Sleepless nights. Many sleepless nights…
Anxiety about the costs of quality health care led to sleepless nights as I approached 70. My husband Jeff and I lived in northern California. I feared I could not afford to stop working. If a catastrophic health issue arrived, would escalating costs bankrupt us?
Can you relate to the merry-go-round I was riding?
Forty years prior, I set my retirement sights on living in Portugal. I had returned to the U.S. from a business trip in Lisbon and the Algarve.
Jeff and I agreed… we needed to do our homework, research the costs, and visit Portugal to experience life there first-hand… live like a local.
What did we learn? We discovered Portugal has a world-class, dual health care system. We’ll share a few of our findings…
Part of the dual health care system is the universal, state-funded public health care or national health called SNS (Serviço Nacional de Saúde). The SNS provides affordable (in many instances, free) medical care for all citizens and legal residents. SNS guarantees all basic health—accidents and illness—is covered.
The other part of Portugal’s dual health care system is private health care. It’s a parallel system offering faster access to doctors and hospitals. Private health features shorter wait times. Citizens and residents access care using out-of-pocket payments or private insurance.
Portugal’s health system is ranked highly among the best in the world.
Portugal’s hospital network offers modern, well-equipped units, and at least 90% of all doctors are English-speaking. Specialty consultations at a public hospital will cost you about €8 and emergencies about €20.
Non-EU citizens are required to have private health insurance for visa entry and residency applications in Portugal.
After obtaining residency with the immigration service (AIMA), you then register with your local SNS health center to access public health care.
SNS prescriptions are discounted uniformly at all pharmacies throughout the country. You don’t have to shop around for better prices.
Some prescription medicines are available over the counter and are significantly less expensive than in the U.S.
Private health insurance is offered by banks and private health groups.
“Show me the numbers,” you probably are asking. We can accommodate that request…
In 2019 residing in California, Jeff and I paid over $12,000 a year for health insurance (salary deductions plus co-pays). I’m told that figure today can reach $19,000 a year for an individual. Our Portuguese private medical insurance is less than $1,000 a year.
Yes! We reduced our healthcare costs by 92%.
My private health insurance this year is €32 per month. Specialty consultations are at least 50% covered by insurance, meaning you pay less than half the total cost of the appointment. For example, an average specialty consultation costs about €80; with insurance you pay only €35.
The news was good. Yes, I could retire and move to Portugal… and Jeff, who is 20 years younger, could retire, too! Our health care would be affordable and a better quality than in the U.S. In 2020 our dream came true.
When we arrived in Portugal we arranged appointments with our assigned private health physician. We were relieved that everyone spoke English. We scheduled a physical and got our prescriptions filled. The prescriptions cost half of what they cost in the U.S.—some were a quarter of what we paid in California.
As we settled into the neighborhood, the pharmacist asked why our prescriptions were not written by a public health doctor?
We explained we hadn’t registered yet with SNS. We had not received our residence cards from immigration services.
The pharmacist urged us to get SNS prescriptions as soon as possible… and when we did, we realized why. The cost of medications were much less.
We’ve explained before that Woodruffs are story tellers… we have a couple more personal stories about the quality and affordability of Portugal’s health care.
The first story is from four years ago when we lived in Braga. Jeff needed to have his gall bladder removed. It was not an “emergency” procedure. The surgery was classified as “elective,” something that needed to be scheduled and planned.
Jeff’s private doctor told him to contact his public physician to write the prescription for the surgery. His doctor wanted Jeff to avoid paying the private health surgical co-pays. The surgery was then scheduled at the public hospital four weeks later.
A year before we moved to Portugal, I had the same elective gall bladder surgery… but I had to wait three months for my surgery in California. I also had a co-pay of $500. Jeff paid nothing in Portugal.
The public hospital in Braga where Jeff had his surgery is a modern hospital, like the private hospitals… just bigger. Not all public hospitals in Portugal are old hospitals… that’s a myth. The public hospital that we now visit in Matosinhos is modern, too. In fact, it recently installed one of the most advanced arthroscopic surgical suites in the EU… cutting edge medical technology that isn’t available yet in the U.S.
Here comes our second personal story…
My private doctor said I was overdue for a diagnostic colonoscopy when we arrived in Portugal. The friendly physician advised me to email my SNS doctor and request a colonoscopy prescription (he even wrote on a piece of paper the Portuguese sentence I should send). Again, my private doc did not want me to pay the private system’s co-pay for the colonoscopy.
And here is the best part of this story… our private hospital performed the colonoscopy because they are contracted by SNS to provide certain procedures. All very easy. One email… one week later the colonoscopy was completed… no polyps or cancer… and I paid nothing.
Portuguese public and private health physicians are focused on preventative health. Visits with our physician are not rushed or hurried… not like our customary three-minute annual visit with the family doctor in the U.S. Conversations are encouraged… explanations are thorough.
I’m 77 years old. My Portuguese doctor sees me every six months to review medications and see how I am doing. It is like having an annual physical twice a year. No cost for the appointments. No cost for the lab tests. It’s awesome!
Dental care is not part of the public health system. However dental care is very affordable in Portugal. A routine dental check-up and teeth cleaning costs between $150 and $400 in California. Last month I paid €52 for a dental check-up and cleaning, reduced from €60 using my private health insurance deduction.
Pinch me to be sure I am not dreaming.
How much does an eye exam cost? Around €20 to €25 in Portugal. The current California average cost for an eye exam without insurance is $150.
We moved to Portugal over six years ago… no unpleasant surprises. Health care is much more affordable than in the U.S. The quality is better and it’s more personable, too.
No more sleepless nights worrying about working for the rest of my life to afford health care. Jeff and I get to visit lots of new places in Europe with the money we were spending on health care in the U.S. How nice is that?
Sincerely,
Joch Woodruff
Contributor, Overseas Opportunity Letter
