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Health Insurance for US citizens


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(@snicmanor)
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Joined: 5 years ago

Hi everyone, thanks for posting so much useful information. If all goes as planned my husband I will be moving to Portugal in Jan or Feb 2018. The whole health insurance thing is quite confusing. From what I understand we will need travel insurance for the first 6 months until we have our residency permit and then will need to buy a policy in Portugal. Is this correct? Also, how much should we expect to pay for a policy in Portugal and does it cover our health care when we visit the US or do we need to buy another travel policy for travel to the US? Any help would be greatly appreciated. Angella & Sandy Nicholls

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(@blythe)
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Joined: 6 months ago

It doesn't look like anyone responded to this but I am curious of the same set of questions. Does anyone have insight or did you resolve these questions and care to share @snicmanor? I assume I will figure out the PT part but am curious about what needs to do for traveling back to the states...

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(@gerry)
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Hello @snicmanor and @blythe

Once you are a legal resident in Portugal, you are entitled to access the state healthcare system which is available free or for very small fees in some circumstances. 

From this point, you don't need to have private medical insurance but if you do, the cost is extremely low compared to costs in USA. The cost will depend on age, previous conditions, level of service, etc., but expect to pay between €70 to €100 per month as a rough guide. 

You can also mix and match between the state system and the private system.

I cannot answer the question about travelling back to USA. This will depend on the insurance company and package you select but I know that my insurance in Portugal, provides coverage in most countries.  

I can recommend a national company if you want to check prices and coverage.

Hope this helps 😊 

 

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(@blythe)
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@gerry Thank you so much! 

I know you need to get health insurance for the visa application and initial stay prior to obtaining residency status. Is it best to get that first segment of insurance for a shorter amount of time (6 months rather than 12, for example)? And then once residency is obtained, you switch over to a cheaper supplemental to the state healthcare? 

Just want to know if I am understanding the timeline correctly and steps in the process in order to not spend more money than necessary!

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(@peggyl)
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@Blythe

We moved from Kentucky, USA to Portugal. I became a resident in 2018 but my husband was still working in the US so he could not apply for residency until 2019. When I became a resident in 2018 I used the US health insurance policy that we had via my husband's employer. It only covered urgencies & emergencies here in Pt. but it was sufficient. SEF just scanned in my health insurance card. My husband retired in August 2019 and kept the same insurance through the COBRA program. His valid health insurance card was again good enough for SEF and he got his residency card via the family reunification plan. We have done extensive reviews of a lot of companies for health insurance because I have rheumatoid arthritis, hypertension, and some other chronic illnesses. Most Pt. health insurance companies will NOT cover pre-existing conditions. However, the MEGA Insurance company discussed on this forum in previous posts says in the policy that you can submit proof that your pre-existing conditions have been being covered by CURRENT  Insurance and it is possible then that MEGA will continue to cover them. The cost of the insurance is extremely low compared to the US. We have tentatively figured that it will be BTW 150-200 euros/month for both of us. Our COBRA policy ends on December 31st. As Jerry said once you are a resident you are entitled to free public healthcare. There is also a private system that is extremely inexpensive compared to the United States. Doctor visits range between €50 to 70 € even for my Rheumatology specialist. Medications are also very inexpensive. I fill approximately 15 prescriptions per month and the cost is about €100. Some of the medications are as low as 1 to 2 euros for a month for 30 days. Medications are free if I go through the public healthcare system. 

If I can be of further help, please message me via this forum

@peggyL

 

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Premium Member
(@brittan)
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@peggyl HI and thanks. 

I see your post is a few years old, can you provide an update on your current costs today? We are planning to move this summer from USA and are 61 years old with no pre. 

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(@peggyl)
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@brittan

Welcome to the world of ex-pats. There are a lot of great people on this site. If no one can answer your questions then by golly we will look it up and find the answer. The post about MGEN was just this Dec 2020-Jan 2021. But we have been looking at policies for years. They all seemed so very expensive & would not cover pre-existing conditions. There is an Ana Veira (sic) on this site who's husband is an insurance broker. He works with several companies and has several plans from which to choose. We choose MGEN because there was a possibility that they would cover pre-existing conditions. It was a bit of a fiasco with all the paperwork to get those covered and we finally gave up. We are on the regular plan where you wait a year before pre-existing conditions are covered. Thankfully health care is very reasonable in Pt. and there are some wonderful doctors in both the Public Health Service and in the Private HPA side. 

The cost for our plan is 235 euros a month but I have a lot of health issues. I have seen Ana reply to others that if they are healthy, they can be insured for as little as 150 euros. But, I would suggest you contact her husband, Rui and tell him what you are looking for. He can be more helpful with an actual price for you to consider. He's very nice and his English is perfect.                                     rui.capdeville@capdeville-seguros.com

Best of luck, Peggy 

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(@ellieb)
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@peggyl

thanks for this detailed reply as we need that information also. 

Cheers, Élise

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 EnSu
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(@ensu)
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@peggyl...As always your replies are very informative, thx a lot!....by any chance maybe you have some info for the following...is it possible to purchase a private health care coverage in Pt for a portion of the year or is it only sold on an annual basis? Can someone without resident permit purchase a private insurance? Best regards Ena

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(@anavieira)
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@ensu Hello!

Health insurances in Portugal are annually but you may pay it monthly. You may have an insurance and only pay the first six months but the moment you stop paying, it will be cancelled. 
And if you want to renew for the next year, the company may refuse you.
Also, you should think that most of the insurances have waiting periods/ grace periods so if you try to have one new insurance every year, probable you will not be able to use it. Some companies have 180 days of waiting periods.

To purchase an insurance in Portugal, you need a NIF and a portuguese address (POX is not enough) but you do not need a resident permit.

Regards,

Ana

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 EnSu
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(@ensu)
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@anavieira Ana, Thank you very much! gr8 insight, best regards Ena

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 EnSu
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(@ensu)
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@anavieira Ana, forgive my rudimentary verification,  - public insurance becomes available only after obtaining the residence permit ...is my understanding correct? best regards Ena

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(@anavieira)
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@ensu
After you have your residence permit here you can have your «Cartão do Utente» - which allows you to use public health service: going to public health centres and have a family doctor as well as access to public hospitals. Its not totally free but it is very affordable. About 5€ for the doctor appointment at local health centres, 18€ for emergency on the hospital, etc.
Its not a insurance. Its public health care. It is very good in Portugal - very good doctors - but it is not an insurance.  
For specialised doctors - Cardiologist or Rheumatologist, for example or for image exams - your family doctor will prescribe the authorisation and you will make an appointment at major hospitals for that doctor. That can take several weeks up to several months of waiting, depending on the place where you live and on the urgency of the appointment.
That is where private insurance is very useful. With a private health insurance you can have an appointment in the next day or next week, for any specialised doctor, image scans, treatments, blood tests, etc.
🙂

Best regards

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 EnSu
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(@ensu)
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@anavieira

Ana - your replies are invaluable! Thank you for being so generous with your time to reply, best regards Ena

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(@anavieira)
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@ensu

happy to help!

🙂

best regards 

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 tdn
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(@tdn)
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@brittan

Hi Brittan, in addition to Peggy’s insights, I also would like to share what we found 🙂

We have just purchased a private health insurance, Medis, while still in the US via the Portuguese bank Millenium. There were three options to choose from, two of them offered a coverage required for D7 visa. We opted for the international option that also covers accidental health issues for 45 days when traveling abroad and staying in a foreign country, as we would want to travel back to the US and still have some coverage. The monthly cost is 256 euros. This option that we picked has no age limit or any grace period. 
I should add that you might need to received your nifs first, and only after that be able to get a bank account and a health insurance, while being still in the US.

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(@anavieira)
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@tdn 
Hello!
Private health insurance (not only from Medis) covers accidental health issues when travelling abroad (some for 30 days or 45 days, others more). But be careful that they work with refund and not full cover. And the refund may be only for 35%, after you present the expenses and the medical report for what has happened.
When travelling, its always best to have also a travel insurance.
Stay safe!

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 tdn
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(@tdn)
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@anavieira

thank you for the tips! You also mentioned somewhere in a chat that if the health insurance is terminated earlier, the insurers might refuse to provide the insurance next time. Would you have any knowledge for the case, if, for example, we decide to carry the current whole year term to the end of its year without a termination, and then in the next year switch between plans or even insurers/companies, would we get refused or will we be fine and get coverage in such a case?
I also heard that people in Portugal who get private insurance typically stick with it for many-many years and insurers expect you to carry it for many years. Is that true? 

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Ask Our Expats Consultant
(@anavieira)
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@tdn 
The problem in switching between companies is that you will have waiting periods and if you have any pre-existing conditions, they will be excluded in the next plan. For instance if you have some health issue when using one company and after one year or two or even five years, you change, that problem will be considered pre-existing condition, and excluded in the new policy.  If you stay in the same company they will cover your problem because it occurred when you were already with them.
That´s why most people stick with one plan for many years and add family (kids) to the same plan. 
And after a certain age is more and more difficult to find a plan.

Some companies may accept your change without grace periods if it is a continuing use, but you need to present papers and documents and both companies must accept the conditions.

You can always change between companies. You are allowed to. But its not always the best option.

🙂
  

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 tdn
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(@tdn)
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@anavieira

thank you, Ana, for helping us to navigate in unchartered waters, we will keep your tips in mind. 

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(@brittan)
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@tdn

Excellent, thank you!!

 

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(@blythe)
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Thank you @peggyL

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(@peggyl)
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@blythe

That is from Ana. Her husband Rui is an insurance broker. This is what he explained to me:

It seems that some, quite a lot actually, Portuguese people have in the past, purchased an insurance policy and abused the policy & cheated the company. The public system here is free to all residents & citizens. It’s what most Pt. People use. Many of the same Dr.s  Work in both systems and the public system is not bad. But some Dr.s  Only work in the private system and there are some patients who “think” the private hospitals are better. They are less crowded. But in the case of getting private insurance it would be for a specific reason. Maybe, they want to use the private hospital system for a birth or maybe a surgery that they would have to wait for on the public system. They would then use the insurance for the birth or surgery and immediate care after.

A few months later they stop paying the insurance premiums. The insurance companies in Portugal got pretty tired of this so they instituted a few universal rules. You must provide (1) a letter from your current insurance co. stating the exact dates that you were covered, (2) what type of policy you had, was it full coverage? Such as, Did it not cover mental illness? (3)what exactly your maximum coverage was for the policy, & (4)the fact that you requested the insurance to stop on a specific date and that the insurance company did not drop you for cause. If you had no maximum on your current insurance, the letter must say that, it can’t simply skip the question because it doesn’t apply. The letter must say what the policy covered, as in--- was it all your medical issues or did it refuse to cover anything. If you are going to ask the new insurance to cover your pre existing conditions you will need another letter stating the conditions that they covered. For all insurance companies and policies here there is also a 90 day grace period before the insurance kicks in to pay the full amount of your policy. As an example, I had a specialty x-ray the first month of the policy. The insurance paid all but 30% of the bill. I only paid 100 euro for an x-ray that would have cost me several thousand dollars in the United States. Our insurance started January 1 so, after April 1 our Dr. visits will cost either 12 euro or 18 euro depending on the complexity of the visit. A dentist will be 15 euro. All prescriptions will be covered. All labs and x-rays will be covered. I think it’s good insurance. I think that pretty much covers it. 
The insurance agent was very helpful explaining everything.

From what I read, if you use the insurance for a few months then stop paying, you will pretty much be screwed without any hope of ever getting health insurance in Portugal again. Even jumping through all the hoops and getting all the paperwork it took us a month to get approval. You might want to consider just using the public health care system if you only need temporary coverage. 

@peggyL

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