In Portugal, she and her family pay for coverage a fraction of what an equivalent American plan would cost. “We didn’t realise how shredded the United States’ social fabric was until we got here,” she says.

According to William Russel, Across the United States, Americans pay wildly different premiums monthly for health insurance. The average annual cost of health insurance in the USA is US$7,739 for an individual and US$22,221 for a family as of 2021, according to the Kaiser Family Foundation – a bill employers typically fund roughly three-quarters of.

Health care is substantially cheaper in Portugal

They go on to say, that the raw cost of treatment is higher in the USA than in many countries, so this influences the cost of insurance. There are several reasons for this cost gap:

Pharmaceutical drugs, for instance, cost nearly four times more in the USA than in other similar countries.

American doctors and nurses enjoy some of the world’s best pay – the average registered nurse in California earns US$113,240 – so this also drives up costs.

The American system also tends to favour more frequent interventions and complicated procedures, which comes with a price tag. In other words, some treatments might be considered unnecessary.

The cost of private health insurance

Americans pay more for healthcare per person than any other developed country ($9,892 in 2016), with Switzerland ($7,919) and Canada ($4,753) in second and third place. For example, the average hospital bill without insurance for a one-night stay in a US intensive care unit might cost you $5,000 or more – while a similar hospital stay in a Portuguese private hospital might cost you at least 75% less.

Compare this with the cost of private health insurance in Portugal. Medis, the leading insurer is dramatically less expensive. A fifty-year-old can get a basic plan for 23.11 Euros a month. A more comprehensive plan, the Medis level two would cost, 72.58 Euros a month. You can check prices for your age group here. Just enter your age to see what plans are available and what cover you get for each plan.

“We felt the tension lift” within weeks of leaving America, agrees Sylvia Johnson, a psychiatrist who moved to Lisbon in 2022. For Ms Johnson and her family, who are black, the central issues were racism and violence. She had been trying for years to persuade her husband Stanley, a lawyer, to move abroad. The strife after the murder of George Floyd in 2020 brought him around. He recalls saying: “‘I think we need to get a gun.’ When I said that out loud, I was like, if I have to live in a country where I need a gun to protect my family, then this is not the country for me.”

Tax is another attraction

In Portugal, a residential visa requires an income of just 150% of the national minimum wage, or about €1,100 ($1,190) a month—an easy hurdle for American retirees. Foreigners can pay a 10% flat tax on “passive income”, such as investments or a pension.

Private healthcare is booming in Portugal and with the reasonable cost of medical insurance it’s a very attractive proposition. In the Algarve, there are hospitals and clinics offering immediate access to a doctor on a 24/7 basis everywhere. Even without insurance, the cost of a consultation is very reasonable by international standards. The major group is HPA and they have three hospitals in the Algarve plus ten clinics and speciality units.

Lisbon and Porto also have some world-class private hospitals, offering every type of surgery and treatment. Although not on offer to health tourists, one or two of the public hospitals are performing revolutionary operations. The husband of a staff member had his stomach cancer treated in Porto by the removal of his stomach, very successful and one year later, clear of what was thought to be an untreatable cancer.

In Lisbon and Porto the best-known group is CUF, which have 18 hospitals and clinics. They have been established in private health care for over 75 years and have a very good reputation for their treatments and specialities.

World-class private hospitals

Most of these hospitals are modern, high tech and equipped with the very latest technology. Portuguese doctors and surgeons are highly trained and extremely skilled. Virtually every health care you may come into contact with will speak fluent English.

Look at the cost of healthcare in Portugal and compare it with what health care and insurance costs in America and it’s no surprise this is a major factor for moving to Portugal. Add to that the fact that in today’s world, you can work from almost anywhere, and Portugal has excellent high-speed internet almost everywhere.

Add all this to stability, low crime rate, excellent international transport, widely spoken English and superb weather and you can understand why Portugal has many attractions for Americans.

PS. And you don’t need to carry a gun!


Resident in Portugal for 50 years, publishing and writing about Portugal since 1977. Privileged to have seen, firsthand, Portugal progress from a dictatorship (1974) into a stable democracy. 

Paul Luckman