The Portuguese Ministry of Health operates the country’s national healthcare system, the Service Nationale de Saude (SNS). It is funded primarily out of taxes, and recently costs have grown beyond the rate of inflation.

The two-tier system features both state and private medical insurance, with some additional insurance cover for certain specialist professions. The Health Regulatory Entity, which is governed by the Ministry of Health, is in charge of regulating all insurance providers.

The SNS is governed regionally, but it applies only to continental Portugal. If you are visiting the islands – Madeira and the Azores – then you will find that these autonomous regions have health systems of their own and you will need to approach health insurance in these parts as a separate issue.

If you pay into the system, you and your family members will be covered to the same degree as other Portuguese residents. However, the range of treatments available under public coverage has been reduced over the last few years and some treatments are now quite expensive.

The system operates on a percentage basis, meaning that not all of the cost of your treatment is covered. If you have a long-term or chronic condition, you may need private cover.

There is discussion about the health insurance system undergoing an overhaul, with fees being scrapped altogether. The Portuguese system is facing reconstruction, due to complaints from users about long waiting times and the sometimes labyrinthine referral system.

Everyone who is paying into the social security system, either through an employer or directly, will be eligible. As an expat who falls under one of these categories, you will be entitled to the same treatment as a Portuguese citizen.

If you do not hold a residence permit, you will still have access to the SNS upon presentation of a document from your local Junta de Frequesia (municipal administration) stating that you have been residing in Portugal for more than 90 days.

If you have a Portuguese employer, your enrolment into the state health insurance scheme should be automatic. If you are self-employed, you will need to sign up with the Social Security Institute in order to be eligible for state care. Once you have signed up, you will need to register at your local health clinic (centros de saude). You will need your:

• passport
• residence permit
• security card

The SSI will give you a temporary certificate, proving that you are covered, and in due course you will receive your healthcare card (cartão do utente), which will entitle you to discounted treatment.

Most medical treatments are covered by the state system but you will usually have to co-pay: a doctor’s visit, for instance, will cost you a small amount. If you fall into certain categories (if you are a student, for example, or if you have diabetes or are pregnant), you might find that you are eligible for further discounts, so do check with your employer or the SNS directly if you think you are in one of these groups. Pre-natal classes might not be covered under state insurance.

The exemptions for co-paying treatment include:

• family planning consultations and any complementary measures prescribed
• consultations, as well as complementary measures prescribed during the consultations for degenerative and demyelinating neurological diseases, muscular dystrophies, chronic pain treatment, mental health treatment, congenital coagulation factor abnormalities, an infection with HIV/AIDS, diabetes and oncological treatment
• the first consultation with a specialist in the hospital, following a referral
• respiratory healthcare at home
• care for patients on dialysis
• consultations and additional measures required for the donation of cells, blood, tissue or organs
• consultations and supplementary diagnostic tests carried out during population-based screening, screening for HIV/AIDS, hepatitis, pulmonary tuberculosis and sexual transmitted infections, early diagnosis programmes and neonatal diagnostics encouraged as part of prevention programs by the directorate-general for health
• consultations carried out at home at the initiative of the services and establishments of the SNS
• urgent care and supplementary measures related to care for victims of domestic violence
• programmes for the treatment of chronic alcoholics and drug addicts
• direct observation programmes
• vaccinations planned as part of the national vaccination programme and persons covered by the seasonal influenza vaccination programme
• visits to the emergency department following: a) a referral from the primary health care network, by the call centre of the National Healthcare Service and by the INEM to an emergency service, including additional measures; b) hospitalisation via the emergency service including complementary measures
• visits to the primary healthcare service network after referral from the call centre of the National Health Service
• consultations, and additional measures requested as part of consultations, in the provision of care by specialist palliative care teams

Your doctor will usually need to make hospital referrals for you if you want to be treated under the state system. You might still have to pay a small fee called a ‘moderating charge’. Portugal has around 200 hospitals but about half of those are private. This does not apply to emergency admission and care at a hospital, however: this remains free.

You will need to make a small contribution towards the cost of your prescriptions.

The Portuguese government is keen to establish preventative medicine as well as treating conditions, and thus some preventative consultations may be available to you under your state coverage.

If you are an EU citizen retiring to Portugal, you will need an S1 form, but will then be entitled to free or subsidized healthcare for up to two years.

If you are coming into Portugal and have no employment or are not making contributions to the social security fund, you will need proof of private insurance before you can apply for a residency permit.

Check with the Social Security Institute (Instituto da Solidariedade e da Segurança Social) if you are uncertain about your eligibility.

You will be covered if you are from an EU member state and have an EHIC card.

You will also be able to seek treatment at a clinic if you are in the country for up to 90 days.

If you are from outside the EU, and need a visa, you must have private cover in order to be eligible for that visa.

Your dependents will be covered by state insurance.

Unless you are exempt due to being in a vulnerable group, such as children and the elderly, you may need to look at separate cover for this. You can take out specific insurance for optical treatments, too.

The amount you will have to pay for state health insurance will depend on your salary and will be deducted from it: it averages around 11% of your gross salary.

A lot of Portuguese citizens take out private health insurance to avoid the problem of long waiting times and treatment gaps. Like most national healthcare systems, the Portuguese model has had funding issues and there is currently a shortfall, which means that the system is overstretched.

There is also the language barrier to take into consideration: in areas where English-speaking medical personnel may be in short supply, this can be important.

Private insurance will ensure speed of access to treatment and better facilities, as well as covering advanced dental care and cosmetic surgery.

Some private insurance does not cover outpatient visits to your local doctor, so you need to check exactly what it entitles you to. This is why many people choose a combination of different types of cover.

Numerous variables can have an impact on the cost of private health insurance in Portugal.

The most important variables are:

• Age (the higher the more expensive)
• Area of cover (i.e. just Portugal or other areas too? If those other areas include any of the US, the Caribbean, Singapore, China, Hong Kong or Dubai this can significantly increase the overall price)
• Product choice (higher end insurance products are more expensive)

Other variables include:

• Deductibles
• Co-insurance
• Payment frequency
• Gender
• Nationality
• Country of residence

As so many variables have an effect on the cost of private medical insurance in Portugal it becomes very difficult to give accurate estimates without knowing the full details of the coverage required. However, as a very rough guide, using a standard profile of a 40 year old British male with no deductibles, no co-insurance, a middle tier plan/product, all modules included and worldwide coverage excluding the US, a ballpark price of around £4,000/$5,000 might be expected. Were coverage to be expanded to include the US then the premium could increase to almost double that amount.

The big internationals and local providers cover Portugal:

• Allianz
• AXA
• Bupa Global
• Cigna Global
• Multicare Feldidade
• Medis

The bigger banks often have arrangements with insurance companies, so if you are with one of the Portuguese banks, such as Banco PI, they can arrange cover for you.

The Association of Foreign Property Owners (AFPOP) also offers private health insurance to expat property owners at competitive rates, through Medal Insurance.

Eu tenho um cartão EHIC - I have an EHIC card

cartão do utente - healthcare card

centros de saude - health clinic

inquerito de diagnostico e tratamento - diagnosis and treatment form

Instituto da Solidariedade e da Segurança Social - Social Security Institute

médico - doctor

seguro(s) - insurance(s)

Service Nationale de Saude - National healthcare system