Portugal: the tax haven for foreign pensioners
Find out what are the tax benefits you will have if you retire in Portugal.
Portugal may not be the first country you'd think of as having an excellent healthcare system - Switzerland, France, or Singapore might top that list - but the country has invested heavily in the SNS (National Health Service) over the last decade, and it now comes 14th in Europe - ahead of the UK and Spain - according to the Euro Health Consumer Index 2017.
That has increased the total number of clinics and hospitals, and put an increasing number of Portuguese hospitals among the European leaders in their specialisms, particularly in oncology. Life expectancy has increased steadily since 2005, and now exceeds 80 years, while infant mortality has been cut from 11 per 1,000 in 1990 to under 3 per 1,000 now. At the same time, a strong vaccination programme has eradicated polio and greatly reduced other infectious diseases. Add to that a pretty healthy Mediterranean diet, and Portugal looks a fairly healthy place to live!
While the backbone of healthcare is the SNS, Portugal operates a mixed system with private as well as public hospitals. Some doctors work in both sectors. Health insurance is also mixed; while the state system covers pretty much 100% of residents, there's also a voluntary private health insurance scheme, used by about 20% of the population, and some public service and major employers have their own schemes. It's also important to note that the SNS only covers the mainland - the Azores and Madeira have their own systems.
One huge advantage of Portuguese healthcare for most people moving to the country is that many medical professionals speak English, particularly at senior levels and in the major cities. Many have worked or studied abroad, so you won't need to worry about lacking the right Portuguese vocabulary if you're hospitalised - someone will be able to translate. (However, knowing basic phrases such as "That hurts" and "I need the toilet" might come in useful.)
Non-residents who are using a holiday home in Portugal for less than 90 days at a time can, if they are EU or EEA citizens (or Swiss), rely on the European Health Card, which should be obtained in their home country. This can be presented to Portuguese health centres and hospitals.Those from outside the EU will need to obtain travel insurance covering them for medical emergencies. (It's currently unclear what happens to British citizens after Brexit, in regard to the EHIC.)
Once you become resident in Portugal, if you're working - whether employed or self-employed - your contributions to the Segurança Social (social security) will make you eligible for public healthcare cover. Unlike Germany, with its 120+ health insurance funds, this single scheme covers all workers for basic healthcare.
Retired EU citizens are covered through reciprocal arrangements with their countries of citizenship, and dependants are covered through the head of household or wage-earner. To register in the system, you'll need a residency card and social security card, or evidence of retired status, as evidence of eligibility; take these to a local health centre to register and get your Portuguese health card.
If you're not working and don't qualify in any other way, you'll need private health insurance. That might not be a bad idea even if you qualify for free public healthcare, as it can speed referrals for specialist services. Depending on your age and circumstances that can cost from a few hundred euros a year for a younger, single, working person, to a few thousand for an older couple or larger family.
You should also note that while most healthcare is free (but you still pay an emergency fee of 20 Euros when you go directly to the hospital), some services are charged at higher rates, and the mixed system means that some specialised care may only be available in the private sector, and thus chargeable. For instance, dental care is free only for pensioners, children, and handicapped persons; for other people it can be expensive and there can be long waits involved. (Pregnant women, patients with diabetes, and low-income earners also benefit from discounted rates on chargeable services and treatments.) Complementary health insurance can help bridge the gap.
Maternity care in Portugal is free (though pre-natal classes are not), and generally good. The system is however quite old school; most births are in hospital, and you may find that breastfeeding and doulas aren't as well recognised as elsewhere. Children benefit from continuing care and a national vaccination programme that delivers inoculations and boosters up to the age of 13.
Some of the services however suppose a wait list due to the fact they are free and there are many people who would like to get them (like some ophthalmologists, pulmonologists etc). That’s why ~2,34 millions Portuguese are using private healthcare to get the right medical treatment asap.
Health centres (Centro de Saúde) are where you'll usually start (except for emergency hospitalisation), and where your registration to the health service will be held. A health centre will group together a number of doctors and other professionals, and sometimes includes a dental clinic and even childcare services, as well as other health related services. A visit to the doctor is required for a referral to specialists; a small contribution is generally required (~ EUR 5). Pharmacies can also give free advice on minor ailments but depending on a pharmacist can be a false economy - drugs are much cheaper when provided on a prescription, and you'll pay more buying them over the counter.
Since the Portuguese health system is mixed, always check with doctors and hospitals which regime you're being treated under and insist on knowing what costs you may need to cover yourself. If you come from a country where patients are generally highly involved in their own treatment, you may also find that you need to be quite insistent in being given adequate information about your treatment; the Portuguese system has tended to be quite practitioner-focused, though this may now be changing (partly due to medics with foreign training bringing new ideas about the doctor-patient relationship into the system).