Yes! With private health insurance in Portugal, you can go directly to a specialist without needing a referral from a general practitioner. Unlike the public healthcare system, where you typically need a referral to see a specialist, private health insurance gives you the flexibility to book appointments directly, ensuring faster access to the medical care you need.

Pre-existing conditions refer to health issues that existed before an individual takes out a health insurance policy. These conditions may include chronic illnesses, like diabetes or hypertension, or specific health issues, such as previous surgeries or diagnosed mental health conditions. In practice, a pre-existing condition may limit or even exclude coverage for treatments and consultations related to that condition.

Read more about it: Pre-existing Conditions in Health Insurance: What You Need to Know

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If you are thinking about taking a health insurance in Portugal, you will be confronted with these two options. Because the differences are not always clear, it’s important to understand the basic differences between health insurance and health plans.

The first thing to bear in mind is that a health plan is not an insurance, neither health nor any other kind of insurance. Therefore, health plans are not subject to the supervision of the Portuguese Insurance and Pensions Supervisory Authority (ASF) on insurance matters. The companies that offer this type of “health plan” can operate freely without having to obey the ASF rules, which leaves the way clear for certain irregularities… On the contrary, the insurance companies that sell health insurance must comply with the strict control of the ASF and the respective Portuguese and European rules and laws.

Unfortunately, the situation is a little confusing for consumers, as it is common to see and hear in the media in Portugal, advertisements and (misleading) publicity about these health plans. It’s easy to confuse the products and think that we’re being offered health insurance, but it’s a health plan.

Also, on the Internet and specifically on social media, there are several advertisements promoting “health plans” that are sold as health insurance, confusing the most incautious consumer, who ends up buying “a pig in a poke”. We will now explain the difference between a health plan and a health insurance in Portugal:

What is a Health Plan?

A health plan is not a health insurance, in fact, it is a discount scheme. By joining a health plan, the customer has access to medical care (consultations, treatments, examinations) at a lower price than under normal circumstances.

The amount of the discount varies, and he can only use doctors and clinics from the agreed network and that belong to the provider’s centres.

In other words, the consumer is not free to choose the doctors he or she wants and is often limited to only one specialist in a given region. There is no reimbursement for services outside the provider’s own centres.

The system for paying for a health plan is through a reduced monthly fee, which allows the client to benefit from these discounts.

The company providing these health plans can terminate the contract with the client at any time, since it is not insurance and therefore not subject to Portuguese insurance legislation.

What is health insurance?

Health insurance allows you to benefit from medical services such as consultations, exams, operations or hospitalisation as a private patient in private clinics and medical centres.

These services are reimbursed in two ways: through a free choice of doctor and a system of reimbursement to the client or through direct billing by chip card in the centres and clinics with which the insurance company has a contract.

Depending on the type of health insurance you have contracted, the co-payment system may or may not apply (reduced amounts that you have to pay each time you use the card)

In the free choice of doctor system, maximum limits may apply in the inpatient or outpatient area, these can vary between 150,000 euros and 2,000,000 euros.

Looking for a Health Insurance in Portugal? Get a quote today!

No, with private health insurance in Portugal, you can book an appointment directly with a specialist without needing a referral from a general practitioner. This gives you more flexibility and faster access to specialized medical care.

Let’s look at the advantages and disadvantages of these two systems

Advantages of Health Plans in Portugal:

• They are suitable as a Supplement – never as the sole option for looking after your health especially if you are a foreign resident without Social Security benefits.
  • If you are entitled to medical care through Social Security (public system), another system (ADSE, etc.) or a medical insurance, a health plan may make sense.
  • However, health plans are completely inadequate as a single system as they are not subject to any legislation, have many exclusions, can be cancelled by the insurer and is a pure discount system.
• They are inexpensive – Evidently, the premiums are much less than those of a health insurance. You can contract a health plan from 17 euros per month, but you cannot expect the covers or benefits of a full health insurance.
• They can be taken out at any age – There is no age limit for hiring and this is an obvious advantage if you compare it to health insurance.
  • They can be a good option for people who can no longer afford health insurance due to their age or who cannot afford the higher premiums.
• No waiting periods and no exclusions: Health plans have no waiting periods (you can start using the discount systems immediately) and no exclusions for pre-existing illnesses or medical conditions.

Disadvantages of Health Plans in Portugal

• They offer limited services – There is no greater inconvenience than needing a specialist and he/she does not exist in the medical chart of the health plan. The plans offer a limited range of medical centres, and no reimbursements are available if the medical services, examinations, or treatments take place outside the agreed network.
• No free choice of doctor – As the reimbursement system is not available, the patient will not be able to choose the clinic, specialist or centre suitable for his/her examination or treatment but will have to abide by the framework of specialists and centres offered by the health plan in Portugal.
• Product not regulated by the ASF – This opens the way to various irregularities that appear when the patient needs to use the health plan and does not have the supervision of the ASF nor the backing of the legislation. For example, imagine you are diagnosed with a serious and chronic illness, now that you are going to start using the health plan frequently, that company decides to notify you that they want to cancel the contract.

Advantages of Health insurance:

• Free choice of doctors and clinics – With the reimbursement system, the patient has a variety of choice in terms of medical centres and clinics, specialists, both in Portugal and abroad.
• Medicines included – Some Health Insurances offer reimbursement of medicines and also prosthesis, glasses, etc.
• They are regulated products – Insurance companies must comply with the legislation and rules of the regulatory authority (ASF) and cannot, for example, cancel the contract to patients whenever they wish, here the consumer has rights that are vehemently fulfilled.

Disadvantages of Health Insurance:

• Exclusions – Health insurance in Portugal has certain exclusions, for example occupational diseases and accidents at work. These are covered by the compulsory occupational accident insurance.
• Exclusion of Pre-existing Diseases – Pre-existing diseases and the patient’s medical history must be declared at the time of contracting and may result in exclusions from the contract or rejection of the policy.
• Waiting periods – You will have to wait a certain period before you can use certain insurance benefits. For example, to have heart surgery you will have to wait
• Has Age limits for admission – Normally you cannot take up health insurance from the age of 65, which is a big problem for elderly patients who want to take up this product.
• Unaffordable prices – As the age of the patient advances, the value of health insurance premiums will also increase, which can be tricky for people on tight budgets.

Looking for a Health Insurance in Portugal? Get a quote today!

There are several Insurance Companies operating in Portugal offering health insurance products and health plans. Some companies are “local” companies, others belong to big international groups. We only recommend to take out  your health insurance only with companies with a solid reputation, like:

• Allianz Health Insurance in Portugal
• Cigna Global Health Insurance in Portugal
• Multicare – Fidelidade – Health Insurance in Portugal
• Victoria – Future Healthcare
• Médis – Health Insurance in Portugal

All of this companies offer different products with several levels of cover, copayments, reimbursement systems and inpatient and outpatient limits. It’s very important to put your health in the hand of a broker specialist in studying and comparing all this products to help you choose the right solution for you.

Looking for a Health Insurance in Portugal? Get a quote today!

Health insurance in Portugal can be purchased from major international and local private insurers.

Health insurance quotes vary wildly depending on the level of coverage, age, co-payments or reimbursement system, free choice of doctors or clinics or only service trough connected network. To get you an accurate quote, depending of your age and pre-existing illnesses you may have to fill a health questionnaire.

One of the most important details you must pay attention when taking out a health insurance in Portugal, are any clauses giving insurers the right to cancel or increase your rates once you reach a certain age.

At C1 Broker, specialists in health insurance, we compare private health insurance products on your behalf.

Health insurance can be a great way to protect yourself from the unforeseen. Some people might not have any medical needs but want preventative care in case something does happen, while others will use it just like anyone else with active lifestyles who likes staying on top of their health! Health insurances come at different levels and prices depending on what you need so make sure that whatever level is best for YOUR situation comes out ahead when choosing an option.

Always remember: if there’s anything about healthcare insurance we’ve learned over these few years then its “buy early save often”.

Expats and foreign residents in Portugal should consider medical insurance after they arrive. At C1 Broker, we offer the best solutions to help you find exactly what your needs are with our diverse selection of products from top providers like Cigna, Allianz or Multicare.

When taking out a health insurance policy in Portugal you should take into account the waiting periods. Waiting periods are periods of time when you cannot use your insurance completely. Specifically, you can only use certain services and covers of your health insurance after a certain number of days or months have passed.

• Most health insurances operating in Portugal have similar waiting periods. For example, to carry out treatments that require hospitalisation and surgery, the waiting period is one year. To activate the Medicines and Stomatology coverage, on the other hand, it would only be three months.
• Insurance companies establish these waiting periods to prevent clients from taking out insurance with a view to using an expensive treatment (for example: having surgery) and then cancelling the policy once they have been treated and recovered from the pathology.

If you have only recently taken out a health insurance policy, you should check the contract conditions of your insurance policy to confirm the waiting periods and avoid unpleasant surprises.

Read our article: Waiting Periods in Health Insurance Portugal: What You Need to Know for the Best Coverage

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If you already have health insurance and you want to change company or coverage plan, you don’t necessarily have to start from scratch with waiting periods. Talk to your broker to help you negotiate these conditions with the insurance company.

We, at C1 Broker, always take waiting periods into consideration when advising and taking out a new health policy and like to explain to our clients the different coverages between insurance companies.

Ask us for a personalised simulation for your health insurance!

If you really need to use a specific service (for example, you have had a heart attack and urgently need hospitalisation) be aware that some insurances foresee this situation and do not apply waiting periods in the case of a serious and vital emergency, or in the case of a simpler pathology, you can use the treatments provided by the insurance network itself. Again, ask your insurance broker what would be the most viable solution in your case.

For example, the waiting periods for Allianz Health products are as follows:

• Hospitalisation and Surgery = 365-day grace period. This includes the following treatments and surgical interventions:
  • Childbirth, caesarean section or involuntary termination of pregnancy (if contracted for Childbirth cover)
  • Treatment of arterial or venous pathology of the lower limbs; medical, surgical or other treatment in the diagnosis of herniated discs , abdominal wall or others
  • Medical, surgical or lithotripsy treatment of kidney, urinary tract, gall bladder and/or biliary tract stones
  • Treatment of proctological pathology such as haemorrhoids, fistulas, anal and perianal sphincter pathology fissures
  • Medical or surgical treatment of gastro-oesophago-duodenal pathology;
  • Non-conservative treatment of gynaecological and benign endocrine pathology* (namely pituitary, thyroid, parathyroid, breast, pancreas, adrenal and ovaries);
  • surgical intervention to ears, nose and throat
    for benign pathology;
  • Treatment of joint pathology by arthroscopy, arthrotomy or arthoplasty;
  • Surgical treatment or by another invasive method of benign prostate pathology.
    Cataract Surgery.
  • Other cases of Hospitalization and Surgery 90 days
  • Oncology 180 days
  • Daily Allowance for Hospitalisation 90 or 365 days
  • Outpatient Care 90 days
  • Prostheses and Orthotics 180 days
  • International Medical Cover 180 days
  • Drugs and Stomatology 90 days. 

Important Note – This list of waiting periods is merely an example. You should check the conditions of your contract to see which waiting periods apply to your health policy.

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The insurance companies that operate in the field of health insurance in Portugal set maximum ages for contracting full medical insurance. The maximum age is 65, and from the age of 60 there are already some limitations and the insurers ask for a series of previous medical check-ups to analyse the patient’s state of health.

After the age of 65, the choice of health insurance in Portugal is drastically reduced to two or three international companies that offer this service, but with premiums of around 600 euros per month. If your budget allows this monthly investment, the medical protection solutions are really extraordinary and worthwhile. In case you cannot afford it, the other option is to contract a health plan.

Health plans in Portugal are not full insurance (we recommend reading our article where we explain the difference between health plans and health insurance in Portugal) but they offer a system of access to private doctors and clinics that belong to the insurer’s network at pre-agreed prices. Prices range from 30 to 70 euros per month and provide access to basic consultations and treatment.

Ask us for a personalised simulation for your health insurance! 

Negotiated rates are the prices previously agreed upon between the insurance company and its network of healthcare providers, including doctors, clinics, and hospitals. These rates are often 20-30% lower than the standard prices charged directly by providers. This means that policyholders can access healthcare at reduced prices by using these providers. Read more: Understanding Negotiated Rates in Health Insurance: How They Work and Their Benefits for Expats in Portugal

Don’t Confuse Negotiated Rates with Copayments and Deductibles

It’s important not to confuse negotiated rates with copayments and deductibles.

• Negotiated rates represent the reduced price agreed upon with the healthcare provider. 
• Copayments are the portion of the bill that the policyholder pays directly to the provider, as per the policy terms. 
• Deductibles are the initial costs that a policyholder must pay before the insurance coverage kicks in.

Ask us for a personalised simulation for your health insurance! 

Mutualism-based health insurances are not recommended because, although they offer low prices initially, they come with several drawbacks.

They operate on a collective system where health costs are shared among members. This can lead to premium increases if there are many claims in the region, and in some cases, the insurance may even be canceled.

Additionally, these insurances usually require the whole family to be insured, which can result in hidden costs and less personalized coverage. These plans also tend to offer less flexibility and may impose restrictions on people with pre-existing conditions by charging high premiums and setting unfavorable terms.

Read More: Why Trusting Your Health Insurance to a Mutualism System May Lead to Regret

The COVID-19 pandemic has left many people separated from loved ones and without family in their home countries. As an expat, it can be difficult to find critical information about coronavirus infection rates or vaccination availability since there is so much uncertainty.

• The Portuguese government has created an informative website about coronavirus symptoms, treatment options, vaccination schedules and locations and more, visit the SNS Coronavirus (COVID-19) website.
• Visit the Portuguese government’s Coronavirus (COVID-19) website for official measures, rules and restrictions on this virus.
• For information about Covid’s Passport visit  Certificado Digital.

At C1 Broker, we offer the best solutions to help you find exactly what your needs are with our diverse selection of Health Insurance products from top providers like Cigna, Allianz or Multicare.

A deductible is the amount of money you pay out-of-pocket for healthcare services before your insurance starts covering the costs. Think of it as your share of medical expenses. Health insurance plans typically require you to meet your deductible each policy year before they start paying for your covered services.

For example, if your deductible is €500, you will pay the first €500 of medical costs (such as doctor’s visits, hospital stays, or medical procedures) out of your own pocket. Once you meet that deductible, your insurance plan will begin to cover the remaining costs, usually with a co-payment or co-insurance.

While deductibles are a common feature in health insurance, they can vary greatly depending on your insurer and the specific plan you choose. Some plans may have low deductibles but higher premiums, while others offer high deductibles with lower premiums. Understanding how these work can help you select the plan that best suits your needs and financial situation. Read more:  The Impact of Deductibles on Your Health Insurance in Portugal

Don’t Confuse Negotiated Rates with Copayments and Deductibles

It’s important not to confuse negotiated rates with copayments and deductibles.

• Negotiated rates represent the reduced price agreed upon with the healthcare provider. 
• Copayments are the portion of the bill that the policyholder pays directly to the provider, as per the policy terms. 
• Deductibles are the initial costs that a policyholder must pay before the insurance coverage kicks in.

Ask us for a personalised simulation for your health insurance!