Romania runs a mandatory social health insurance system (CNAS) funded by income-based contributions (CASS); anyone who pays in, or who is exempt, is covered on the same basis as Romanian citizens. Here is what that actually means for an American or Briton living in Romania: what the public system gives you, what it does not, and where private cover fits.
Can you use the public system?
- Working for a local employer: Yes, by paying contributions
- Self-employed: Yes, by paying contributions
- Retired or not working: Only in limited cases
Registered employees have CASS withheld automatically via payroll and are covered from when contributions start. Registered self-employed/freelance residents pay CASS via their own ANAF declarations and are covered once registered. A non-working retiree first needs a long-stay residence permit, which itself requires proof of private medical insurance as an immigration condition; only after securing residency can they register with CNAS and pay the ‘no income’ CASS contribution (2,430 lei for 2026, payable in installments) to get covered. No reciprocal US-style deal exists, and UK retirees moving now (rather than before the Brexit cutoff) get no automatic S1-style cover either.
If you are retiring here
No automatic pension-linked public cover exists for a foreign retiree. After securing residency they must actively register and pay the annual ‘no income’ CASS contribution (2,430 lei in 2026) or rely on private insurance. Separately, under rules running August 2025 to December 2027, pension income (including foreign pensions) above 3,000 lei/month is itself now subject to CASS.
What public cover will not give you
- long waits for specialists and elective procedures in public hospitals
- English-speaking staff concentrated in Bucharest and other major-city private hospitals
- dental almost entirely private, out of pocket
- medicine co-payments
So do you need private health insurance?
Legally required as a precondition for the non-EU residence permit itself, and commonly kept afterward for faster or better private-hospital access even once enrolled in CNAS. Proof of health insurance is also a condition of the main residence routes here, so most expats need a policy in place before they apply.
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General information, not insurance, immigration or medical advice. Rules change and individual situations differ; check the official position before you commit. Researched from official sources, July 2026.