Quality and Cost of Healthcare

Like many in the United States, I was convinced that while healthcare costs were outrageously high, the care was the best in the world. I believed that to justify the cost. I was lucky to have access to really good healthcare plans through all my former employers, most recently Johnson & Johnson. When I left J&J, I was offered the option to continue with the plan Won and I had been on for one more year at our cost. Knowing that we were planning to move to Portugal, we decided to take advantage of it. The cost for that plan was $1,769.00 per month and covered medical, dental, and vision. While we are getting older, neither Won nor I qualify for Medicare at this time so the cost of healthcare was a real worry and clearly justified.

I won’t lie, even with the excitement of moving to Europe, healthcare was one of my biggest areas of concern. I have had a few spills in the last couple of years as well as ongoing problems with my knees. I was anxious about the standard of care, the potential language barrier, and navigating a complex healthcare system in a new country.

Before we left for Portugal, we made the decision to end our US-based healthcare coverage on January 31. This would give us nearly three weeks, upon arrival, to find and secure insurance. As with everything else, there was a bit of a learning curve involved. We did a lot of research before we moved even requesting quotes from insurance providers based in Europe. We also learned that a variety of private companies in Portugal, like banks, utilities, telecommunications providers, etc., offered medical plans either as a part of their service package or for a small monthly fee. We didn’t fully understand these plans at the time, but remained open to learning more.

On the day we signed the lease for our apartment, our real estate agent, Marta offered to accompany us to the electric, water, and cable companies to open accounts and get those services turned on. Won went in to open the account at the electric company while I stayed outside with Sweet Pea. He returned to tell me that in addition to opening the account he had also signed us up for a medical plan. The plan was €8.95 per person per month. I was floored! Could this really be the cost of health care here?! The plan covered 50% of healthcare services and required minimal co-pays. The brochure showed that it was affiliated with a large network of health providers and eight different hospital chains. Interesting.

Fast forward a few weeks and Marta invited us to a regular luncheon she coordinates for all the American expats she has helped find homes. I met Kevin that day. Kevin and his wife Carolyn have been in Portugal for three years having moved from Oregon. He formerly worked in high tech and she’s an interior designer. As we chatted amicably over lunch, I broached the subject of health insurance and asked him who he used as his insurance provider. He was kind enough to give me the name of the company as well as the name and contact information of his insurance broker. I made a note to follow up later that afternoon.

As we continued to talk, I shared my concerns about healthcare and he shared the following story with me.

Shortly after moving to Portugal, Carolyn began to experience extreme back pain. One day it was so bad she asked him to take her to the emergency room. Their insurance plan did not cover preexisting conditions for the first year (I will explain why a little later). Kevin did a quick Google search for the nearest hospital and drove straight there. Within 15 minutes they were being seen by a doctor who spent 30 minutes with them. [Let that sink in for a moment…when was the last time you spent 30 minutes with a doctor when you weren’t under anesthesia??] He took the time to listen and examine her carefully. At the end of the appointment he prescribed four medications and gave them his personal cell phone number in case they had any questions or needed anything further. This entire experience cost them €60,00. They then went to the pharmacy to fill the prescriptions and paid €17,00. All of this was without insurance.

As it turned out, Carolyn needed back surgery. She was worried about the potential cost without insurance, but Kevin reassured her that they would do whatever needed to be done to resolve her pain. Her surgery was a complete success and the experience was absolutely amazing from start to finish.

So, how much did the surgery and four days in the hospital cost without insurance? €9.000,00. Kevin received a detailed invoice with all the costs broken out. He told me that a bag of saline solution cost €0,75. He did a quick Google search and found that the same bag of saline solution in the US costs between $300.00 and $400.00 He was so impressed with the quality of care and the level of service provided that should he ever return to live in the US and have a health situation that required significant care, he’d come back to Portugal to get it.

Won and I reached out to the broker Kevin referred us to, and we scheduled an appointment for Monday, February 17. Once again, I brought all my preconceived notions with me, including, I’m embarrassed to admit, that I was wary he was going to scam us because we are Americans. Miguel could not have been more direct, open, honest and efficient. He explained the difference between a health plan like the one we had signed up for with EDP (the electric utility) and a private health insurance plan.

Health plans, like the one through EDP, are helpful for Portuguese citizens and legal residents who primarily use the public healthcare system. It allows them to see healthcare professionals quickly while covering some of the costs themselves. A private health insurance plan covers the majority of costs and is similar to what we had in the US. It also allows us to take advantage of both public and private resources. As an example, Miguel instructed us to use public health care facilities in emergency situations like accidents or sudden illness requiring emergency care. For everything else, like doctor consultations, regular care appointments, x-rays, mammograms, planned surgeries, etc. we should use the private health plan. The quality of care is NOT different, but the wait times can be. All doctors work in both the public and private sectors. I love the fluidity this system provides.

Our insurance plan is with Allianz Portugal. Allianz Portugal is part of the Allianz Group, one of the largest financial groups in the world serving more than 60 million customers in 70 countries worldwide. For those interested in the details, our plan covers the following:

  • In patient care (hospitalization, surgery, and oncology) up to €150.000,00 Euros per person per year with 90% of costs covered. Co-pay is 10% with a maximum of €1.500,00 annually.
  • Out patient (medical expenses and in-office consultations, home visits, emergency consultations, external hospital assistance, and treatments) up to €4.000,00 per person per year with co-pays that range from €12,50 to see a doctor and up to €32,50 for emergency consultations. 80% of costs are reimbursed.
    • It’s also important to note that we can log onto a doctor’s or hospital’s website and see the available appointments for that day or any other day and book directly. We do not need to secure a referral in advance, the doctor’s office or hospital does that on behalf of the patient. Plus, every doctor has a bio listed online that includes experience, background, languages spoken, skills, etc.
  • Dental treatments up to €300,00 per person per year (no co-pay) with 80% reimbursement
  • Vision care is €300,00 per person per year with 80% reimbursement
  • Medicine is up to €200,00 per person per year with 80% reimbursement
  • International coverage for serious illness up to €1.000.000,00 with automatic coverage for 60 days of travel (and an option for up to 90 days with prior notice to the insurance company)
  • Personal assistance with any health care need provided by the insurance broker and/or their team

During our meeting with Miguel, we learned that to get the best possible coverage at a negotiated reduced premium we needed to join AFPOP, Portugal’s largest foreign resident’s association. The membership fee was €100,00 and included a €35,00 joining fee. Subsequent annual dues will be €65,00 and covers membership for us both.

Our combined health insurance premiums are €3.035,00 per year, less than the cost of two months of premiums back in the US and the coverage is better!

The premiums offered through the plan we chose are tiered based on age range. As an example, a single person 25 years or younger would pay €530,00 per year. An individual between the ages of 26-45 would pay €980,00 per year and someone between 46-55 would pay €1.092,00 per year. Annual premiums cap at €1.967,00 for anyone 66 or older. There are other plans that are less expensive and more expensive depending on need and preference.

To complete the application process, Miguel asked us if we were currently covered. We told him that we had canceled our US-based coverage on January 31 because we had signed up for the EDP plan. He told us that it would have been better if we had kept our US coverage and then canceled after we had switched to a new plan. The reason for this is because if you switch from your current insurance to Allianz directly, preexisting conditions are grandfathered into the coverage. Since it had not been very long, he suggested we ask Aetna (our former provider) for an Insurance Coverage statement that showed how long we had been insured, which happened to been for the last five years. If the time frame had been a lot longer, then preexisting conditions would not have been covered for the first year. This was the case with Kevin and Carolyn; however, other regular healthcare needs were covered by their plan that first year. We contacted Aetna that same afternoon and they provided the statement within a few hours.

Our Insurance Coverage statement was accepted and our policy was retroactively dated to begin on February 1 to show no break in coverage. Premiums are paid annually and renew on January 1 of each year. The next step will be to cancel the EDP medical plan we signed up for a few weeks ago.

Obviously, we haven’t had the chance to use the insurance yet, but I’ll be happy to let you know how things go when we do. I’ll be interested to see if our experiences are as positive as those of Kevin and Carolyn. Stay tuned; I’m pretty sure it won’t be long before I fall down again and need a doctor. 😦

From Portugal with love,


Published by Beth Thomas-Kim

After working in corporate America for companies like Mattel, Nestlé, and Johnson & Johnson, I retired and moved to Portugal in January of 2020 with my husband Won and our 12-year old wire fox terrier, Sweet Pea. We now live in Monte Estoril, a lovely seaside town just outside Lisbon. We spend our days happily exploring this beautiful country and learning about its fascinating history, engaging culture, warm and welcoming people, delicious food and wine, and stunning architecture. This blog was started primarily as a way to keep family and friends updated on our transition from the US to Portugal. Now, my subscribers include people from all over the world. Enjoy!

15 thoughts on “Quality and Cost of Healthcare

  1. Thank you for sharing this,and hoping to dispel the great myth that US health care , including cost, is the best in the world!!


  2. I am floored. I cannot believe that as a country our biases keep us from being able to learn anything about running a healthcare system from anywhere else in the world. Absolutely insane. I will stop there before I descend into a political diatribe…. As always thanks for sharing your experiences!


  3. Hi Beth!
    I keep forgetting to tell you that my very close cousin is an amazing doctor located in Cascais. He is a GP that practiced here in Rhode Island until he decided that the insurance system here was getting out of hand. So he decided to move back to Portugal for a better way of life and he set up practice there. He has a private practice, I am not sure if he accepts insurance, but he speaks perfect English and I know he has an excellent reputation there. Great bedside manor, patient and thorough. Our whole family is always bombarding him for all our medical advice. I adore him!!

    His name is Dr. Antonio Maia he is at Clinica do Rosario Cascais 351 214 826 860 Google him and you can check him out.


  4. Given your history of clumsiness and those cheap insurance prices, I think it’s fair to say that the Portuguese healthcare system is in for a shock over the next few years and some potentially big losses! Ask Won if there is some way to short Portuguese sovereign debt, you may be crashing their healthcare system soon, it may be a good bet! Ha, ha – hopefully you do not! Keep us posted!


    1. You’ll be pleased to know that Won and I have joined a health club and are working out at least 3 days a week. I told the trainer that my goal is to fall down less. For real!! So we’ll see how much strain I put on the Portuguese health system. Hopefully, a lot less than I did in the US!!


  5. As I have been studying the healthcare system for the past several years, I have come to the conclusion of scalability. European countries can manage great national healthcare systems because they are small. The United States and it’s 300+ million residents becomes increasingly complex to cover. Also, most Europeans are heavily taxed to cover social welfare programs. It’s not uncommon for European citizens to be taxed upwards of 50% of their income. This would not fly in the U.S. The Affordable Care Act is a good start, but it made the mistake of doing to much too soon. It also doesn’t help that we have leaders in office that are more willing to spend money on killing bad guy’s then covering it’s citizens. So until there is a radical mind shift in the people of the this country, we are doomed to be stagnant. ¯\_(ツ)_/¯


    1. You are absolutely right, Matt. But something has to be done. The current model is not sustainable and too many people are still in need or are being financially ruined by the cost. I don’t have the answer, but I truly hope something changes soon.


  6. As a Canadian, the whole healthcare debate is so interesting. When we hear of Canadians moving away from the country, I always wonder how they handle health care in their new country. I guess we would see it as an additional expense from our norm.


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