comprehensive coverage, though the practical reality can vary considerably based on your location and the particular service you require.

The public healthcare system funds broad access to care through social security contributions. GP consultations and emergency treatment are available free of charge at the point of use. Emergency care is accessible to everyone regardless of insurance status — in a life-threatening situation, attend the nearest public hospital or call the emergency number 112 without hesitation.

Romania’s broader social security framework is designed to support workers and residents across a range of life circumstances, including retirement, illness, maternity and paternity, unemployment, and occupational accidents. Within this framework, health insurance covers medical services, hospitalisation, preventive care, and maternity — meaning that families planning for childbirth are provided for under the public system.

However, there are notable gaps. Certain categories of care are largely left to private provision, with dental treatment being one of the clearest examples. Although emergency dental care may be accessed through contracted dentists on the basis of the European Health Insurance Card (EHIC), routine and cosmetic dental work falls outside the scope of public cover and must be financed privately or through a supplementary insurance plan. Basic dental services exist within the CNAS framework but are limited in scope and subject to waiting times.

Waiting periods for specialist appointments can be considerable, and the medical technology available in public hospitals is not always current, which can affect the quality of diagnosis and treatment. Mental health services, optical care, and many elective or non-urgent procedures are either excluded from public cover or subject to significant delays. Optical treatment, in particular, is generally not reimbursed by the public insurance system.

What are the advantages of international private health insurance for expats in Romania?

Although the Romanian public system offers free or subsidised healthcare to all enrolled residents — expats included — a large number of foreign nationals choose to hold private health insurance alongside their public coverage. The principal motivation is to sidestep the congestion and delays that characterise the public system. This practical consideration drives a substantial share of the expat community toward private plans, even when they are simultaneously contributing to CNAS.

Private health insurance in Romania opens the door to faster access and often a higher standard of care than the public sector can routinely deliver. It is particularly valuable for those who wish to see specialists directly without first obtaining a GP referral and then waiting weeks for an appointment — a significant benefit for anyone managing a chronic condition or requiring prompt diagnosis.

Private medical facilities are mainly found in larger cities, including Bucharest, Cluj-Napoca, Timișoara, Constanța, and Iași, where staff are generally well-trained and English is widely spoken. This multilingual environment makes private hospitals far more accessible for expats who have yet to acquire fluency in Romanian. Nationally recognised private healthcare networks include Regina Maria, MedLife, Medicover, and Sanador.

International health insurance — as opposed to a locally issued Romanian policy — offers further advantages that are particularly relevant to the expat lifestyle. An international plan is well-suited to those who travel frequently or who want the flexibility to seek treatment in multiple countries. Many expats select international coverage to overcome the geographic limitations of domestic plans and to secure higher levels of reimbursement for private care within Romania. Coverage for medical evacuation and repatriation to one’s home country is another important feature of international policies — one that local Romanian plans rarely incorporate.

Many expats take a dual approach, relying on CNAS for basic entitlements and using private insurance for convenience and quality of care. Private insurance costs in the range of approximately €300–€1,000 per year depending on the level of coverage (as of 2025). This range is broad by design — a basic local plan for a young and healthy individual will sit toward the lower end, while a comprehensive international policy that includes inpatient, outpatient, dental, and worldwide treatment will be priced considerably higher.

How do international private health insurance plans work in Romania?

Expats based in Romania can choose between locally issued private health insurance policies and internationally designed expat health insurance products. Both can be suitable, but they function differently and cater to different needs. Private insurance in general provides access to private clinics and hospitals, shorter waiting times, and improved comfort standards. Premiums differ according to the provider and the scope of coverage selected, but are broadly affordable relative to Western European markets.

Local Romanian private health insurance products are typically sold as annual subscriptions by insurers licensed to operate in Romania or directly by private hospital networks. Major groups such as Regina Maria and Medicover market their own subscription packages, granting policyholders access to their clinic networks. These plans offer good value for routine care within Romania but typically provide no coverage abroad and do not include repatriation benefits.

International expat health insurance is offered by global insurers and is designed specifically for individuals residing outside their country of origin. Such plans are also a strong option for those who wish to be treated in other European countries, as they offer a wider geographic scope than locally issued policies. When evaluating international plans, pay close attention to the following: whether the plan covers both inpatient and outpatient care (some budget plans restrict coverage to hospitalisation only); how pre-existing conditions are handled (most insurers apply waiting periods or exclusions for conditions that predated the policy start date); the geographic scope of coverage (some plans exclude treatment in the United States or Canada, which may be relevant if you travel frequently); and whether direct billing arrangements exist with private hospitals in Romania, or whether you must pay upfront and subsequently claim reimbursement.

Payment practices vary between private hospitals — some require settlement in full at the time of treatment, with later reimbursement from your insurer, while others have direct billing agreements with international insurers. Before committing to a policy, confirm which private hospitals in your city accept direct billing from the insurer you are considering. The Financial Supervisory Authority (ASF) is the body responsible for regulating insurers operating in Romania; visit asfromania.ro to confirm that any local insurer you are assessing holds the appropriate authorisation.

What should expats watch out for with health insurance in Romania?

A frequent mistake is arriving in Romania without any health coverage during the interval between arrival and the completion of CNAS enrolment or the start of employment. Non-EU expats in particular should ensure that a valid private health insurance policy is in place before they travel to Romania. Even EU citizens, who are not obliged to hold private insurance, may find themselves in an awkward coverage gap if they have not yet registered with CNAS or enrolled with a family doctor. It is worth noting that travel insurance is not an adequate substitute for health insurance during an extended stay — it is designed for short-term emergencies rather than routine or ongoing medical care.

To qualify for the full range of public health services, expats are generally required to have contributed to the social security system for a minimum of six months within the preceding 12 calendar months. This qualifying period is an important detail: simply registering with CNAS does not instantly entitle you to every benefit available. Begin making contributions as early as possible after arrival to meet this requirement without delay.

Pre-existing conditions represent another area requiring close attention. The majority of private health insurers — whether local or international — will either exclude pre-existing conditions altogether or impose a waiting period before agreeing to cover them. Read all policy terms with care and disclose your complete medical history honestly; concealing relevant information can result in claims being denied. If you live with a chronic condition, look for an international plan offering moratorium underwriting or a medical history disregarded option — though these tend to carry higher premiums.

Foreign nationals commonly encounter a range of challenges when trying to navigate the Romanian health system, including insufficient guidance on registration procedures, administrative complexity, limited familiarity with local healthcare arrangements, language difficulties, and inconsistent application of the legal framework by local administrative or medical staff. Retaining copies of all contribution records, insurance certificates, and registration documents is essential, as providers may request these at any point when you seek treatment.

Finally, avoid confusing an EHIC or GHIC with comprehensive expat health insurance. Short-term visitors from EU and EEA countries can present the EHIC for emergency treatment, but it covers only public providers and does not extend to private facilities. UK nationals may use the Global Health Insurance Card (GHIC), which replaced the EHIC for British citizens following Brexit. Neither card, however, covers private medical treatment, repatriation costs, or the broad range of services that someone living in Romania on a long-term basis will typically require.

Frequently asked questions about health insurance in Romania

Can I use my home country’s health insurance in Romania?

This will depend on your specific policy. Certain international health insurance plans offer Europe-wide or worldwide coverage that extends to Romania, so reviewing your policy documentation carefully is essential. EU residents may present the European Health Insurance Card (EHIC) to access necessary healthcare during temporary visits, but this is not a substitute for comprehensive coverage for those living in Romania long-term. If you are relocating to Romania permanently or for an extended period, you will generally need to enrol in the public CNAS system or hold a qualifying private plan.

Do I need private health insurance if I have a work visa for Romania?

Citizens of third countries seeking temporary residence in Romania are required to arrange private health insurance prior to arrival. Once they take up employment under a formal contract of employment on Romanian territory, they acquire insured status and become entitled to the same rights as Romanian citizens. In practice, you will typically need private insurance in order to obtain your initial visa or residence permit, after which you can transition to the public CNAS system once employment begins.

What happens if I get sick before my CNAS registration is complete?

Emergency treatment is provided at all public hospitals irrespective of insurance status. For non-urgent care needed before your CNAS registration is finalised, you will need to pay out-of-pocket at a public or private facility, or draw on private health insurance. This is one of the key reasons why expats are encouraged to hold private cover from the moment they arrive in Romania, rather than waiting until the public registration process is concluded.

How much does public health insurance cost in Romania if I am self-employed?

The health contribution rate is 10% applied to a base equal to six times the national minimum wage (24,300 RON for 2025), resulting in a total annual payment of 2,430 RON. Payment of this amount secures 12 months of coverage. This figure is recalculated each year alongside revisions to the national minimum wage, so always confirm the current amount with ANAF before submitting payment.

Is dental care covered under Romania’s public health system?

Dental treatment is one of the areas most dependent on private funding within the Romanian healthcare system. Basic dental services are accessible through CNAS but are limited in scope and involve waiting times. Emergency dental care may be covered through the EHIC for EU visitors when treated by contracted dentists. For routine, restorative, or cosmetic dental work, most people — Romanian and expat alike — turn to private dental clinics, which tend to be competitively priced by European standards.

Can I access public healthcare in Romania as an EU citizen without contributing to CNAS?

EU citizens may use their European Health Insurance Card (EHIC) to receive public healthcare in Romania during short visits, provided the card was issued by another EU member state. For longer stays and formal residency, enrolment in and contributions to the CNAS system are expected. EU citizens who are not working in Romania can make voluntary contributions in order to achieve full insured status.

Are mental health services covered by Romanian public health insurance?

Basic psychiatric and mental health services fall within the CNAS framework, but practical access is frequently constrained by a shortage of mental health professionals and extended waiting periods. The private sector provides quicker access to psychologists, psychiatrists, and therapists, generally on a self-pay or private insurance basis. International health insurance policies may include mental health benefits, though coverage limits and the number of sessions reimbursed vary considerably between plans — always review the specific terms carefully before purchasing a policy.

Does Romania have a digital nomad visa, and what are the health insurance requirements?

Romania’s digital nomad arrangement permits stays of up to three months, with the possibility of converting to long-term residency. Valid health insurance is a requirement for obtaining this visa — you will generally need to show proof of private health coverage for the full duration of your intended stay. Once you move to long-term residency and establish a legal source of income in Romania, you may enrol in the public CNAS system or continue with an international private plan. Consult the General Inspectorate for Immigration for the requirements currently in force, as these may be subject to change.