Healthcare in Portugal for expats: the SNS, family doctors, private insurance and the S1

Since 2024 the SNS has been organised into 39 local health units (Unidades Locais de Saúde, ULS), each running the hospitals and the primary care in one area. Primary care happens at a centro de saúde (health centre), where you are seen by a family-health team: either a USF, a self-organised team with performance incentives, or a UCSP, the traditional health-centre unit. For you the difference is small: registration, rights and fees are the same.1 source

Your route into the system is the health centre for your address, or SNS 24, the national phone and online service (808 24 24 24), which triages symptoms, gives advice and refers you to the right place. Hospital specialists normally see you on a referral from your health centre. In a life-threatening emergency, call 112.2 sources

Portugal spends about 10% of its GDP on health, but only 62% of that is public money. Households pay 29% directly, about twice the EU share, mostly for medicines, dentistry and private consultations. That gap, not the quality of treatment, is what you are planning for as a newcomer.1 source

Your SNS user number (número nacional de utente) is created the first time you go to a public health centre or hospital, free of charge. If you have a Portuguese address and have applied for or obtained a residence permit, or you are an EU citizen, you can instead request your NIF, NISS and SNS numbers together at one of 12 Espaços Cidadão, with your passport and an activated Chave Móvel Digital.3 sources

The number alone does not mean the SNS pays. gov.pt is explicit that the number does not guarantee coverage: for the SNS to take on the cost, your record needs an identity document, your Portuguese NIF, your full address in Portugal and, for foreign nationals, a valid residence permit.2 sources

You do not need a NISS (social security number) to register if you are retired or not working. The register rules list the NISS as needed only 'when applicable', which in practice means when you work in Portugal.2 sources

If your residence permit is still pending, you can still be seen. Under Despacho 25360/2001, foreigners who have lived in Portugal for more than 90 days can access the SNS with a certificate from their junta de freguesia (parish council), though non-urgent care may be billed until a valid permit is on your record. Urgent and vital care, maternal and child health, vaccination and care for minors are never refused.1 source

Despacho 3118/2026, published on 11 March 2026, replaced the old register statuses. ACSS applied it in phases from July 2026 across about 20 million records. What matters is your record's status, not the number itself: only a 'registo atualizado' lets you enrol at a health centre, get a family doctor and have the SNS pay.3 sources

Foreign nationals must submit their residence permit for the record to be updated. If data is still missing after 180 days, the record becomes 'incompleto'. You are never refused care, but the cost can fall on you or on a third party such as an insurer.2 sources

The scale is large. In August 2026 the register held 1,262,426 updated records for foreign nationals, against 1,062,475 incomplete ones and 78,777 still in progress.1 source

The clean-up has had side effects. Some patients lost their medicine reimbursement at the pharmacy because their record was no longer up to date, and some health centres, for example in Oeiras, have threatened to cancel enrolment if residents waiting for AIMA to renew their permit do not show a new card within two months of expiry, a rule that is not in the despacho.2 sources

Enrolling at your health centre is not the same as having a family doctor. Under the 2026 rules you are assigned one only if three things hold: your ULS has a vacancy, your record is 'atualizado', and you have used the SNS at least once in the last five years. People with no contact for five years lose their doctor but keep their access to care.3 sources

In June 2026, 1,672,130 of 10,811,298 registered users (15.5%) had no family doctor. That is more than twice the 2019 level, though below the December 2023 peak. The July 2026 clean-up assigned a doctor to about 107,000 more people, but left more than a million without one.2 sources

Where you live decides most of this. In Lisboa e Vale do Tejo, 30% of users had no family doctor in June 2026, and in some ULS around Lisbon it was close to half. In the Norte region it was 2.4%. Wealthier people are also more likely to have one: 85% in the top income fifth against 70% in the bottom fifth.2 sources

Without a family doctor you still have SNS primary care. You can book health-centre appointments through SNS 24, and since October 2025 local agreements let private and social-sector GPs see SNS users who have no family doctor in some areas. New USF model C units contracted to private and social providers have a legal framework, but none had opened by April 2026.2 sources

Since 1 June 2022, user fees (taxas moderadoras) have been abolished across the SNS except in hospital emergency departments. Health-centre consultations, hospital specialist appointments, tests prescribed by the SNS, surgery and admissions carry no fee.2 sources

Even in the emergency department there is no fee if you were referred by the SNS (SNS 24, your health centre or the INEM emergency service) or if you are admitted. When a fee applies it is €18 at a large polyvalent emergency department, €16 at a medical-surgical one and €14 at a basic one, plus fees for tests, with a cap of €40 per episode.3 sources

Many people are exempt altogether, including pregnant women, children under 18, people with a disability of 60% or more, registered unemployed people, refugees and asylum seekers, blood donors and firefighters, and households whose average monthly income is no more than €805.70 in 2026 (1.5 times the IAS).2 sources

For a life-threatening emergency, call 112, the free European emergency number. For anything else, call SNS 24 on 808 24 24 24 first: it triages you and can refer you to your health centre, an open-access service or the emergency department, and that referral waives the fee. The clinical line runs 24 hours a day; calls cost the price of a landline call.2 sources

SNS 24 also runs a psychological counselling line staffed by about 170 psychologists, which has answered about 448,000 calls since April 2020.1 source

Public and private emergency departments use Manchester triage: a nurse gives you a colour that sets how soon you are seen. Portugal has the EU's highest use of emergency departments, so a 'green' or 'blue' case can wait hours at a busy hospital. Drive times to the nearest departments are under 15 minutes on the urban coast but approach an hour inland.2 sources

Private hospitals run their own emergency services, which you pay at the desk or through insurance. Network prices for an urgent general consultation averaged €65.41 nationally in 2024, and Médis, for example, charges its members a €50 co-payment per emergency visit.2 sources

The law sets maximum guaranteed response times (tempos máximos de resposta garantidos, TMRG). For a normal-priority referral the maximum is 120 days for a first hospital consultation and 180 days for scheduled surgery, with shorter limits for priority cases, cancer and heart surgery.1 source

The SNS often misses them. In the second half of 2025, 51.4% of first specialist consultations in public hospitals took place after the legal maximum, with a median wait of 114 days, and 86.4% of first cardiology consultations were late. On 31 December 2025, 1,099,094 people were waiting for a first hospital consultation.1 source

Surgery does better once you are on the list. Only 13.2% of scheduled operations in public hospitals (excluding cancer and heart surgery) happened after the maximum, with a median wait of 51.6 days. In July 2026, 69.5% of the 284,210 people on the surgical waiting list were still within the limit. For hip fractures in people over 65, 54.7% were operated on within 48 hours between January and July 2026.3 sources

Waiting lists are the main reason people buy private insurance: 43% of policyholders cite difficulty accessing the SNS and 25% want shorter waits. Unmet needs because of waiting lists tripled between 2014 and 2024.1 source

Prescribed medicines are reimbursed at the pharmacy according to their tier: the state pays 90% for tier A, 69% for B, 37% for C and 15% for D. Exceptional regimes pay more for some conditions and groups.1 source

Where a generic exists, the state's share is calculated on the group's reference price, so if you choose a dearer brand you pay the difference. Pensioners whose annual income is no more than 14 times the previous year's minimum wage get 95% on tier B, C and D medicines priced at or below the fifth-cheapest in their group.1 source

A prescription from a doctor in another EU country is valid in Portugal if it has your name and date of birth, the date, the doctor's details and signature, and the medicine's common name, form, strength, quantity and dose. For prescriptions from the US, UK or elsewhere, plan to get a Portuguese one from a GP.1 source

Infarmed, the medicines regulator, says importing medicines for personal use has no legal basis, and travellers who bring their own should carry copies of their prescriptions or a doctor's letter listing what they take. For controlled medicines such as strong painkillers or ADHD stimulants, ask Infarmed before you travel.1 source

Most dentistry is outside the SNS. The cheque-dentista scheme gives €45 vouchers to children aged 2 to 18, pregnant women (three per pregnancy), recipients of the Complemento Solidário para Idosos pension supplement and people with HIV. More than 15% of adults needing dental care went without it in 2024 because of cost, distance or waiting.2 sources

A cheque-prótese for dentures is due to start on 1 January 2027 for financially vulnerable SNS users, pending regulations that will set its value. Most expats are in none of the eligible groups, so budget for a private dentist: network prices in Lisbon in 2024 were about €24 for a scale and €26 for a one-surface filling.2 sources

Pregnancy and childbirth are covered by the SNS without fees, and pregnant women and children are exempt from emergency fees. Maternal and child health, vaccination and care for minors are provided to everyone, whatever their immigration status. A private birth without insurance cost about €2,975 for a normal delivery and €4,208 for an elective caesarean at Lisbon network prices in 2024, and insurers usually impose a 365-day waiting period for childbirth.6 sources

For mental health, SNS 24's psychological counselling line is the free entry point, and health centres can refer you to psychology and psychiatry. Private policies cover it unevenly: Médis applies a 60-day waiting period to psychology and psychiatry consultations, and Multicare 60+ excludes psychology and psychotherapy sessions.3 sources

EU, EEA and Swiss visitors are covered for necessary care with the European Health Insurance Card, but once you live in Portugal you register with the SNS as a resident. A Portuguese EHIC then needs your legal residence and registration with the SNS and Social Security.2 sources

UK nationals who live in Portugal cannot use a UK-issued EHIC or GHIC, unless they are students, UK state pensioners with a registered S1, or frontier workers. UK state pensioners can apply to the NHS Business Services Authority for an S1 up to 90 days before moving. Register it at a Segurança Social office, then at your health centre: the UK then pays for your SNS care, and you get a UK GHIC for trips to other EU countries. An S1 does not cover private care.3 sources

Medicare does not cover you in Portugal: outside the US it pays only in three narrow hospital situations. Some Medigap plans pay 80% of emergency care abroad after a $250 deductible, but only during the first 60 days of a trip and up to a $50,000 lifetime limit, which is no substitute for SNS registration or proper cover.1 source

Brazilians can ask their Ministry of Health for the CDAM, known as the PB4, which lets them be treated in Portugal's public network like local residents under the two countries' agreement. The Portuguese consulates accept it instead of travel insurance for a residence visa.2 sources

For residence visas such as the D7 and D8, the consulate asks for valid travel insurance covering necessary medical expenses, including urgent medical assistance and possible repatriation. Brazilians with the PB4 and UK nationals with an S1 can use those instead, and CPLP citizens are exempt.2 sources

No minimum amount is stated for national visas. The €30,000 minimum often quoted online is the rule for short-stay Schengen visas, not for residence visas. Nothing on the consulate pages requires a Portuguese insurer, so ask your insurer to state in writing the amount covered, that it is valid in Portugal, the dates, and that repatriation is included.2 sources

We found no official AIMA rule requiring private health insurance at the residence-permit stage for most categories; the foreigners law mentions health insurance 'or equivalent' only for some, such as students and researchers. Once you have your card, the SNS is your cover.2 sources

In 2024, 4,060,378 people in Portugal had health insurance, the first time the number passed four million, and about half of policies are provided by employers. The average premium was €417.84 per insured person a year, up 14.8% in a year. Insurers still paid only 5.3% of the country's health spending.2 sources

Portuguese policies are built from a few parts: an annual limit (capital) for each type of cover, a co-payment you pay at each visit, sometimes an excess before cover starts, waiting periods (carências) before each cover begins, and a network of private hospitals and clinics where prices are agreed. Outside the network you pay and claim back a percentage.3 sources

Waiting periods are long. Médis applies 60 days for outpatient care, 90 for hospital stays and 365 for childbirth. Multicare 60+ applies 180 days for hospital stays and 360 days for listed operations such as cataracts. Allianz applies 365 days to a long list of operations, including joint replacements and cataracts.3 sources

In June 2025 the insurance regulator, ASF, published a voluntary standard policy so that buyers can compare like with like: €30,000 of hospital cover with a 10% co-payment, €1,000 of outpatient cover with a €10 consultation co-payment, and €300,000 for serious illnesses. Dentistry, prostheses and medicines are excluded, and each insurer sets its own price.1 source

Age is the hard limit. Médis Vintage accepts new members from 55 to 75, Multicare 60+ from 61 to 70, UNA's senior range from 55 to 74, and Allianz's main policy up to 65. Once you are in, the senior products have no upper age for staying. We found no verified product that accepts a new member at 77.4 sources

Cheap senior policies are cheap because their limits are low. In DECO PROteste's 2024 survey, policies costing about €500 a year at 70 paid at most €2,500 to €5,000 a year for hospital stays, while the ones with €200,000 of hospital cover cost €2,373 to €4,070 at 70.1 source

Pre-existing conditions are excluded by Multicare 60+ and Allianz. Médis says pre-existing conditions are considered under Vintage and a chronic illness does not stop you joining; ask how yours would be treated. Read the exclusions and the hospital limit before you compare premiums.3 sources

Private care in Portugal is affordable by Western European standards. Network prices agreed by insurers and mutual societies averaged about €40 for a GP or specialist consultation in Lisbon in 2024. Walk-in list prices are higher: in 2026, private hospitals in Viana do Castelo and Paredes charged €45 to €65 for a GP and about €65 to €80 for most specialists.3 sources

The largest private groups in the Lisbon area do not publish walk-in prices, so ask for a quote before a test or procedure, and ask whether your insurer or a discount network has an agreed price.1 source

On outcomes, Portugal does well. Life expectancy at birth was 82.7 years in 2024 (85.4 for women, 79.8 for men), a year above the EU average though below Spain and Italy. Deaths from preventable and treatable causes are 17% below the EU average, and avoidable hospital admissions are among the lowest in Europe.1 source

The weak points are access and cost. In 2024, 4% of adults who needed medical care and more than 15% who needed dental care went without it, both above the EU average. In 2022, 7.5% of households faced catastrophic health spending, against 6.4% across the EU.1 source

Our country comparison guide sets Portugal's health figures against the EU, UK, US, Australia and Brazil.2 sources

The steps below, in this order, cover most of what goes wrong for newcomers.3 sources