The Medicare Reality: No Coverage in Portugal
Medicare does not provide any healthcare coverage in Portugal. This surprises many Americans planning to retire or relocate abroad, but the reality is straightforward: Medicare operates exclusively within the United States and its territories.
The US and Portugal have no bilateral healthcare agreement. The existing Acordo sobre Segurança Social (Decree 48/88) covers only pension coordination, not healthcare services. This means Americans cannot rely on Medicare Part A, Part B, Part D, or Medicare Advantage plans for any medical care in Portugal.
Medicare Emergency Coverage Myth
Even medical emergencies are not covered by Medicare in Portugal. Unlike some international scenarios where Medicare provides limited emergency coverage, Portugal falls completely outside Medicare's coverage area. You must maintain alternative insurance from your first day in Portugal.
Healthcare Insurance Requirements for American Visa Applicants
American citizens applying for Portuguese residence visas face two-stage insurance requirements. Understanding this framework prevents visa application delays and potential denials.
Stage 1: Visa Application Insurance
Your visa application to the Portuguese consulate requires €30,000 minimum Schengen-compliant travel insurance. This policy must cover medical expenses, hospitalization, emergency medical assistance, and repatriation throughout the Schengen Area.
The insurance must remain valid for your entire four-month temporary visa period. Your policy holder name must match your passport exactly. Portuguese-issued policies need only a company declaration, while foreign certificates require authentication.
Stage 2: AIMA Residency Appointment Insurance
Your AIMA appointment for the residence permit requires comprehensive 12-month Portugal-specific coverage. This must be renewable and demonstrate continuous protection. April 2025 policy changes mean AIMA requires 100% complete applications with no grace period for missing documents.
Failure to present proper insurance documentation can result in residence permit denial. Additional penalties include €60-160 fines for administrative non-compliance.
Reference guide: Portugal Health Insurance for Visas: D7, D8 & Golden Visa Requirements
Accessing Portugal's SNS After Establishing Residency
Once you obtain legal residency in Portugal, you gain access to the Serviço Nacional de Saúde (SNS) public healthcare system. The process is identical for Americans as for other non-EU nationals.
SNS Registration Requirements
You must register for your Número de Utente (SNS user number) after receiving your residence permit. Required documents include your Portuguese Tax Number (NIF), residence permit, Social Security Number (NISS) if employed, proof of address, passport, and Portuguese phone number.
Registration can be completed in-person at your assigned Centro de Saúde for same-day results. The newer Espaço Cidadão integrated service locations allow simultaneous processing of NIF, NISS, and Número de Utente at 900+ expanding locations nationwide. Online applications take 3-6 months, making in-person registration strongly preferred.
What SNS Covers for Americans
SNS provides comprehensive healthcare coverage after registration. Primary care consultations are free. SNS-referred specialist care is free. Hospital admissions are free. The June 2022 co-payment reform eliminated most user fees, making healthcare largely free at point of use.
However, over 1.5 million registered users lack assigned family doctors despite legal entitlements. Actual wait times exceed two years in many areas. Americans should expect to use "consultas de recurso" (walk-in consultations) rather than having an assigned primary care physician immediately.
International Health Insurance Options for Americans
Most American expats in Portugal adopt a hybrid approach: SNS for comprehensive major coverage plus international insurance for convenience, global portability, and US visit coverage.
Popular International Providers
Cigna Global offers worldwide coverage with Portugal inclusion. Plans range €150-300/month with comprehensive benefits including emergency evacuation, US provider networks during visits home, and direct billing arrangements with Portuguese private hospitals. Americans value the familiarity of working with a known US-based insurance brand.
Bupa Global provides flexible international plans with Portugal coverage and global portability. Premium ranges €200-350/month depending on age and coverage level. Coverage includes private facility networks in Portugal, emergency services worldwide, and optional US coverage for extended visits.
GeoBlue specializes in expatriate coverage with strong US connectivity. Plans cost €150-400+/month with benefits designed specifically for Americans living abroad. Features include telehealth with US-licensed doctors, prescription management, and mental health services with English-speaking providers.
Why Americans Choose International Insurance
International insurance provides three key advantages over domestic Portuguese policies. First, global portability means coverage continues during US visits for family emergencies or extended stays. Second, customer service operates in English with US business hours availability. Third, plans often include medical evacuation coverage back to the US if needed for specialized treatment.
The trade-off is cost. International policies typically cost 2-3 times domestic Portuguese insurance premiums but provide peace of mind through familiar insurance structures and global coverage.
The Hybrid Healthcare Strategy for American Expats
The optimal approach for most Americans combines SNS access with international or domestic private insurance supplementation.
Use SNS for major medical issues, hospitalizations, chronic disease management, and routine preventive care. The quality of Portuguese public healthcare matches or exceeds US standards for most specialties. SNS provides comprehensive coverage without the financial stress of US medical bills.
Use private insurance for faster specialist access, English-speaking providers, more convenient appointment scheduling, and coverage during US visits. Private facilities in Portugal offer modern equipment, shorter wait times, and higher likelihood of English-speaking medical staff.
Cost Comparison: SNS Plus Insurance vs US Healthcare
The total annual cost of healthcare in Portugal including SNS registration (free) plus comprehensive international insurance (€2,000-4,500/year) remains dramatically lower than US health insurance premiums for equivalent coverage. Americans over 65 particularly benefit, as Medicare supplement policies plus out-of-pocket costs in the US often exceed €5,000-8,000 annually.
Prescription Medication Savings in Portugal
Prescription medication costs in Portugal average 40-80% less than US prices for identical drugs. This represents significant annual savings for Americans managing chronic conditions.
Portugal's pharmaceutical subsidy system provides additional savings. Medications receive 15-95% state subsidies depending on medical necessity. Generic medicine policies mandate 50% minimum price reduction versus brand-name drugs, or 25% for medicines under €10.
Common Medication Cost Examples
Popular US medications cost substantially less in Portugal. Lipitor (atorvastatin) for cholesterol costs approximately €8-15/month in Portugal versus €50-120/month in the US without insurance. Metformin for diabetes costs €3-8/month versus €20-50/month in the US. Even specialty medications show dramatic savings, though exact comparisons vary by drug and dosage.
Americans can access these prescription savings immediately upon SNS registration. No separate prescription insurance policy is required. The SNS electronic prescription system allows chronic medication renewals for up to one year, with patients collecting two-month supplies directly from pharmacies.
Common Questions from American Expats
Can I Keep My US Health Insurance While Living in Portugal?
You can maintain US health insurance policies, but most provide no coverage in Portugal. Some policies offer limited emergency coverage abroad but require immediate return to the US for continuing care. Review your policy terms carefully and plan for Portugal-specific insurance.
What Happens If I Need Emergency Care Before SNS Registration?
Emergency care in Portugal is available to all persons regardless of residency status under constitutional protections. You will receive necessary treatment. However, non-referred emergency visits cost €18-20 if no hospital admission results. More importantly, lacking proper visa insurance during your temporary visa period violates legal requirements and risks residence permit denial at your AIMA appointment.
Should I Cancel Medicare When Moving to Portugal?
Do not cancel Medicare Part A if you paid Medicare taxes during your working years, as it remains free. Consider keeping Part B if you plan to return to the US eventually, as late enrollment penalties apply. However, you will pay premiums for coverage you cannot use in Portugal. Medicare Part D (prescription drug coverage) provides no value in Portugal and can be cancelled. Consult with a Medicare advisor about your specific situation before making changes.
Does Travel Insurance Count as Visa Insurance?
Short-term travel insurance typically does not meet visa requirements. Visa insurance must cover the entire four-month temporary visa period with €30,000 minimum medical coverage, plus meet Schengen Area specifications. Then your AIMA appointment requires separate 12-month renewable comprehensive Portugal coverage. Standard travel insurance rarely provides sufficient duration or coverage amounts.
Next Steps for American Citizens
Register for Portugal's SNS immediately after receiving your residence permit. Use the in-person method at Centro de Saúde or Espaço Cidadão for same-day results rather than waiting months for online processing.
Research international insurance providers while still in the US. Many policies require enrollment before departure or have waiting periods for coverage activation. Compare Cigna Global, Bupa Global, and GeoBlue specifically for features important to Americans like US visit coverage and English-language customer service.
Confirm your visa insurance meets both consulate requirements and AIMA appointment specifications. Work with insurance brokers familiar with Portuguese residence visa requirements to avoid documentation issues that delay or deny residence permits.
Plan for continuous insurance coverage from your visa application through SNS registration completion. Legal gaps in coverage can result in fines, residence permit denial, or exposure to significant medical bills during your transition period.