Tips for Choosing Private Health Insurance in Portugal

Choosing health insurance in Portugal can be challenging when you’ve just relocated. The dual public/private healthcare system in Portugal sometimes differs from its European neighbors. Here are my best expatriate tips to help you make an informed choice about your health insurance in Portugal.

Understanding the Portuguese Healthcare System

Portugal has two distinct healthcare systems:

• The public system: SNS (Social Security)
• The private system, which operates independently from the public system

The Public Healthcare System

The public system is accessible to all residents of Portugal. To access it, you must first register with the Serviço Nacional de Saúde (SNS). Registration is done through Social Security, which will provide you with a social security identification number (NISS). You can also request a NISS online if preferred.

Once affiliated with Portuguese Social Security, you can register at your local health center. At this point, you’ll receive an identification number (utente number) and be assigned a family doctor. This doctor will be your primary point of contact and will refer you to other specialists when needed.

Consultations and care in the public system are almost free, requiring only minimal financial contribution. The main disadvantage of the public system is the often very long waiting times for routine examinations, though this varies by location. This is why many people turn to the private sector by subscribing to health insurance.

The Private Healthcare System

Many doctors in Portugal practice in both systems (public and private). Key information about the private healthcare system:

• It operates autonomously
• Unlike in France, its primary purpose is not to complement the public system
• It is a separate pathway offering faster and more personalized care
• Consultations are more expensive than in the public system (between €80 and €120 for a specialist consultation)

Choosing Between Health Plan and Health Insurance

Health Plan: Discounts on Medical Expenses In Portugal, you can choose between a health plan and private health insurance. These two options are distinct, so it’s important to understand them to make the right choice.

A health plan functions similar to a discount card. When subscribing to a health plan in Portugal, you gain access to healthcare services from partner providers at reduced prices. If you wish to use a provider outside the network, you must pay the full expense.

Advantages of health plans:

• No waiting period after subscription
• No age limit for membership
• No deductible
• Pre-existing conditions are not excluded
• No medical examinations or questionnaires required before subscribing
• More accessible to seniors or those with medical history
• Premium costs don’t increase with age

The main disadvantage is that you will be limited to the provider network offered by the health plan.

Some companies offer health plans, such as Keepwell (accessible via the Continente card). Similarly, some private hospitals, like Trofa Saúde, also offer healthcare coverage options.

Health Insurance: Expense Reimbursement Unlike health plans, health insurance reimburses you according to guarantees and amounts specified in the contract.

The cost of health insurance in Portugal depends on several criteria:

• Age
• Medical history
• Selected coverage

For medical care, you must choose from doctors who have an agreement with your insurance (the “contracted network”). When choosing a network doctor, you only pay the non-reimbursed portion (co-payment). The remainder is covered directly by your insurance.

Important Note: Some insurance policies also allow you to consult doctors outside this network. In such cases, you must first pay the total expense, then request reimbursement for the covered portion.

Health insurance is a good alternative to the public healthcare system, offering shorter waiting times for consultations and examinations. Another advantage is the ability to deduct premiums from your Portuguese income tax.

Often, health insurance is more expensive than a health plan. Additionally, its price increases with age or in cases of pre-existing conditions.

Targeting Your Healthcare Coverage Needs in Portugal

Before subscribing to health insurance in Portugal, it is essential to carefully consider your healthcare coverage needs. Key considerations should include:

Understanding Your Healthcare Requirements You should evaluate your regular medical needs, including how frequently you require dental or optical care, whether you use alternative medicine, and what level of hospitalization coverage you desire. If you have pre-existing medical conditions or are planning to have children in Portugal, it is crucial to adjust your coverage level accordingly.

The most important aspect is identifying the guarantees that will be most beneficial for your situation. It is worth noting that in Portugal, it is rare to find health insurance that fully reimburses medications. However, you can be reimbursed through the SNS (public system) with a prescription from a private doctor.

Digital Management Portuguese health insurance providers offer efficient digital management systems. Their applications are modern and intuitive, allowing all operations to be conducted remotely.

Choosing Your Healthcare Network

This is perhaps the most crucial consideration when selecting health insurance. Before signing an insurance contract in Portugal, you must verify which healthcare networks include quality practitioners in your area, as well as private clinics.

In other words, before selecting insurance, you should first determine where you plan to receive medical care. It would be unfortunate to choose a contract only to discover that the best doctor in the city is affiliated with a different network.

Major Portuguese Healthcare Networks include:

• Médis
• Allianz
• Multicare
• AdvanceCare
• Mapfre
• Saúde Prime

Determining Your Budget for Health Insurance in Portugal

To effectively select health insurance, it is essential to determine the monthly budget you can allocate to healthcare coverage. When planning your financial considerations, there are three key elements to account for:

1. Insurance Premium: The amount of your regular contribution
2. Co-payment: Expenses that remain your responsibility after insurance reimbursement
3. Deductible: Fixed amount to be paid before insurance reimbursement, depending on the type of claim

For reference, health insurance costs in Portugal typically range between €15 and €40 per person per month, varying according to the desired level of coverage.

Comparing Health Insurance Offers

Before making a final decision, it is advisable to obtain multiple quotes. When evaluating different options, the following critical factors should be compared:

• Coverage level offered
• Insurance premiums, deductibles, and co-payments
• Partner healthcare networks
• Contract renewal and termination conditions
• Coverage limits (reimbursement caps)
• Coverage exclusions (situations not covered by insurance)
• Waiting period (time between subscription and coverage effectiveness)

Understanding and Interpreting a Quote

When receiving a health insurance quote, it is crucial to thoroughly understand all terms and conditions of the contract. This involves:

• Identifying key elements of the quote, including medical coverage, deductibles, co-payment, exclusions, and general conditions
• Analyzing the proposed health coverage in detail, with particular attention to your most frequent healthcare needs
• Calculating the total insurance cost
• Understanding the contract duration, renewal conditions, and procedures for termination or modification
• Consulting with an industry professional to avoid potential pitfalls