# Health Care for US retirees



## Pam2017 (Apr 20, 2016)

I have searched the forum and I'm not really coming up with an answer. My husband, age 63, and me, age 58, want to move to Portugal next year. I am a Type 2 diabetic and have a thyroid condition, both well controlled. 

I keep reading about national health care, but I am confused by the residency requirement. There is also information about private insurance available through the banks and insurance dropping you after age 70. I'm hoping someone can answer my questions.

1. Do you have to be in Portugal five years to quality as a permanent resident and use the public health care system?
2. Is there private insurance available through the banks that will cover pre-existing conditions such as my own? Will my husband be dropped after 70? Is the private insurance mostly for major surgery? 
3. If private insurance doesn't work, what other options are there?
4. Approximately how much can we expect to pay for insurance?
5. Does it make sense to just sign up for Medicare Plan B and pay for our day-to-day health care needs?

:juggle: Lots of questions...but these are, as you can imagine, deal-breakers if it turns out that we'll have to pay thousands of dollars for coverage!

Can someone please help? Thank you!

Pam


----------



## travelling-man (Jun 17, 2011)

Welcome to the forum. 

I'm certainly not an expert but as I understand it, you can only have access to the PT NHS if you have a passport from an EU country or if you have residency AND have contributed to the system by way of social security payments and assuming you have a US passport my guess is you'll need to have private medical insurance and probably the best way to get that is through afpop.com but whether you'll get cover for a pre-existing condition is another matter....... The good news is that if you are diabetic, PT is a very good place to be diabetic. The treatment here is very good indeed.  

On the subject of residency, if you don't have a passport from an EU country you don't have right of residency and have to qualify for it but I assume you've looked into that already?


----------



## grammymissy (Jun 21, 2009)

Pam2017 said:


> I have searched the forum and I'm not really coming up with an answer. My husband, age 63, and me, age 58, want to move to Portugal next year. I am a Type 2 diabetic and have a thyroid condition, both well controlled. I keep reading about national health care, but I am confused by the residency requirement. There is also information about private insurance available through the banks and insurance dropping you after age 70. I'm hoping someone can answer my questions. 1. Do you have to be in Portugal five years to quality as a permanent resident and use the public health care system? 2. Is there private insurance available through the banks that will cover pre-existing conditions such as my own? Will my husband be dropped after 70? Is the private insurance mostly for major surgery? 3. If private insurance doesn't work, what other options are there? 4. Approximately how much can we expect to pay for insurance? 5. Does it make sense to just sign up for Medicare Plan B and pay for our day-to-day health care needs? :juggle: Lots of questions...but these are, as you can imagine, deal-breakers if it turns out that we'll have to pay thousands of dollars for coverage! Can someone please help? Thank you! Pam


 As non eu, you will have to carry private health insurance for VISA and then residency card requirements. VISA, then 1 year card, then 2 two year cards, all temp residency. After 5 years, 5 year perm cards, still have private health insurance requirement is our understanding. We just received our first 2 year temp cards. After 6 years citizenship can be applied for, with passing a Portuguese language test, then access to healthcare without private health insurance is our understanding. Private insurance is available widely. We have Multicare.pt. The US embassy in Lisbon has some insurance company listings also. Research the insurance well, some policies do drop, if purchased after age 60, and yes pre existing is still an issue here. We have a full medical, hospital, prescriptions, dental and eye plan that cost just over 3000 euros per year, similar plan in the US would have cost us over 12,000 . Many carry minimum plans here because the costs are so low, certainly another option, but we are insurance happy people . Medicare part b will not pay here, and my understanding will not reimburse here. Contact your closest Portugal embassy for the health insurance requirement for your visa application, they may accept a travel insurance policy for the application, ours wouldn't, they wanted to see a full plan. Each embassy, as each SEF office here is a little different with requirements. Hope this helps!


----------



## Pam2017 (Apr 20, 2016)

grammymissy said:


> As non eu, you will have to carry private health insurance for VISA and then residency card requirements. VISA, then 1 year card, then 2 two year cards, all temp residency. After 5 years, 5 year perm cards, still have private health insurance requirement is our understanding. We just received our first 2 year temp cards. After 6 years citizenship can be applied for, with passing a Portuguese language test, then access to healthcare without private health insurance is our understanding. Private insurance is available widely. We have Multicare.pt. The US embassy in Lisbon has some insurance company listings also. Research the insurance well, some policies do drop, if purchased after age 60, and yes pre existing is still an issue here. We have a full medical, hospital, prescriptions, dental and eye plan that cost just over 3000 euros per year, similar plan in the US would have cost us over 12,000 . Many carry minimum plans here because the costs are so low, certainly another option, but we are insurance happy people . Medicare part b will not pay here, and my understanding will not reimburse here. Contact your closest Portugal embassy for the health insurance requirement for your visa application, they may accept a travel insurance policy for the application, ours wouldn't, they wanted to see a full plan. Each embassy, as each SEF office here is a little different with requirements. Hope this helps!


GrammyMissy, thank you for taking the time to respond. This info is very helpful. If you don't mind my asking, are you are your partner in your 60s? I know Medicare Part B won't pay there, but I understand some people return to the US for major procedures. Not sure how feasible that is, especially if you have an emergency type situation or are deemed incapable of travel. I'm going to contact the embassy, as well as look into Multicare. Cross your fingers for me...we really want to do this! :fingerscrossed:


----------



## grammymissy (Jun 21, 2009)

We are not yet 60. We feel so far, the doctors here are excellent, and would not travel back to the US for care. Since as non eu we do not qualify for the free or reduced price Portugal NHS, their healthcare, we don't use their health centers, we use private doctors. But, we have heard good things about their system. We are told even some of the Portuguese carry private health care insurance, they use the system for some items, and private for others. Being non eu in a eu country does cause a little extra work, and cost for some things, but it is all worth it! I hope I am not confusing, its not that we can't use the health centers, we can, we were even assigned a public doctor and center, when we registered for our Portugal health numbers, but we would have to pay full rates to see their doctors. And since we have private insurance anyway, we go to a private health center that has not only medical services, but also a dental office in it. Much more convenient then sitting for hours and waiting in our local health center.


----------



## grammymissy (Jun 21, 2009)

http://www.expatexchange.com/ctrygu...ving-to-Portugal-Demystifying-the-Paper-Trail. This guide was helpful when we first started considering Portugal, some of the items did not apply to us. Each Portugal Embassy in the US seems to add or subtract items from the list, is what we have seen. The Portugal embassy in NJ, where we applied, required the fingerprint reports direct from FBI, took 14 weeks to receive, but I think the Washington DC one allows the electronic ones that only take days to receive


----------



## Kathrynj (Jul 14, 2014)

I can add a little about the over 60 issue. I was already 66 when I moved here last fall. I ended up with Medis insurance which is not wonderful coverage but it works for obtaining residency. It also works from age 55-75. I also had a pre-existing condition of hypertension. No one has even asked about it and I have received medical treatment from a cardiologist and, of course, purchased medications. 
The care from the cardiologist and the medications are a fraction of what I would have paid in the U.S. Both times I saw the cardiologist, my 50% co-pay was 15 euros.
I also chose to have Medicare part B deducted from my Social Security ( if you are that point). If you don't pay it now, and return to the States, your premium could double depending on how long you were out of the country.


----------



## Pam2017 (Apr 20, 2016)

grammymissy said:


> Expat Exchange - United States Citizens Moving to Portugal: Demystifying the Paper Trail - Moving to Portugal, Porgual Residency Visa. This guide was helpful when we first started considering Portugal, some of the items did not apply to us. Each Portugal Embassy in the US seems to add or subtract items from the list, is what we have seen. The Portugal embassy in NJ, where we applied, required the fingerprint reports direct from FBI, took 14 weeks to receive, but I think the Washington DC one allows the electronic ones that only take days to receive


Thanks for this and all the other information. It does seem a bit overwhelming. I'm happy that I'm getting an early start...and getting so much advice!


----------



## Pam2017 (Apr 20, 2016)

Kathrynj said:


> I can add a little about the over 60 issue. I was already 66 when I moved here last fall. I ended up with Medis insurance which is not wonderful coverage but it works for obtaining residency. It also works from age 55-75. I also had a pre-existing condition of hypertension. No one has even asked about it and I have received medical treatment from a cardiologist and, of course, purchased medications.
> The care from the cardiologist and the medications are a fraction of what I would have paid in the U.S. Both times I saw the cardiologist, my 50% co-pay was 15 euros.
> I also chose to have Medicare part B deducted from my Social Security ( if you are that point). If you don't pay it now, and return to the States, your premium could double depending on how long you were out of the country.


Kathryn, did you obtain insurance after you arrived in the country? Do you mind if I ask how much you pay? What is your plan after 75...return to the US? If I'm being too nosy,  feel free to ignore the question(s). Also, this is off topic, but since you just moved last fall, did you ship household goods? We are thinking of paring down and just taking our personal belongings and sentimental stuff. Thank you!

Pam


----------



## Kathrynj (Jul 14, 2014)

Yes, I obtained the Medis after I arrived and had obtained a NIF number. I took out a World Nomads travel insurance policy to serve until I obtained the permanent insurance. I pay €42.96 per month! Which I think is amazing. 
I really don't know what my plan is for after 75. I don't definitely plan to move back to the U.S. I'm just kind of taking it a few years at a time and, frankly, avoiding thinking about what happens then if I still want to be here.

Regarding household stuff - I sold most everything or am having my daughters store/ keep it. Actually, the biggest thing I would do differently is shipping boxes over after I arrived. I had to pare things down after I got here, the cost was more than I expected, and the process of 'walking my boxes through customs' was a major pain. One of my two boxes sat in Porto for two months because I had packed a can of hair mousse - which was dangerous according to the Portuguese customs people!
If I had to do it again, I would pay the extra for an extra piece of luggage or two. It would have been much easier and cheaper!


----------



## loupow (May 27, 2013)

KathrynJ,
Do plan to always pay the Medicare Part B premiums if you don't plan on returning to the states? I am thinking about paying for the first year or two to see if I plan to stay overseas, but if I believe that if I decide not to live in the US full time I will drop it. Seems like a lot of money to spend if you will never use it. Just interested in how many Americans pay the Part B if they decide to stay overseas. Thanks.
Louis


----------



## Kathrynj (Jul 14, 2014)

Hi Louis ,
I'm paying it for now but really don't know what I will do long term. Since I've just been here about six months, it's hard to say what I will do a few years down the line. I'm loving it so far, but I'm here solo so want a back up in case I were to get sick and want to be around family.


----------



## loupow (May 27, 2013)

KathrynJ,
Thats what I was thinking what we will probably do. Get the Part B at first and see how we will like it and if we do then just drop it. Your health plan price through Medis seems like a really good price, there is no way you could get anything here in the US for that price. Could you tell me if you don't mind, how would you compare the costs in general in Portugal compared to the US. Things like apartment or flat rental and just everyday living expenses.
Thank you,
Louis


----------



## Pam2017 (Apr 20, 2016)

grammymissy said:


> Private insurance is available widely. We have Multicare.pt. The US embassy in Lisbon has some insurance company listings also. Research the insurance well, some policies do drop, if purchased after age 60, and yes pre existing is still an issue here. We have a full medical, hospital, prescriptions, dental and eye plan that cost just over 3000 euros per year, similar plan in the US would have cost us over 12,000


GrammyMissy, is that for BOTH you and your partner? That's a phenomenal rate for full coverage! I think we've almost decided not to worry about pre-existing and just leave it. But, even without pre-existing being covered, I'm not seeing anything near that. I have a feeling it's because I'm getting quotes that are based on the fact that I'm trying to do it from Oregon! Did you purchase Multicare.pt before you left the States? When I google Multicare.pt, I get the website in Portuguese. Unfortunately, I don't yet speak Portuguese. Any idea how I can reach these folks? :confused2:


----------



## grammymissy (Jun 21, 2009)

Yes, that is for both of us. We emailed Multicare.pt in English, and they responded in English. We purchased it, to begin the day we arrived in Portugal. There were waiting periods for certain things, longest was a year, we have been here over a year, so we have cleared those. We are pleased so far, great customer service, and every doctor, dentist, testing facility, etc has accepted Multicare so far.


----------



## Pam2017 (Apr 20, 2016)

Kathrynj said:


> Yes, I obtained the Medis after I arrived and had obtained a NIF number. I took out a World Nomads travel insurance policy to serve until I obtained the permanent insurance. I pay €42.96 per month! Which I think is amazing.


That's amazing, alright! So, Kathryn, I'm assuming Medis is like bare bones major medical for hospitalization with a super high deductible. Am I right? With this insurance, when you have a checkup or the flu or something like that, do you see private doctors and just pay out-of-pocket? 

The whole private vs. public thing is confusing to me. Because I have Type 2 diabetes and it doesn't respond neatly to diet and exercise like for most other people, I have some concerns. I check in with my doctor here about twice a year and he runs labs. If I don't opt for pre-existing loaded insurance and, instead, get something like the Medis plan you describe, will I be able to freely choose any doctor? Or will I be at the public clinics?

One more thing...which embassy did you go through that let you come over on travelers insurance. It seems that some do and some don't. If we are shipping household goods at the same time that we move, will we be able to use travelers insurance? 

LOL...I know you didn't sign up for a new day job...I really appreciate the help from everyone!


----------



## windwalker (Dec 21, 2009)

grammymissy said:


> Yes, that is for both of us. We emailed Multicare.pt in English, and they responded in English. We purchased it, to begin the day we arrived in Portugal. There were waiting periods for certain things, longest was a year, we have been here over a year, so we have cleared those. We are pleased so far, great customer service, and every doctor, dentist, testing facility, etc has accepted Multicare so far.


Does this plan also end at 75?


----------



## grammymissy (Jun 21, 2009)

The plan we chose from Multicare.pt has to be purchased before age 60, or at age 70, you are dropped. It is a full insurance plan similar to what we had in the US, with small copays. There are other health insurance plans here to choose from. Multicare, our understanding, has the largest network of doctors and services. Our bank, BPI, sells a plan that is much cheaper, but a smaller network, does not cover after 75, and less services are covered. For us, we are used to going to specific doctors, not waiting for hours, and getting prompt appointments. When we arrived, we were assigned a local doctor at a local health center, who I am sure is fine, but the center is only open certain days and limited hours, we were told you can wait up to 3 hours depending on the day, for an appt. As non eu we have to carry private health insurance, so we did the research and found a private health center, has multiple doctors and a dental office. We get prompt appointments, we have minimal wait times and we see not only a GP, but specialists there as needed. If the embassy being applied at allows a minimal policy to secure VISA, then perhaps go with that, then research and purchase a Portugal plan after arriving. There are insurance agents everywhere here, and they can sell you it all, house, car, health insurance, all in one sitting


----------



## Kathrynj (Jul 14, 2014)

Yes, the Medis insurance is pretty bare bones and there is no medication coverage. However, I pay less than €20 per month for medication that cost me a $35 co-pay in the U.S. I also paid €50 for an echocardiogram and EKG combined. So my experience so far is that the costs are so low, 50% is still a fraction of what I would pay in the U.S.
I see private doctors. The insurance also provides for house calls for a very low cost in case I was ill and didn't want to go to the CUF Hospital - private hospital in Cascais and most other towns (I think).
I used the embassy in Washington, D.C. But, you don't get to choose which embassy you use - it's dependent on your location. I don't know about the travelers insurance if you are shipping goods since that's not what I did.
I really don't mind answering the questions. I just realized I had stopped looking at this site after I had jumped through all the hoops. And, I received so much good information and support when I was struggling, I want to start giving back.


----------



## Pam2017 (Apr 20, 2016)

Kathrynj said:


> Yes, the Medis insurance is pretty bare bones and there is no medication coverage. However, I pay less than €20 per month for medication that cost me a $35 co-pay in the U.S. I also paid €50 for an echocardiogram and EKG combined. So my experience so far is that the costs are so low, 50% is still a fraction of what I would pay in the U.S.
> I see private doctors. The insurance also provides for house calls for a very low cost in case I was ill and didn't want to go to the CUF Hospital - private hospital in Cascais and most other towns (I think).
> I used the embassy in Washington, D.C. But, you don't get to choose which embassy you use - it's dependent on your location. I don't know about the travelers insurance if you are shipping goods since that's not what I did.
> I really don't mind answering the questions. I just realized I had stopped looking at this site after I had jumped through all the hoops. And, I received so much good information and support when I was struggling, I want to start giving back.


Thanks, Kathryn. I hope to be one of those givers, too! I have already gotten a TON of information from so many directions and I am grateful for the support.


----------

