Portugal's governing parties are pushing a fresh bill that would end free access to the national health service (SNS) for foreigners who don't live in the country. The PSD and CDS-PP have re-submitted amendments to the Basic Health Law that lapsed when early elections were called, reviving a proposal that previously passed a general vote with the support of CHEGA.
Under the new text, SNS beneficiaries would be Portuguese citizens plus foreigners legally in Portugal — including EU nationals, third-country nationals with temporary or regular stay, stateless persons and asylum seekers. Anyone in an irregular situation, or simply not resident in Portugal, would have to pay for treatment, show proof of healthcare coverage, and provide documents for identification. The bill also introduces mechanisms to collect charges up front, including demanding a guarantee or advance payment in some cases. One carve-out survives: emergency and urgent vital care would still be provided — but patients would need to produce proof and paperwork afterwards.
The parties behind the bill point to a report from the Inspectorate-General of Health Activities dated 27 November 2024. It found that between 2021 and September 2024, roughly 330,000 foreign nationals who weren't resident in Portugal were treated in SNS hospital emergency departments — and more than 140,000 of them had no insurance or international agreement covering the care. The trend, the report says, is growing.
The money involved isn't trivial. In the Algarve's Local Health Unit alone, over €1.23 million in emergency care for uninsured foreigners went uncollected across 2023 and 2024. Nationally, unpaid debts from non-residents are estimated to cost the SNS well over €5 million a year. The bill's sponsors argue the current Basic Health Law — shaped by the PS and the parliamentary left — opened the door to the problem by including third-country nationals and migrants among SNS beneficiaries even before their status was legalised, and frame the change as a matter of 'sustainability of the Welfare State and social cohesion'.
Why should holidaymakers care? Because it signals a direction of travel: Portugal is tightening the rules on who gets state healthcare for free. Tourists from the EU can currently rely on the EHIC/GHIC for medically necessary state treatment during a visit, and that's the route the bill effectively pushes non-residents towards — proof of coverage or payment. For non-EU visitors, including Britons and Americans without a reciprocal arrangement, the assumption of free emergency treatment was never guaranteed, but enforcement looks set to get stricter, with hospitals potentially asking for payment guarantees before care outside true emergencies.
Practical upshot for anyone planning a Portuguese break: carry your EHIC if you're eligible, check whether your travel insurance covers medical treatment in Portugal, and keep documentation handy in case hospitals start asking. The bill is still a proposal, not law, so nothing changes immediately — but if it passes, the era of quietly relying on Portuguese A&E as a tourist will likely be over.
