Healthcare in Portugal: the SNS, the three ways in and the taxas moderadoras that are almost gone

Yes, as a Dutch national you enter the Portuguese public system, the SNS — but through one of three doors, and which door decides who pays the bill. If you work in Portugal, your cover runs through the Segurança Social. If you come with a Dutch pension or benefit, you are obliged to arrange healthcare through the CAK and you join with an S1 form. If you come on your own means, you insure yourself, because the law demands that of anyone who does not work. What it costs after that is modest: the co-payment, the taxa moderadora, has been abolished at the GP and for tests ordered in primary care. The trap is at the front: you get your número de utente at your first visit to a centro de saúde, but the number gives no cover — the government says so itself.

Which of the three routes is yours?

Situation	Counter	What you bring	Who pays
You work in Portugal, employed or self-employed	Segurança Social, via your employer or your own registration	your NISS	your contributions run through work; the SNS covers you
You come with a Dutch pension or benefit	the CAK beforehand; in Portugal the Centro Distrital of the Segurança Social	the S1 form from the CAK	the Netherlands, through the treaty contribution withheld from your pension
You come on your own means and do not work	an insurer of your choice	a policy that covers you in Portugal	you

The law behind this is Lei 37/2006, article 7: as an EU citizen you may stay longer than three months if you work, or if you have sufficient means "and health insurance". So whoever comes on savings cannot do without a policy — not for healthcare, and not for the registration with the municipality either.

How does the S1 from the CAK work?

Whoever moves to a treaty country with a Dutch pension or a Dutch benefit is obliged to arrange healthcare through the CAK; the Dutch basic insurance ends on departure. Preferably give your moving date to your health insurer two months before you leave, register with the CAK, and it assesses within at most four weeks whether the scheme applies to you. If it does, the CAK sends you the S1 form.

In Portugal you hand that S1 in at the district office of the Segurança Social — the Centro Distrital de Solidariedade e Segurança Social — and not at the centro de saúde. After that you are in the SNS like any resident, with the Netherlands as payer in the background: the treaty contribution is as a rule withheld automatically from your pension or benefit. Family members without their own income go on your application; the Portuguese system decides whether they are co-insured.

If you leave before your AOW age, watch the date. The CAK route is expected to remain open from 1 November 2026 only to new registrants with a statutory benefit. Whoever brings only an early retirement pension or an RVU payment then falls outside it and insures themselves until AOW age. Whoever is already a client keeps their rights — what exactly changes.

Where does your health number come from, and what is it worth?

Portuguese nationals get their número nacional de utente automatically with their identity card. For foreigners the number is assigned at the first visit to a public healthcare unit — a centro de saúde or a hospital. With it you register at the centro de saúde, and the government adds: preferably choose the one in your own area, and if you have no number yet, you get it at the moment of registering.

What the government also says, literally: assigning the number does not guarantee that the SNS covers your healthcare costs. The number identifies you; the cover comes from the route above. So arrange the cover first and then get the number — on a quiet Tuesday, not on the day someone has a fever.

What do you pay at the doctor?

Less than you think. The health framework law of 2019 lays down that the taxas moderadoras are waived in primary care and, if the referral comes from the SNS, beyond it too. Since Decreto-Lei 37/2022 consultations and all prescribed tests in the primary care network are actually exempt. What remains in co-payments sits mainly with care you go to without a referral, such as the emergency department.

There is also an income exemption: a household with an average monthly income up to € 805.70 (in 2026 one and a half times the IAS of € 537.13) pays no taxas moderadoras at all, and that is automatically reassessed every year before 30 September on the basis of your tax return. Always exempt are, among others, children up to and including twelve, pregnant women and anyone with a disability of 60% or more.

What the public system does not take away are waiting times for specialists; many residents take a supplementary private policy for that. That is a choice, not an obligation — and an item for your monthly budget. In the roadmap for Portugal healthcare is a step of its own, with the S1 and the centro de saúde in their place in the order.

In Vertrekklaar this is phase 5 of 5 of the journey, step 5.2: the same steps, but for your situation — in your order, tickable, and with the deadlines watched. See the whole journey to Portugal or go straight to step 5.2 in the open plan.