Medical Milestones

I was going to have a food article today, but I thought it might be more interesting to talk about what it’s like to navigate the health care system here in Portugal.

Healthcare was a major factor in our decision to move. It has actually colored most of our thinking about retiring out of the United States for decades – with the ridiculous cost of health care in the US, we realized it would be a challenge to afford to stay in the country.

When I obtained Portuguese citizenship, this simplified things. Portugal has pretty comprehensive National Health, and as an EU citizen I have benefits throughout Europe – even if we should decide not to live in Portugal permanently, we have plenty of good options. Kristie’s citizenship is in the works (it’s actually a little late in arriving, but hey, COVID …)

National Health, although good, isn’t perfect. Like many other things here, there are a lot of bureaucratic hoops to get through. After four months, I have finally been assigned to a clinic, although I don’t have a family doctor yet. This delay was caused in part by mistakes made by my lawyer´s office, in part because I had to get multiple appointments to fix different parts of my records at different agencies, and in part by the pandemic – you have to make appointments which are typically weeks out for everything.

At this time, if I have any serious issue, I can head to the public clinic and they’ll find me a doctor to take care of it. But things like check-ups, routine blood tests, and my arthritic hip would just have to wait.

The good news is that what we and many other people decided to do was opt for additional private insurance. Almost every hospital and medical group in Portugal accepts most of the top companies, and the coverage is great.

Once again, it was a bit of a chore getting it set up. We’ve been working with an agent for a couple of months, but we couldn’t even really get started until we got Kristie’s tax ID (another miss by the lawyer’s office). Everything finally rolled into place a couple of weeks ago.

Since we’ve been here over four months, we both had prescriptions which ran out. This had us a little freaked, since we didn’t yet have coverage, but it was actually simple – we just carried the prescription forms or medications themselves with the doctor information into one of the local pharmacies and they filled them with no questions. We paid full retail price, but that was without exaggeration about 25% of US prices, and less on some medication.

So, private insurance is in place now – and it has higher coverage amounts, less exclusions, lower deductible, and lower total out of pocket limits that we had through Nike employee insurance – plus it covers dental and eyes (although at a sliding scale that doesn’t reach 100% for five years). No limit on doctor’s appointments, although you do need to be referred to specialists. Also, the cost of everything medical is very much lower here than the US – this is a medical tourism destination for that reason.

Our total combined annual premium for all this? At over 60 with pre-existing conditions? 3800€, or a little less than the employee contribution for coverage at Nike.

Slight digression – did I mention we bought a car? Originally, we had planned to do without, but after we got the lay of the land, we decided it would be a little too limiting. This means we need to turn in our Oregon licenses and get Portuguese ones at some point (we have two years officially, but we won’t wait that long).

Other paperwork requirements – a clean driving record (check, you can get that online from ODOT) and a medical certificate saying you’re capable if you’re over 60 … which I totally get, but which meant a visit to the doctor!

So, last Monday, armed with our new policy numbers, I contacted the insurance company to make appointments for us. I spoke with a very helpful woman who got us in to see a doctor at a nice shiny new hospital two blocks from our flat on Wednesday morning – she apologized about not getting us in on Tuesday, but it was a national holiday!

Kristie and I had separate one-hour appointments with the doctor, got to discuss current health and get prescriptions refilled and written. I got my driving certificate, although Kristie couldn’t get hers yet because she doesn’t have a National Health number (I’m suspicious of this, so I’ll be following up, but worst-case scenario we just wait for her citizenship to arrive). Kristie got scheduled for blood tests next week. Total combined fees for visit – 60€.

I mentioned my hip pain, and the doctor saw me wincing when I stood up, so she referred me to an osteopath – appointment Thursday afternoon!

The osteopath gave me a quick exam and then personally walked me down to the X-Ray lab. 20 minutes later I was back in his office, where he was already looking at the electronic versions of the pictures that I was hand carrying back to him. The bad news is that I will need a hip sooner or later, although I’m going to delay that for at least a little while. The good news is that I got a cortisone shot and some new medication which seems to be helping. Total for this visit, including X-rays, exam, and injection – 38€.

When I get the hip done, it will be a four or five day stay in the hospital – they won’t let me leave until I can get out of bed by myself, dress myself, and go to the bathroom by myself, which has Kristie very relieved. I’ll use a cane for a couple of months but should be driving again within a month. I don’t have an exact amount all this will cost, but a retail hip replacement here only costs US$10,000 … my guess is I’ll be out of pocket less than 2000€, but I’ll update you all on that when it happens.

One final complication – flu vaccines. We weren’t able to get these from the doctor, although we did get prescriptions so that the insurance pays for them. Pharmacies were all giving shots, but since it’s a little late in the season they’ve all run through their supplies. I’ve sent a message to my health clinic, which will have vaccines for sure, but I need to wait for them to respond. We’ll probably have to pay for Kristie’s if we don’t want to wait (we don’t!), and we also want to try and get on the priority list for the COVID vaccine that they’re going to start giving out before the end of the month. Portugal bought 18 million doses for a country with 10 million people!

So, all in all, we’re feeling pretty good about the health situation. National Health is slow and complicated, but a great fallback. Private insurance is quick, thorough, and cheap – the way health care ought to be.