Maria Melnikova is a doctor who first helped people fleeing the war get medical care as a volunteer and later founded her own clinic. She is still helping those who have left, now with sound advice. For Xpat.Land, she has written a detailed breakdown of how much healthcare will cost you depending on your level of anxiety.
When people ask me about the price of healthcare here, I start haggling as if we were at a market. How much is acceptable to you? Will you buy private insurance? Which city will you live in? What level of service are you expecting? How robust is your health (and your nerves), and that of your family?
Probably the biggest shock for an expat in Portugal is realizing that there is no single “good” or “bad” healthcare here. There is a set of tools, certain rules by which the system works, and the skill of using them. How well protected you are depends not only on which hospital you ended up in today, but also on how much information you gathered BEFORE you got sick. And then there is the famous “Portuguese randomness”, of course.
Below are four levels of patient “anxiety”, with an example of a financial approach for each.
🟢 Level 1: The Zen Patient (Budget: €0 per month)
Strategy: faith in the state and a basic life jacket, good luck, robust health and rare visits to the doctor.
How to get access. Get a Número de Utente (temporary or permanent) at your local health center (Centro de Saúde). This gives you access to free public healthcare (SNS, Serviço Nacional de Saúde) on the same terms as Portuguese citizens.
The route when something goes wrong. A call to SNS 24 (808 24 24 24) ➔ a visit to the Centro de Saúde or a public emergency department (Urgência).
Financial reality. Free (or token user fees, Taxas Moderadoras, in isolated cases).
Pitfalls
They most likely won’t let you die: public hospitals handle heart attacks, serious injuries, infections and emergency surgery. But you can wait anywhere from several months to a couple of years for an assigned family doctor (Médico de Família) or an appointment with a specialist such as a dermatologist or neurologist.
The main trap: without a valid residence permit (Autorização de Residência), you will be helped, and you will certainly be resuscitated in an emergency, but the hospital may later bill you at the full commercial rate.
Does a residence permit solve everything? Well, almost
From the moment you have a residence permit, your rights to medical care are the same as those of Portuguese citizens: surgery, expensive treatment, discounts on medication, all on equal terms. There is one condition: you need to show your residence permit at your Centro de Saúde so that it is entered into the system.
If you don’t have a residence permit yet (for example, it is still being processed), you won’t be left without help, but from there it varies. Vaccinations are free, and so is care for pregnant women and children. Everyone else is treated free of charge only for life-threatening conditions. You will also receive care if you have a disease that poses a risk to public health: HIV, hepatitis or tuberculosis. There is one condition: you must live in Portugal permanently, meaning you have been in the country for more than 90 days.
In all other cases, such as an ordinary visit to the Urgência, planned surgery or a trip to the family doctor for a prescription, treatment is charged at the market rate. A visit to the Urgência will cost about €120, and a family doctor appointment about €100. The bill arrives by post after the visit.
An example: a patient without a residence permit ended up in the emergency department with a very serious illness. He was admitted and given the treatment he needed. A few months later, a bill for €10,000 arrived. He managed to contest it: it was shown that although he had no residence permit, the illness was life-threatening, and the bill was cancelled. So if you receive a bill like that and your condition was life-threatening, don’t rush to pay.
One interesting feature to bear in mind: public healthcare is unevenly distributed. In the north of Portugal (Porto and the surrounding area), there are enough doctors, the queues for specialists are not as long, and institutions and planned care work better. In the Lisbon region, “it’s complicated”: some departments may be closed, especially in summer, there is a regular shortage of obstetricians, pediatricians and anesthesiologists, and planned consultations stretch out indefinitely. In other regions (the south and the interior, closer to Spain), free healthcare barely functions, and nobody is even surprised anymore.
🟡 Level 2: The Illusion of Control (Budget: ~€10–25 per month)
Strategy: a plano de saúde (Medicare, KeepWells, Wells).
What it really is. This is not insurance but a discount card. You pay for a subscription that gives you access to negotiated prices at private clinics (CUF, Luz, Lusíadas).
Financial reality. A consultation at a private clinic costs about €90–120 if you pay in full. With a discount card you pay less, around €35–45 out of pocket.
Pitfalls
The card comes with no hospitalization cover. If you are admitted to a private hospital for surgery, the bill will be €5,000–15,000, and the card won’t cover a cent.
The marketing promises “access to the best clinics” but is silent about the fact that this does not protect you from catastrophic expenses. Besides, far from all doctors are available through these discount cards, and you may find you still have to pay full price to be seen this month and not next year.
🟠 Level 3: The Sensible Pragmatist (Budget: ~€30–70 per month)
Strategy: local private insurance (Seguro de Saúde: Multicare, Médis, Fidelidade, Tranquilidade).
How it works. This is a co-payment model. The insurance takes on the serious risks (hospitalization up to €100,000–1,000,000) and gives a good discount on doctor’s visits, lab tests and diagnostics.
Financial reality. For a doctor’s consultation at a private hospital, even with insurance you pay a co-payment (usually €15–20), and the clinic bills the insurer for the rest. In the case of surgery or hospitalization, you pay about 10% of the cost of the procedure, and your insurance pays the rest. That is how we had our daughter operated on last year: adenoid removal costs €2,500, and we paid €250 (the rest was billed to the insurance).
Pitfalls, or what brokers don’t tell you
Waiting period (Carência): you can’t buy insurance and go in for surgery tomorrow, treat chronic conditions or plan a pregnancy. The waiting period for surgery is 60 to 180 days, and for childbirth it is 365 days.
Exclusions (Exclusões): the insurer will strike out everything you had before signing the contract (pre-existing conditions). You need to fill in the health questionnaire honestly, otherwise you may be refused at the first serious claim.
Age barrier: after 55–65, it is almost impossible to get into decent insurance for reasonable money (or you have to move to stripped-down senior plans).
Limitations: many top specialists don’t accept insurance (it may not be worth it for the doctor, since insurers pay below the market rate for services). In the Lisbon area, for example, you can’t book a dermatologist through insurance, only as a self-paying patient. Or you run into queues: a gynecologist through insurance will be available in two months, while for full payment you can be seen as soon as tomorrow. Many policyholders are rightly indignant about this, but that is the reality.
🔴 Level 4: Maximum Anxiety, or Top Management (Budget: €150–400+ per month)
Strategy: top-tier expat plans or international insurance (Cigna, Allianz Care, Bupa).
How it works. This is reimbursement, or a full refund. It often works like this: you pay 100% at the clinic yourself ➔ upload the receipts and medical forms to the app ➔ the insurer returns 80–100% of the money to your account.
Financial reality. Expensive, but it erases borders. It covers treatment both in Portugal and at any clinic in Europe and the world. It often has no restrictions on age or previous conditions.
Pitfalls
It requires a constant cash reserve: to have a comprehensive check-up or a minor procedure, you need to pay one or two thousand euros of your own money and wait one to four weeks for the payout.
There is also a bureaucratic nuance: if the doctor doesn’t record the diagnosis according to the international classification (ICD), the insurer will block the refund.
A “health rescue plan” in Portugal is built in layers. The SNS, free public healthcare, is your foundation for when your life is hanging by a thread or you have been diagnosed with a serious illness that requires expensive treatment. It is slow and complicated, but it still works.
Private insurance with co-payments is a tool for comfortably dealing with everyday issues at private clinics. It lets you save money and get a more predictable level of service. And I have never yet seen a case where private hospitals refused to see someone paying the full price in cash.
So do your best, if you can, to be healthy and wealthy. Then the local healthcare system won’t be so frightening.
