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Happy Sunday, expat family 🌞
In today’s newsletter, I’m reflecting on the healthcare journey we’ve been on since arriving in Portugal and sharing the lessons we’ve learned along the way. We’ve had more than our fair share of close encounters with the public health system, and I know many of you are navigating the same questions.
So I’ve pulled together the 10 healthcare questions that come up most often in expat communities, along with the answers other expats consistently rate as the most helpful, and added our own lived experience where it felt useful.
And to balance things out, we’re diving into another Portuguese language lesson with our wonderful tutor, Mia Esmeriz.
So grab a coffee, get comfortable, and let’s dive in, shall we?
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📷 Pic of the week
Detrelo da Malhada, Arouca UNESCO Global Geopark. Photo Credit: Arouca Geopark
Detrelo da Malhada is a circular lookout platform perched on the northern slope of the Serra da Freita in the Arouca UNESCO Global Geopark, where you can see all the way from the Arouca valley and its monastery up to distant mountain ranges like Marão and Peneda‑Gerês on clear days. Geologically it sits on steep, vertically standing spotted schists that form natural “walls” above the valley carved into softer quartz‑diorite, so the view literally reads like a cross‑section of Portugal’s tectonic history, and the spot has become iconic enough to anchor a 12 km hiking loop and several hardcore trail‑running races with names like “Filhos da Freita” and “Ultra Trail da Serra da Freita.”
📰 Featured Expert Insight
US expats in Portugal, this one’s for you. This short slide deck explains why standard US tax-loss harvesting advice doesn’t always apply here, and how timing your moves incorrectly could cost you years of potential tax benefits. A smart, fast read before you make any year-end decisions. Click the image above to go straight to the slides, alternatively click HERE.
🩺 Healthcare in Portugal - TOP 10 MOST FREQUENTLY ASKED QUESTIONS
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Let’s talk about healthcare in Portugal.
Not the glossy brochure version and definitly not the “Europe has free healthcare” fantasy. The real version. The one you only start to understand once you have a bladder infection on a public holiday, a husband in ER with a malfunctioning VP shunt, or waiting 6 months for an appointment with a specialist through the public health system. Ask me how I know these things.
Over time, I’ve noticed a steady stream of healthcare questions from readers and fellow expats that haven’t been fully covered in the articles we’ve already shared. So today’s newsletter focuses on those exact questions. The ones you and other expats keep asking. I’ve gathered the top 10 most common concerns and paired them with the answers that expat communities consistently vote as the most helpful, adding a bit of real-life context where it felt useful.
If you are new here, thinking of moving, or already living in Portugal and quietly wondering if you are doing this healthcare thing wrong, this one is for you.
This article is built on hundreds of real conversations in expat Reddit threads and Facebook groups, where the same healthcare questions come up again and again. These are the top 10 concerns, ranked by what gets asked most and voted most helpful by other expats living in Portugal. I’ve pulled together the most consistent, highly rated answers and added my own lived experience where it helps add context or clarity.
Let’s get into it.
1. Public vs Private Healthcare - Which Should I Choose?
The Question (Most Upvoted): "Public vs. private healthcare—can newcomers realistically rely on Portugal's SNS for day-to-day care, or is private the only realistic route?"
Top Answer (15 upvotes): "If you can afford insurance, then get insurance. The public system lacks resources which can cause delays in treatment. Newcomers can also have a hard time getting registered for care.
Key Insights:
Hybrid approach recommended: Use SNS for serious emergencies and hospital care, private for routine consultations
Waiting times: Public system can have 2+ week waits for urgent cases, private offers same-day appointments
Quality comparison: Private isn't necessarily better clinically, just faster and more comfortable
Cost factor: Private consultations €50-150 vs (frequently) free public consultations
Do I Really Need Private Insurance?
Short answer. Yes.
Longer answer. Yes, but not instead of public healthcare.
Most expats end up with a hybrid setup. You use the public system for emergencies and serious hospital care, and private healthcare for day to day life.
Waiting weeks or months for a GP or specialist appointment is common. Getting registered can take time. Being assigned a family doctor can take even longer. And unless your Portuguese is solid, things can feel confusing fast.
Private healthcare, on the other hand, is faster, easier, and more expat friendly. Same day appointments are common. English is widely spoken.
Private is not necessarily bettet, it’s just quicker and calmer.
Our experience:
My husband has been through the public emergency system twice, and both visits resulted in emergency surgery. While the hospitals were clean and clinically efficient, the public system is heavily stretched and waiting times can be painful. We struggled with the language barrier to the point where I was in tears. For non-urgent, scheduled appointments with specialists, which require a referral from a family doctor, our waiting times have been between six and eight months.
2. What Private Health Insurance Should I Get?
Most Recommended Companies by Expats:
MGEN - Covers pre-existing conditions (rare in Portugal)
Multicare - Most common, good network coverage
Médis - Premium option with comprehensive coverage
AdvanceCare - Good value for money
Allianz - Popular through AFPOP association
Cost Range: €30-150/month depending on age and coverage level
Most expats choose private insurance because it gives peace of mind, speed, and access. Not because it replaces the public system entirely.
Our experience:
We’ve taken out insurance through a few different providers and have yet to find one that fully covered the care Wayne needed for his pre-existing conditions. We often ran into limits around what was included and what we had to pay for out of pocket. If you have a complex or pre-existing condition, I would strongly recommend speaking to a medical concierge, such as Serenity Portugal, to help you find coverage that genuinely suits your needs.
3. How Do I Register for Public Healthcare (SNS)?
Main Challenge: "Newcomers can have a hard time getting registered for care. Need to speak some Portuguese to interact with staff; long waiting times; difficulty getting GP."
Process:
1. Get residency permit first
2. Visit local Centro de Saúde with documents
3. Apply for Utente (SNS) number
4. May need Portuguese speaker to help
5. Can take months to assign family doctor
You can and should register for the SNS once you have residency.
You will need to go to your local health centre with your documents and apply for an SNS number, also known as a Número de Utente.
PRO TIP:
You can now apply for your NIF (Tax ID), NISS (Social Security), and SNS Utente (Health Number) in one appointment. Look for the Espaços Cidadão (Citizen Spaces) in major cities like Lisbon, Porto, Faro, or Cascais, which offer integrated services.
A few honest truths:
It may take multiple visits
You may be told to come back later
You may not get a family doctor for months
Portuguese helps. A lot
Despite the frustration, it is worth doing. The SNS is essential for emergencies, major procedures, and long term care.
Our experience:
When we first arrived, we applied for our SNS numbers (Número de Utente) shortly after receiving our residency cards and then requested a family doctor. We were warned that, due to a shortage of family doctors in our area and long waiting lists, it could take months before we were assigned one. It did. Eventually, though, we received confirmation that a family doctor had been assigned to us.
Now, nearly two years later, we truly understand the value of having one. During my husband’s recent health challenges, our family doctor was able to prescribe the medication and X-rays he needed and refer him to specialists who could analyse his condition and provide further care. It has been a huge benefit.
4. What Are the Best Hospitals for Expats?
Well-regarded private hospitals with English-speaking staff:
Hospital da Luz (Lisbon)
CUF Descobertas (Lisbon)
Hospital Lusíadas (Lisbon)
Hospital CUF Porto
Hospital Particular do Algarve
These hospitals are frequently mentioned for efficiency, modern facilities, and expat-friendly services.
5. How Much Does Healthcare Cost Compared to the USA?
Common comparison shared by expats:
“Healthcare in Portugal is significantly cheaper than in the United States, even when using private insurance.”
This is where most Americans, in particular, breathe a huge sigh of relief. Compared to the US, healthcare in Portugal is dramatically cheaper.
Very roughly:
Private insurance: €400 to €1,000 per year
Private GP visit: €50 to €80
Specialist visit: €90 to €150
MRI: €250 to €500
Public appointments, when available, cost only a few euros (if anything!)
6. What About Dental Care?
Reality:
Dental care in Portugal is almost entirely private and not usually included in basic health insurance.
Typical prices:
Check-up: €20–€40
Cleaning: €25+
Extraction: €40+
Implants: from €400
Braces: €800–€3,500
Despite being private, dental care quality is considered high and good value compared to many countries.
Our experience:
Dentistry is expensive here compared to South Africa. One of the main local franchise dental clinics in Portugal would not treat my husband’s toothache as a once-off issue and instead insisted on a full treatment plan, with a quotation running into several thousand euros. When my daughter later needed a series of treatments, they did allow us to treat one tooth at a time, which was far gentler on our budget. Our biggest takeaway has been to ask locals where they go for dental care.
7. What Are Waiting Times Like?
Public system (SNS):
GP appointment: weeks to months
Specialist referral: months
Non-urgent surgery: 6 months or longer
Emergency care: immediate for life-threatening situations
Private system:
GP or specialist: same day to one week
Diagnostic tests: 1–3 days
Elective procedures: 1–4 weeks
Public system waiting times can test even the most patient among us.
Weeks or months for GP or specialist appointments is not unusual. Non-urgent surgery can take much longer.
Private healthcare flips this completely. Same week, sometimes same day, is normal.
This is why so many expats combine both systems instead of choosing one.
8. What Mental Health Services Are Available?
Public system:
Limited access to therapy
Focused mainly on psychiatric care rather than talk therapy
Long waiting times
Private system:
Therapy sessions: €50–€115
Psychiatric consultations: €80–€150
English-speaking therapists widely available in Lisbon and Porto
Several clinics specialise in expat mental health support
Mental health support in the public system is limited, especially when it comes to talk therapy.
Most expats use private therapists, particularly in Lisbon and Porto, where English-speaking professionals are widely available.
Expect to pay between €50 and €115 per session.
Given how emotionally demanding relocation can be, this is one area many expats say they underestimated.
9. What About Prescription Medications?
Medications are categorised and subsidised under the public system
Subsidies typically range from 10% to 90%
Private insurance coverage for medication varies widely
Common prescription costs with subsidy usually range from €5 to €50
Medications in Portugal are subsidised through the public system. Depending on the medication, you may receive significant discounts.
Even without insurance, many common prescriptions remain affordable compared to other countries.
Private insurance coverage for medication varies, so it is worth checking your policy.
Our experience:
Once you have an SNS number (Número de Utente), you can call the SNS 24 helpline and, once they answer, request a teleconsultation. The service operates in Portuguese, but I was fortunate to have a telephone consultation with a doctor who kindly assisted me in English. She prescribed an antibiotic for a severe bladder infection, and the consultation itself was free. After government subsidies, the prescription cost came to under €5.
10. What Do I Need for Visa or Residency Requirements?
Common requirements for residency visas (e.g. D7):
Travel insurance with sufficient coverage for the initial visa phase
Portuguese private health insurance for residency appointments
Travel insurance is not accepted for renewals
Long-term residents must have Portuguese-based health insurance
For visas like the D7, you usually start with travel insurance.
Once you move into residency, you must have Portuguese private health insurance. Travel insurance will not be accepted long term.
This catches people out every year, so plan ahead.
🩺
EMERGING TRENDS AND CONCERNS (2024–2025)
Healthcare System Strain
Staff shortages affecting public hospitals
Temporary emergency department closures in some regions
Longer waiting times in the public system
Emigration of healthcare professionals contributing to gaps
Quality and Outcomes
Portugal ranks well in European healthcare comparisons
Life expectancy remains high
Healthcare spending is significantly lower than in countries like the USA, with comparable or better outcomes
Expat Sentiment
High satisfaction with private healthcare
Ongoing frustration with public system bureaucracy
Language barriers remain a major issue
The hybrid public-private approach is the most popular solution
PRACTICAL TIPS FROM EXPERIENCED EXPATS
Start with private health insurance
Register for SNS even if you use private care
Learn basic Portuguese medical vocabulary
Ask expat groups for English-speaking doctor recommendations
Consider medical concierge services if struggling with bureaucracy
Maintain valid travel insurance during the visa process
Budget separately for dental care
Keep personal copies of all medical records
Accept that bureaucracy is part of the deal
🩺
If I can leave you with one wish as you navigate healthcare here, it is a simple one. May the force be with you. 🖖
Your experiences matter. If you’d like to contribute to one of our recent surveys on healthcare in Portugal, I’d really appreciate it. The survey takes just two minutes and can be found here.
🗣 Lost in Lingo - Mini Lessons by Mia Esmeriz
In this reel, Mia shares some traditional Christmas dishes in Portugal. You have for example:
🐟 Bacalhau cozido – salted cod with vegetables, eaten on Christmas Eve
🍗 Peru assado – roasted turkey
If you're spending Christmas in Portugal, these are the dishes you’ll hear everyone talk about!
🗣 For more everyday Portuguese tips, Mia offers a free starter course to help you learn the basics of the language.
💡 Mia from Mia Esmeriz Academy is a Portuguese teacher from Porto with more than 15 years of experience teaching foreigners. She helps expats become fluent in Portuguese in a clear and practical way. Alongside her courses, she also shares free content on Instagram, Facebook, and TikTok.
…And That’s All Folks
Thanks for reading! 💌
Hustle on!
Angelique🧞♀️
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