Sick in Portugal without insurance: what to do first
Life in danger: call 112.
Ill, but not an emergency: call SNS 24 on 808 24 24 24. Clinical help runs 24 hours a day, every day, and the call is free.
"My husband is in Porto with a very high fever, no other symptoms, no insurance. Where do we go?" A question like this appears in expat groups almost every week. Here is the order that works in Portugal, and what it can cost if you are not, or not yet, in the national health service (SNS).
1. When to call 112 straight away
A fever on its own is common and usually not serious. Some signs are different. Health services list these as warning signs of sepsis in adults, and they mean an ambulance, not a phone line:
- breathing very fast or struggling to breathe;
- confused, slurred speech, or not making sense;
- blue, pale or blotchy skin, lips or tongue;
- a rash that does not fade when you press it;
- a very high or very low temperature, feeling cold to the touch or shivering hard.
If you go to hospital yourself in that state, do not drive. Ask someone else to drive or call 112.
2. Otherwise, call SNS 24 first
SNS 24 is the health service's phone line for problems that are not an emergency, and fever is one of the examples it gives. A professional asks questions and then sends you to the right place: care at home, a health centre (centro de saúde), the hospital emergency department, or INEM if it turns out to be an emergency.
Have ready the address where you are, the person's age, how long the fever has lasted, the highest temperature measured, medicines taken and any illness they already have.
Calling first is not only about advice. For people covered by the SNS, the hospital emergency department is the one place that still charges a user fee (taxa moderadora), and that fee is not charged when the SNS referred you there, for example through SNS 24, or when you are admitted to hospital from the emergency department.
3. Health centre, public hospital or private hospital
Health centre. Primary care. This is where most fevers end up after a call to SNS 24, and where you will later register for a family doctor.
Public hospital emergency (urgência). For serious cases or when SNS 24 sends you. Patients are seen by priority, not by arrival, so a mild case can wait for hours.
Private hospital or clinic. Open to anyone who pays, with no referral. Without insurance you pay the whole bill yourself. Ask for a price estimate before tests, because a night with scans and blood work adds up quickly.
4. What it costs if you are a foreigner
Resident with a número de utente: SNS care has no user fees except at the hospital emergency department, and even there none with an SNS referral or admission.
Resident still waiting for a número de utente: the hospital may bill the full cost, but only if, within 10 days of being asked to pay, you cannot show that you have the card or have applied for it. Keep that proof.
EU visitor with an EHIC: the same rights as people insured in Portugal.
UK visitor with a GHIC (or a UK EHIC still valid): medically necessary state care on the same basis as a resident.
Other visitor without insurance: you are not an SNS beneficiary, so the hospital bills the cost of the care given, at SNS prices.
Foreign residents have the same access to the SNS as other beneficiaries and follow the same rules on user fees. To get a número de utente you need your residence document: how to get your SNS number.
Urgent and life-saving care is given to foreigners even without papers. Being uninsured changes who pays, not whether you are treated.
What about paying at the door?
In September 2026 the health inspectorate recommended that hospitals look at charging non-resident foreigners on arrival at the emergency department. A Lisbon hospital group answered that a bill cannot technically be issued before the visit is closed. In practice the bill, if any, comes after the visit: the news in short.
5. Keep every paper
If you have travel insurance, or a card from home that reimburses care abroad, the claim depends on documents. Ask for, and keep:
- the invoice (fatura) in the patient's name, with passport number or NIF;
- the discharge note or clinical report, with the diagnosis;
- every prescription and pharmacy receipt;
- proof of payment: card slip or bank statement;
- taxi or transport receipts if your policy covers them.
If your insurer has an assistance line, call it before you pay a private hospital. Some policies only cover what they approved first.
Traps to avoid
- Skipping the call. Walking into the emergency department without an SNS referral can cost you the user fee that a call to SNS 24 would have avoided.
- Using the EHIC in a private hospital. The EHIC does not cover private healthcare.
- Treating the EHIC or GHIC as travel insurance. Neither replaces it, and the EHIC does not pay for transport home after a serious illness.
- Ignoring a bill while your SNS number is pending. Answer within 10 days with proof that you applied.
- Waiting too long. If the person gets worse, drowsy or confused, call 112 rather than calling SNS 24 again.
How the public and private systems fit together: healthcare in Portugal for expats. Choosing a policy before the next time: insurance in Portugal.
Guidance, not legal or tax advice — verify your case with official sources.