Health Insurance for a Family of Five in Portugal: Real Quotes From €3,200 to €39,600 a Year

We’re a family of five living in Cascais: two adults in their thirties and forties, two school-age kids and a baby. I asked four brokers to quote all of us for a 1 November 2026 start, with a simple brief: full cover in Portugal and abroad, and free choice of doctor. Abbeygate, Adler & Rochefort, GED and Winsurance all came back within a few days.

The answers ranged from about €3,200 a year to almost €40,000. Most of that spread comes from two policy details that never make it into the brochure, so I’ve laid out what each plan costs and what it actually buys.

Every figure below is an annual premium for all five of us, taken from the insurer’s own simulation or quote document. Where two brokers quoted the same plan, their numbers matched to within 1%. Your premiums will differ with ages, and none of these quotes is binding until the insurer underwrites the policy.

Why Most Portuguese Plans Can’t Offer Free Choice or Real Cover Abroad

Portuguese health plans advertise “livre escolha” (free choice) and “cobertura internacional.” Both sound like what I asked for, and neither means it.

Free choice outside the network is paid as a percentage: Multicare pays 60% of out-of-network hospitalization, MGEN and Victoria Universal TOP pay 50%. Surgeon and anesthetist fees are then capped at a fixed euro value per “K,” the unit in the Ordem dos Médicos fee nomenclature, and the version still in use dates from 1997. At €6.75 or €7 per K, the cap covers a fraction of what a Lisbon surgeon invoices today. Médis skips the K mechanism and pays a flat 35% out of network, so a €120 specialist visit at CUF gets you about €42 back.

The cover abroad is the bigger problem for anyone who travels. The Médis general conditions limit cover abroad to accidents or sudden illness during stays of up to 45 days, and suspend it entirely for any longer absence, backdated to the day you left. Multicare’s travel assistance stops at 60 days, MGEN’s and Allianz’s at 90.

What the market calls international cover is usually a serious-illness benefit: treatment abroad for a closed list of conditions like cancer, neurosurgery or a transplant, at a center the insurer picks, after prior authorization, with pre-existing conditions excluded. It’s a good benefit, but it isn’t health insurance abroad. I covered the other exclusions, oncology especially, in the gaps that matter most in Portuguese health insurance.

Plans That Meet the Brief

The Victoria prices include a 15% household discount. The Cigna quote has no deductible and is indicative until underwriting. The IMG quote came as a one-page price summary with no benefit schedule, so I can’t yet confirm its outpatient limits or whether it allows free choice.

Victoria Saúde Executive is the one domestic plan that qualifies

Its coverage table pays 100% in network and 100% out of network with no annual ceiling. The territorial clause covers care abroad for anyone domiciled in Portugal, with no day limit and no restriction to accidents or sudden illness, so planned treatment abroad is in scope. Inside the Future Healthcare network the hospital bills Victoria directly. Outside it you pay and claim back.

The €1,200-excess option costs €6,400 a year less than Cigna Silver and covers maternity, which Silver doesn’t. It saves €3,411 a year over the no-excess option, and the excess never touches in-network care or a hospital stay. The quote doesn’t say whether that excess is per policy or per person, and the answer decides whether the trade is worth it: per policy, the worst case is €1,200 a year; per person, it’s €6,000. Get it in writing before choosing.

Victoria has two weak points. Out-of-network surgeon fees are still capped, at €9 per K, though that cap sits on top of 100% cover rather than 60%. Renewal also isn’t guaranteed on the same terms: each year Victoria can propose changes to covers, copays and premiums on 30 days’ notice, and refusing them ends the contract.

The Other Approach: An International Plan That Includes Portugal

Everything above starts from a Portuguese policy and asks how far it stretches abroad. International private medical insurance starts from the other end. It’s built for people living outside their home country, it covers the world or a region you choose, and Portugal is simply your country of residence inside that area, covered in full.

That removes both problems with the domestic plans. There’s no day limit on time abroad, because being abroad is the point of the product. Free choice is the default: the Cigna Global customer guide says that outside the US “you can select a provider of your choice,” the Allianz Care benefit guide says members are “not restricted to using the providers listed in our directory,” and the AXA Global Healthcare benefit summary sets no network condition outside a few UK facilities. Bupa Global and William Russell market the same model, but I couldn’t get their policy wordings to confirm it.

It costs more, and the area of cover sets how much

Healthcare in Portugal is cheap by Western European standards, so a local insurer prices against local hospital tariffs. International insurers price by area of cover and a country-of-residence zone, and Portugal sits in a cheaper zone (Zone 4 on Foyer Global Health‘s rate card). What pushes the premium up is the area of cover. A worldwide plan has to price the risk of you being treated in Switzerland or the US, and including the US is what drives a premium into the tens of thousands.

Our quotes show the spread. Cigna Global ran from €19,769 for Silver to €39,634 for Platinum, against €3,200 to €8,400 for the Portuguese network plans. A Europe-only plan closes most of that gap: IMG Global Prima came in at €7,917 to €14,332. Foyer’s published rates for a family like ours run €10,068 to €21,744 a year with no excess, and €5,904 to €15,276 with a €1,000 excess.

If you rarely go to the Americas, ask for Europe-only cover first. Allianz Care added a Europe-only area when it replaced its whole individual range in November 2025, with plan limits of €1M, €2M and €3.7M per person a year. Most comparison articles online still describe the old range. I’m waiting on Allianz Care and AXA quotes.

What to check before buying one

Check direct billing at the hospitals you’ll actually use. Allianz Care, Cigna and AXA all direct-bill at Hospital da Luz Lisboa. Foyer doesn’t appear by name on the payer lists at CUF, Lusíadas or Hospital da Luz and routes billing through an assistance company, so inpatient stays are billed directly but you’d front the cash for routine outpatient visits and claim it back.

Ask for moratorium underwriting. The IMG quote assumed full medical underwriting, which turns anything you disclose into a permanent written exclusion. A moratorium sets aside the last five years of history and covers those conditions once you’ve gone two years without symptoms or treatment.

Check maternity waiting periods. Cigna Silver has no maternity cover at all, and Gold and Platinum only pay after 12 months on the policy.

Read the policy wording before trusting a price. The IMG quote was a one-page summary with no benefit schedule, so I can’t yet say what it pays for outpatient care.

The other advantage is portability. An international plan moves with you if you leave Portugal, while a domestic policy ends when you do.

Network-Based Portuguese Plans

Where a range appears, two brokers quoted slightly different figures. The Médis prices include its current offer of two free monthly premiums.

For most families living in Portugal and traveling a few weeks a year, one of these covers what goes wrong. At about a quarter of Victoria Executive’s price, the gap pays for a lot of out-of-pocket care.

Cancer drug cover differs more than the price suggests

Médis Option 3 covers chemotherapy and drugs given in hospital, with a 10% copay up to €500, but not cancer drugs you collect from a pharmacy and take at home. Allianz Saúde Total covers those for adults up to €1M after a 180-day wait. MGEN covers oral cancer drugs taken at home, with a 10% copay per pack on Ideal and none on Total. Multicare Vital has unlimited oncology cover, though GED notes that some of that plan’s other copays are higher. If you only compare one thing beyond price, compare this.

MGEN accepts pre-existing conditions, after a year

MGEN is a mutual with no medical questionnaire, no age limit and no individual premium loading after claims. Pre-existing and congenital conditions are covered after 365 days. It was the only insurer on our broker’s panel that accepts pre-existing conditions at all. In the first year, though, hospitalization carries a 30% copay with a €500 minimum, except for childbirth.

Médis Option 3 also carries a separate €75,000 international benefit: the Clínica Universidad de Navarra at 100%, Barcelona Centro Médico, Deutsches Herzzentrum Berlin and Johns Hopkins at 80%, and any other centre abroad at 60%, after a €1,500 annual deductible per household. GED describes a cancer protocol at Navarra with unlimited expenses and no copay, while Adler & Rochefort lists the 10% copay for cancer drugs given in hospital, so check which benefit applies to which treatment.

MGEN asks for a long commitment

Winsurance, which also quoted MGEN, says all household members must join together on the same plan, the annual contract renews automatically, an upgrade is only possible after three full years and subject to approval, and someone who cancels isn’t accepted again. It describes the pre-existing cover as no exclusions within the mutual’s rules, while Adler & Rochefort quoted the 365-day wait, so ask for the exact clause in writing.

Travel Cover Is a Separate Purchase

Both Winsurance and Adler & Rochefort describe the cover abroad on Portuguese and international plans as basic, limited in practice to emergency treatment, and Winsurance recommends an annual travel policy on top for anyone who travels often, with unlimited medical repatriation and accident expenses. IMG is one of the few health plans with a travel assistance component, but its repatriation goes to the nearest appropriate facility, not to your country of residence.

GED sells an optional family protection add-on for €24.48 a month for the whole family. It pays up to €10,000 of medical bills abroad with a €100 copay, plus emergency transport and repatriation to Portugal, and adds a €20,000 accidental death benefit (€40,000 for a road accident) and long-term disability cover for ages 16 to 64.

Check How the Baby Will Be Covered

Newborn waivers that skip underwriting usually require the mother to have been insured with that company before the birth: eight months for Allianz Care, twelve for Cigna. If you’re switching insurers after a birth, the baby joins as an ordinary dependant and gets underwritten on their own history.

Victoria is the interesting exception. Its pre-existing condition exclusion, congenital anomalies included, doesn’t apply to anyone insured “desde o seu nascimento,” from birth. Whether that holds for a baby enrolled at a few months old is the question I’ve put to our broker, and it’s worth getting the answer in writing before you sign.

Budget for the Ten-Year Cost

Medical inflation is running well above general inflation: WTW projects 10.3% globally for 2026 and Aon 9.8%. International premiums also step up through age bands, and the steps get steep in your fifties. For a top-tier plan around €17,700 in year one, 5% annual trend compounds to about €235,000 over ten years, and 10% to about €300,000.

Buy the tier you can still afford in fifteen years. Trading down later is easy, and trading up after a diagnosis isn’t.

Register With the SNS Anyway

The public system is free, it’s your backstop if a private insurer disputes a claim, and it handles the childhood vaccination schedule. I wrote up the process in how to register with Portugal’s SNS.

It also matters for emergencies. Cascais has no 24-hour private emergency room: CUF Cascais and Hospital da Luz Oeiras both close at 22:00. After that the private options are in Lisbon, 25 to 40 minutes away, and the only 24-hour pediatric and obstetric emergency in the municipality is the public Hospital de Cascais. No premium changes that, so if you’re new here, it belongs on the list in moving to Portugal as an EU citizen.

What I’d Ask Before Signing

• Is the out-of-network excess per policy or per person?
• How does out-of-network reimbursement work in practice, and what does the per-K surgeon cap leave you paying on a typical Lisbon surgery?
• Can I have moratorium underwriting instead of full medical underwriting?
• Does the newborn waiver apply to my youngest?
• With a mutual like MGEN, do all household members have to join together, and what happens if one of us cancels?
• Does the insurer bill directly at the specific hospital units I’ll use, not just the group? CUF expects your insurer to issue a guarantee of payment in advance for non-urgent care, and getting it is your job.

I’ll update this post with the plan we choose and any answers that change the picture.

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