My Story
I am a US expat who moved to Lisbon in December 2020 and, due to the pandemic, didn’t sign up for private health care until April 2022. I have an unusual story because I moved to Japan right after university and started using their national healthcare system as part of my working visa there. I have never been part of a healthcare plan as a working adult in the United States and have only paid for healthcare out of pocket in the United States when I visit my family.
The Healthcare System in Portugal
Portugal has both a free public health care system and paid private health care options. When you first move to Portugal, you need to sign up for the public health care system by getting a numero de utente from your local freguesia (district office). This can, in theory, be done by walking into the frequesia office with your passport and receiving the numero de utente on the same day.
I received mine in only about 15 minutes, and they also emailed the number to me. I was told that I would eventually get a family doctor assigned to me within the public system, although I was told even then, in the middle of the pandemic, that this could take a while. I never heard back nor did I try to go back to my local office, as I knew that I would be signing up for private health insurance.
I have heard that it can take months or even years to get a public doctor assigned, but I’m sure that if you follow up frequently with your local office, you may get quicker results. I have also heard that there can be very long waiting times if you go into a public hospital, especially if it’s not an emergency.
If you do have a genuine emergency, however, you will often end up in a public hospital, even if you are in the private health care system. This will depend, of course, on your location when an emergency occurs. Another surprising thing about public vs. private is that the doctors in the public system in Portugal are supposedly better than the private hospitals. People tell me that a public hospital is where you want to be if something truly serious happens, but private is better for more minor issues and faster care.
If you’ve been following the healthcare situation in Portugal over the last few years, and Portugal is certainly not alone in this, the public healthcare system is seriously underfunded and many doctors trained in Portugal are also moving abroad to be paid higher wages. Many rural districts in Portugal no longer have any family doctors and doctors have been going on strike demanding higher pay for the long, arduous hours that they must juggle in a system with more and more patients on their plate.
Catia Martins, a family doctor in Porto, reported in the Euronews that wages have “not actualized for 10 years and because of that we are one of the worst-paid doctors in Europe.” In the same article, it was reported that 1.6 million people are currently without a family doctor and ten strike days were planned in 2023 to protest the current working conditions.
I experienced the ramifications of this situation directly in a private hospital as I was sitting with my doctor. After taking an urgent phone call with a patient, she looked at me and said, “That’s another public healthcare patient that has just moved over to the private system. Many of them are switching. I have so many patients. People are looking for a place where they can get quicker care or care period.”
Private Healthcare Options in Portugal
I signed up for Medis, one of the top main private healthcare insurance providers in Portugal, through a healthcare broker. My broker provided me with options for both Medis and Advancecare. I will provide you with the prices from 2022 below to give you an idea of how coverage generally works. The price went up for Medis by 10%, therefore keep in mind these are examples to help illustrate the types of insurance and expected prices.
Medis
Medis’ options 1 and 2 are lifetime coverage when subscribed up to 54 years of age. Option 3 is lifetime coverage when subscribed up to 64 years of age.
Copayments
For any of the options above:
- Hospitalization: 10% of the bill with a maximum copay of €500. For example, a €16,000 surgery will only cost you €500, the rest of the expense comes out of the annual allowance.
- Birth: €250
- Doctors appointment: €17 for any type of doctor, whether a family doctor or a specialist doctor within the company network. For example, if the overall cost of a doctor’s appointment is €60, you pay €17, and the rest of the expense comes out of the annual allowance. However, if the doctor’s appointment is outside the network, you pay fully out of your pocket but get a refund of 35%.
- Emergency room visit: €40 copay
- Medical exams: Blood test €1.50, Pathology Anatomy €7.50, X-Ray €7.50, Sound Scan €12.50, Nuclear Medicine 10%, CAT Scan €27.50, Magnetic Resonance Imaging €65
Grace Periods
- 60 days – Outpatient Assistance, Dental and Prosthetic Devices and Orthosis
- 90 days – Hospitalization
- 180 days – Serious Illness Cover; Surgical or other invasive treatment of benign prostatic hypertrophy, benign uterus condition
- 365 days – Birth
AdvanceCare
All options offer lifetime coverage when subscribed up to 55 years of age. When Subscribed after 56 and up to 65, coverage ends at 75 years of age.
Copayments
For any of the options above:
- Hospitalization: 10% of the bill with a maximum copay of €500. For Example, a €16,000 surgery will only cost you €500, the rest of the expense comes out of the annual allowance.
- Birth: €250
- Doctors appointment: 15€ for any type of doctor, whether a family doctor or a specialist doctor within the company network. If the overall cost of a doctor’s appointment is €60, you pay 15€, the rest of the expense comes out of the annual allowance). If a doctor’s appointment is outside the network, you pay fully out of your pocket but get a refund of 50% up to a maximum of 35€.
- Emergency room visit: €37.50
- Medical exams: Blood test €2.50, Pathology Anatomy €7.50, X-Ray €7.50, Sound Scan €15, CAT Scan €25, Magnetic Resonance Imaging €50
Grace Periods
- 60 days – Outpatient Assistance, Dental and Prosthetic Devices and Orthosis
- 90 days – Hospitalization
- 180 days – Serious Illness Cover; Surgical or other invasive treatment of benign prostatic hypertrophy, benign uterus condition, cystocele and rectocele
- 365 days – Birth
What Did I Choose?
I ended up going for Option 3 with Medis at the cost of €87 per month (in 2022). As you can see from the grace periods, signing up for private health care will not give you immediate coverage. You will need to pay, for example, for two months of payments before you can even be covered for outpatient services. In fact, you will not get coverage for childbirth until a full year later. This is standard no matter what health care plan you sign up for. If you are interested in using private health care, I therefore encourage you to sign up as soon so you can start the clock on being able to get coverage.
It is also important to note that private insurance premiums are also going up every year. My 2023 costs for the same plan increased by 10%. I currently pay 95 euros per month, and I expect this to go up again in April, especially with the increasing stress placed on the private systems due to the ongoing issues in the public system.
I shouldn’t finish this section without mentioning an insurance company called Multicare, the third option in Portugal. When I was registering for my first surgery in Portugal (more on that below), I was told that Multicare has been the most responsive and professional as of late among the different private health insurance companies in Portugal. Multicare is often offered as an option through your bank or also through private brokers. Check it out for a possibly even better option.
My Experience with Medis
Full disclosure, I am now 41-year-old female with no major history of chronic conditions. I go to one of the CUF private hospitals in Lisbon and occasionally go to Hospital da Luz, one of the hospitals that is considered the best in the country. These are the only private hospitals that I am currently familiar with, and I have been very happy with their services.
For the majority of my medical appointments with CUF, I have had to wait for around 15-45 minutes to see the doctor despite having a pre-arranged appointment, but the doctors always apologize for my wait and give me as much time as I need. My general appointments cost a €17 copay and I had one trip to the emergency room that included a CT scan with contrast and blood being drawn which cost me a grand total of €40.
The most I’ve ever been charged at one time for a general procedure was around €70 which included X-rays and an MRI. Every doctor that I’ve seen has been thorough and caring, but like every trip to the hospital, and this is true in any country, it is important to advocate for your own care.
Getting Surgery in Portugal
I experienced this when a tumor was found in one of my ovaries after my doctor ordered a pelvic MRI. My male doctor told me that he wouldn’t be able to remove the tumor without also removing my ovary. I scheduled a surgery and waited for it with some anxiety and trepidation.
However, a visit to the emergency room the week before my surgery (due to persistent pain on my left side) revealed endometriosis near my intestine. I mentioned this to the doctor the day before my surgery and he decided to postpone my surgery and try to add an endometriosis specialist to the team. By sheer luck, this new doctor turned out to be the main doctor on the team and ultimately removed my tumor without needing to remove my ovary.
I mention all of this to say that it doesn’t hurt to get a second opinion when preparing for medical procedures. You never know what options may appear when you ask about the possibilities.
My surgery cost me €500 out of pocket and I have nothing but good things to say about my procedure. I spent one night in the hospital and received the least invasive option for my condition. The entire experience made me so grateful for having private healthcare in Portugal and the fact that I was already signed up when a tumor was discovered.
Final Thoughts
If you are reading this and considering getting private healthcare in Portugal, I would urge you to go for it. The fact that it is a fixed monthly price regardless of your salary is quite remarkable and it is comforting to know that you have quicker access to healthcare on a daily basis if something goes wrong. The private hospitals also use mobile apps such as myCUF or MY LUZ to help you easily book appointments, view exam results, and even pay invoices directly online. These apps even offer regular tips for a healthy lifestyle. You will also get calls and texts from the hospital to confirm your appointments and English has always been available when I really needed it.
