A Comprehensive Guide for Elderly Americans and Those with Chronic Health Problems
Portugal has become an increasingly popular destination for Americans, particularly those who
are elderly or have chronic health problems.
The country’s warm climate, high quality of life, affordable cost of living, and robust healthcare
system make it an attractive option for retirees and those seeking better healthcare options.
This article provides a comprehensive guide for elderly Americans and those with chronic health
issues considering a move to Portugal, including an overview of the Portuguese healthcare
system.
Why Move to Portugal?
High Quality of Life
Portugal offers a relaxed pace of life, friendly locals, and a strong sense of community.
The country is known for its excellent climate, with mild winters and long, sunny summers,
making it an ideal place for those looking to escape harsh weather conditions.
Portugal ranks highly for quality of life factors such as safety, peacefulness, climate, and
hospitality of the locals. The country has a temperate climate with long, sunny summers and mild
winters, ideal for an active retirement lifestyle.
It is also considered one of the safest countries in the world, ranking sixth in the 2022 Global
Peace Index.
Affordable Cost of Living
Portugal is one of the most affordable countries in Western Europe. The average cost of living,
excluding rent, is approximately €600 per month.
excluding rent, is approximately €600 per month.
Rent for a one-bedroom apartment in major cities like Lisbon or Porto ranges from €1,200 to
€1,700, while it is lower in smaller towns and rural areas.
€1,700, while it is lower in smaller towns and rural areas.
A couple can live comfortably on $2,500 to $3,000 per month outside major cities. This budget
includes rent, groceries, utilities, and leisure activities.
includes rent, groceries, utilities, and leisure activities.
Safety
Portugal is one of the safest countries in the world, ranking sixth in the 2022 Global Peace Index.
Its low crime rates and stable political environment make it an ideal place for individuals and
families seeking a secure living environment.
families seeking a secure living environment.
Healthcare in Portugal
Public Healthcare System
Portugal’s public healthcare system, known as the Serviço Nacional de Saúde (SNS), is a
national health service that is tax-funded and provides most essential medical services free of
charge or with a small co-payment.
national health service that is tax-funded and provides most essential medical services free of
charge or with a small co-payment.
The system is accessible to legal residents who contribute to social security. Health centers play
a crucial role in providing primary medical care, including services such as general doctors,
maternity and childcare services, basic non-life-threatening emergency care, and sometimes
dental services.
a crucial role in providing primary medical care, including services such as general doctors,
maternity and childcare services, basic non-life-threatening emergency care, and sometimes
dental services.
The SNS provides coordinated care through a network of primary care providers and specialists,
which is particularly beneficial for managing chronic conditions.
which is particularly beneficial for managing chronic conditions.
The SNS is organized into five regional health administrations, each responsible for managing
healthcare services in their respective regions.
healthcare services in their respective regions.
Private Healthcare System
Many expats opt for the private health system and obtain private medical insurance to avoid long
waiting times associated with the public system.
waiting times associated with the public system.
Private healthcare in Portugal is of high quality and relatively affordable compared to the U.S.
Private insurance for healthcare in Portugal has plans can range from €425 to €1,170 per person
per year, depending on age and health conditions.
per year, depending on age and health conditions.
Those who opt for private healthcare over the national health service generally experience much
shorter waiting times. Private health insurance allows patients to book appointments directly
with specialists, often within days or weeks.
shorter waiting times. Private health insurance allows patients to book appointments directly
with specialists, often within days or weeks.
Private hospitals and clinics offer a wide range of services, including specialized care and
advanced medical treatments.
advanced medical treatments.
Access for Non-EU Citizens
Non-EU citizens, including Americans, can access the public healthcare system once they are
employed and paying social security. There are some private medical insurance options that do
not have those requirements.
employed and paying social security. There are some private medical insurance options that do
not have those requirements.
The regions of Azores and Madeira have their own healthcare systems. They will need to register
at their local health center to receive a healthcare card. This card grants access to public
healthcare services, including primary care, specialist consultations, and hospital care.
at their local health center to receive a healthcare card. This card grants access to public
healthcare services, including primary care, specialist consultations, and hospital care.
Health Insurance Options
Public Health Insurance
Public health insurance is available to all legal residents who contribute to the social security
system.
system.
This insurance covers most medical treatments, but there may be out-of-pocket expenses for
certain services like dental and vision care.
certain services like dental and vision care.
Public health insurance provides access to a wide range of healthcare services, including primary
care, specialist consultations, and hospital care.
care, specialist consultations, and hospital care.
Private Health Insurance
Private health insurance is recommended for those who want additional coverage and shorter
wait times. It is also perfect for those who do not qualify for the public national health service.
International health insurance providers like Cigna Global and Allianz Care offer plans tailored
for expats.
wait times. It is also perfect for those who do not qualify for the public national health service.
International health insurance providers like Cigna Global and Allianz Care offer plans tailored
for expats.
Private health insurance coverage can include access to private hospitals, shorter waiting times
for specialist appointments, and additional services not covered by the public system.
for specialist appointments, and additional services not covered by the public system.
Living with Chronic Health Problems in Portugal
Availability of Specialized Care
Portugal has a well-developed healthcare infrastructure with numerous hospitals and specialized
clinics.
clinics.
Expats can benefit from various health education campaigns and screening programs for chronic
conditions like cancer, diabetes, and cardiovascular diseases.
conditions like cancer, diabetes, and cardiovascular diseases.
Specialized care is available through both public and private healthcare systems, ensuring that
patients receive the necessary treatments and follow-up care.
patients receive the necessary treatments and follow-up care.
Emergency Services
Emergency medical services in Portugal are efficient, with quick response times.
Expats can use the general EU emergency number, 112, which has English-speaking operators.
Public hospitals are equipped to handle emergencies, and private hospitals also offer emergency
services for those with private health insurance.
services for those with private health insurance.
Residential Care for the Elderly
Care Homes
Portugal offers various residential care options for the elderly, including private care homes and
family care arrangements.
family care arrangements.
The cost of care homes ranges from €1,250 to €4,400 per month, depending on the level of care
and facilities provided.
and facilities provided.
Care homes offer a range of services, including medical care, personal care, and social activities.
Legal Obligations
In Portugal, there is a cultural and legal expectation that adult children will care for their elderly
parents. This has led to a higher prevalence of family-based care services. However, professional
care services are also available for those who need additional support.
parents. This has led to a higher prevalence of family-based care services. However, professional
care services are also available for those who need additional support.
Financial Considerations
Cost of Living
The cost of living in Portugal is significantly lower than in the U.S. A couple can live
comfortably on $2,500 to $3,000 per month outside major cities.
comfortably on $2,500 to $3,000 per month outside major cities.
This budget includes rent, groceries, utilities, and leisure activities.
The lower cost of living allows retirees to stretch their retirement savings and pensions further.
Tax Benefits
Portugal previously offered favorable tax conditions for retirees through the Non-Habitual
Resident (NHR) status, which provided tax exemptions on foreign income for up to 10 years.
Resident (NHR) status, which provided tax exemptions on foreign income for up to 10 years.
However, significant changes have been made to the NHR regime starting in 2024. The
traditional NHR status, which offered a flat 20% tax rate on certain income types and exemptions
on foreign-sourced income, officially ended on January 1, 2024.
traditional NHR status, which offered a flat 20% tax rate on certain income types and exemptions
on foreign-sourced income, officially ended on January 1, 2024.
The new “NHR 2.0” program retains many original scheme benefits but is now tailored towards
attracting professionals in specialized sectors like scientific research and innovation.
attracting professionals in specialized sectors like scientific research and innovation.
For retirees, the 10% tax rate on foreign pension income has been removed, and pensions are
now taxed as regular income.
now taxed as regular income.
Visa and Residency
Visa Options
Americans can enter Portugal without a visa for up to 90 days. For longer stays, they need to apply for a residence permit.
Popular visa options include the D7 Retirement Visa, the Golden Visa program, and the D8 Digital Nomad Visa. The D7 Visa is designed for retirees and individuals with passive income, while the Golden Visa program offers residency to those who make significant investments in Portugal.
The qualifications for the Golden Visa program have changed and no longer include the purchase of residential property.
The D8 Visa, introduced in October 2022, allows remote workers, freelancers, and digital nomads to establish residency by demonstrating a monthly income of at least €3,280. This visa provides a pathway to long-term residency and even Portuguese citizenship after five years.
Permanent Residency and Citizenship
After five years of legal residency, expats can apply for permanent residency or Portuguese
citizenship, provided they meet the necessary requirements, including passing a Portuguese
language test.
citizenship, provided they meet the necessary requirements, including passing a Portuguese
language test.
Permanent residency and citizenship offer additional benefits, including the right to live and
work in other European countries.
work in other European countries.
Healthcare Access and Waiting Times
Public vs. Private Healthcare
Public System
The public healthcare system in Portugal often has long waiting times for
specialist appointments, sometimes exceeding a year for non-urgent cases.
For example, ophthalmology appointments can take around two years. There are
reportedly instances where patients have had to wait up to three years for a specialist
appointment.
Private System
In contrast, the private healthcare system offers much shorter waiting times, typically days to weeks, making it a preferred choice for those who can afford it or have private health insurance
Strategies to Reduce Waiting Times
Portugal has implemented several strategies to reduce waiting times for specialist appointments,
including:
- Setting Maximum Waiting Time Targets and Guarantees
- Portugal has set legally defined maximum waiting time targets for specialist consultations and treatments. For example, the highest priority patients should wait no more than 30 days for a specialist appointment.
- Increasing Supply and Capacity
- Strategies to increase the supply of specialist services include having doctors work extra hours, acquiring additional resources (hiring more doctors), and subcontracting extra capacity from the private sector.
- Improving Demand Management and Patient Prioritization
- Initiatives to better prioritize patients on waiting lists based on clinical urgency and appropriateness criteria.
Use of Information Systems and Data Analysis
- Implementing integrated computer systems to better manage and analyze waiting list data.
- Increasing Private Sector Involvement
- Promoting greater use of private healthcare services, which tend to have shorter waiting times.
Medication Availability and Costs
Availability of Medications
Americans can generally find equivalent medications in Portugal, although the brand names and
formulations may differ.
formulations may differ.
Many common medications, both prescription and over-the-counter, are available, but some
specific drugs might not have a valid marketing authorization in Portugal.
specific drugs might not have a valid marketing authorization in Portugal.
For example:
Tylenol (Acetaminophen): Known as Paracetamol in Portugal. Common brands include
Ben-U-Ron.
Advil (Ibuprofen): Known as Brufen in Portugal.
Aspirin: Sold under the same name, Aspirina, in Portugal.
Pepto-Bismol: For heartburn, Gaviscon is a common alternative. For diarrhea, Imodium
Rapid is used.
Sudafed (Pseudoephedrine): Known as Sinutab in Portugal.
NyQuil/DayQuil: Various cough syrups like Bisoltussin, Grintuss, and Bisolvon are
available.
Vicks Vaporub: Available under the same name in Portugal.
Medication Costs
Medications in Portugal are generally much more affordable than in the United States.
For example:
For example:
Humira: $2,436.02 in the U.S. vs. $577.62 in Portugal.
Eliquis: $6.98 in the U.S. vs. $1.49 in Portugal.
Pradaxa: $6.68 in the U.S. vs. $1.60 in Portugal.
Xarelto: $13.95 in the U.S. vs. $2.75 in Portugal.
The significant price differences are due to various factors, including regulatory environments,
market competition, and the availability of generic drugs.
market competition, and the availability of generic drugs.
For Americans considering moving to Portugal, this represents a substantial potential saving on
prescription drug costs.
prescription drug costs.
Conclusion
Portugal offers a high quality of life, affordable living costs, and excellent healthcare, making it
an ideal destination for elderly Americans and those with chronic health problems.
an ideal destination for elderly Americans and those with chronic health problems.
With careful planning and consideration of healthcare and financial aspects, moving to Portugal
can be a rewarding experience for those seeking a better lifestyle in their golden years.
can be a rewarding experience for those seeking a better lifestyle in their golden years.
We can help you to compare your various private health insurance policy
options and help you make sure you get the best policy for your needs. We
can also help you to get your national health service number if you do not
have that. Contact us if you’d like our help. Info@MoveToPortugalNow.com
options and help you make sure you get the best policy for your needs. We
can also help you to get your national health service number if you do not
have that. Contact us if you’d like our help. Info@MoveToPortugalNow.com