Private Health Insurance in Bulgaria

@margatumbarello

Bienvenido a Bulgaria!

We spent some years in Argentina and Chile, and catching that looooongggg bus ride over the Andes. We had an apartment in San Telmo, Buenos Aires, and very much enjoyed the food and culture there.

Bulgaria has a public healthcare system that you can be part of, if you make your social security contributions (from being employed, self-employed, or unemployed). It's very decent, so you don't necessarily need a private healthcare policy. You can also pay a little extra to get private treatment.

For example, the unemployed contribution is about 25 leva/month, about 12 euros.

I have a very nice private hospital (Pulmed) near my apartment in Plovdiv, and I've gone there a few times for minor issues. I haven't used either the state system or a private insurance policy. Even the private patient off the street price is very inexpensive, I was surprised.

There is a common policy here, Health Insurance for Foreigners, which is pretty inexpensive (less than 100 euros). This is just an emergency cover, rather than a true private health insurance. This is what you get to show immigration (for D visa or residence application) to show that you have medical cover, and Bulgaria won't have to pay for you.

Bulgaria's a nice country with a low cost of living, and probably one of the easier countries in the EU to get into. For non-EU citizens, usually the easiest options are student or retiree... but there are other categories, of course. If you have a business in Argentina or Ecuador (more than 2 years old, in good standing) then it's fairly straightforward to do a TRO (Trade Representative Office) here, and get residence on that basis.

I would suggest you could also consider two other countries. Our neighbor, Serbia, is not currently EU, but is expected to join in the next couple of years, so I think it's a good potential "back door". It is currently very easy to get Serbian residency on the basis of buying a property (no minimum price specified), or starting a business (by incorporating a Serbian company and opening a business bank account).

The other one is Spain, as I'm sure you know they have quite a welcoming approach to Ibero-American citizens, with many Argentines there. In particular, the Ibero-American exception allows you to gain a passport after only 2 years. Whereas Bulgaria is more typical of the EU, with 5 years to gain permanent residence, and then another 5 years to qualify for citizenship.

We have Bulgarian and Spanish residence. We applied in Bulgaria first, and once we had it we went to Spain and applied there. My partner is applying for her Spanish passport this year.

But... the passport doesn't really matter. If you are legally resident in Bulgaria (or other EU country) for 5 years, you qualify for permanent residence. This allows you to live and work in any EU country, pretty much on the same basis as EU citizens (apart from right to vote).

"This allows you to live and work in any EU country, pretty much on the same basis as EU citizens (apart from right to vote)"

I have been trying to research this but couldn't find clear confirmation that with permanent residence in one EU country you have freedom of movement to the rest of the EU? I thought you only had this if you were a citizen of an EU country.

Also just to add I also didn't think you could have two EU residence permits at the same time (because you can only be a resident in one place at a time).

Thanks in advance.

@Zooldrool

You're quite right, there is a lot of confusion about "residence".

Physically, we can clearly only be in one country at a time. Fiscally (your tax residence), you will typically be paying tax in only one country (although it can happen that you become liable in more than one). This is normally the country where you spend more than 183 days in the year (and/or have your "centre of interests").

Being a "legal resident" of a particular country is typically considered to be when you hold an official residence permit for that country, as opposed to holding a visa, or visiting visa-fee (as UK citizens can do in EU countries), or even overstaying your visa/visa-free period.

You can hold many residence permits, with no problem.

I held residence permits for Panama, Chile (non-EU) and Bulgaria, Cyprus and Spain (EU). My colleague held them for Bulgaria, Cyprus, Spain, France and Italy.

In the EU, they are divided between "temporary" (the initial ones given when you first apply, typically 5 years for EU citizens, 1 year for non-EU citizens), and "permanent" (afer 5 years). The permanent one is called the "Long Term Resident's EC Residence Permit".

While you can have many temporary residence permits from many EU countries, you can only hold one permanent residence permit in the EU at a time.

However, to add to the confusion, I can confirm that my colleague, as mentioned, just received his permanent residence permits in France and Cyprus. They were issued for 10 years. But... they were special permits issued under Article 50, the Brexit Withdrawal Agreement. These appear to be permanent residence permits within the specified country only, rather than the typical EU permanent residence permit mentioned above.

I believe that UK citizens who move now (i.e. after Brexit) to an EU country, and obtain a temporary residence permit (as a non-EU citizen), will still be on track to get the permanent EU permit as described above.

@Zooldrool

You're quite right, there is a lot of confusion about "freedom of movement".

As you say, most people know that the EU directive on Freedom of Movement allows EU citizens to live, work, study and retire in any EU country. There is some bureaucracy involved, and you still go through the process of applying for a temporary residence permit (if you intend to stay more than 90 days there), but it's a formality.

The EU citizens directive is:
"Directive 2004/38/EC on the right of EU citizens and their families to move and reside freely within the EU"

Now that the UK has left the EU, British citizens have to apply as non-EU citizens, which is significantly more challenging. And the non-EU citizen temporary permit is usually issued for only 1 year, initially.

Many people think this directive applies only to EU citizens.

However, the EU's view on "social integration" and freedom of movement also applies to non-EU citizens, after they have legally resided in the EU for over 5 years.

So there is a similar directive for non-EU citizens:
"COUNCIL  DIRECTIVE  2003/109/EC concerning  the  status  of  third-country  nationals  who  are  long-term  residents"

In particular this says:

"Legal framework:
The Directive on the status of non-EU nationals who are long-term residents sets the conditions under which non-EU nationals can obtain the status of long-term residents, which grant them a set of uniform rights, similar to those enjoyed by EU citizens.

Objectives:
- ensure that non-EU nationals who have lived in an EU country for at least five years have a permanent and secure residence status
- grant these non-EU nationals a set of rights that are similar to those enjoyed by EU citizens, in terms of work, education, social security, access to goods and services
- make it easier for these non-EU nationals to move to other EU countries to work and study"

search: Wikipedia long-term resident (European Union)
search: European Commission Long-term Residents
search: DIRECTIVE 2004/38/EC
search: DIRECTIVE  2003/109/EC

[Post deleted]

I really am beginning to loose my faith in humanity. I consider myself Pantheistic and love this world, but to walk a dog and live with a good woman is all I’m starting to trust. I liked the 80’s and was hoping Bulgaria would be a little more in this mentality.

[Post deleted]

Thanks alot, very comprehensive!

Hi, thank you very much for your detailed explanation

I have Italian passport

My first stop will be Sandanski (close to Greece), my daughters have friends there (a french and bulgarian couple) with nice projects, so, I’ll see, I’m a bit of a gypsy, love to move. It seems that there can be something for me there, i was in marketing all my life, now I find speakers for some clients, and I love staging.

My second option after Bulgaria, Italy, a place I love

For now, thank you very much for all your help regarding health. I’ll be in Sandanski september 8

All the best, Marga

@margatumbarello

Italian passport too? Lucky you!

That means Europe is your oyster... and you can easily become a resident in any EU country, thanks to the Directive on Free Movement.

Good luck with your move.

Hi there,

Sorry to bother you again, but it seems that you’re really very well informed.

I’ve seen that money exchange in Bulgaria is really bad.

I’m going with dollars. Very soon the new government in Ecuador will take out the high rate they charge when you pay with debit or credit card abroad.

I’ll open, once there, an international online account like Revolut or similar

Any suggestions?

Sorry again to ask you so many questions like if you were my private advisor

Thank you very, very much

There are a number of other expat members here who are far more knowledgable about financial issues than me. So hopefully they will respond too.

The forums are here for you to post as many questions as you like. It's a pretty big move from Ecuador to Bulgaria (or Italy), so it's natural to have some concerns!

I don't know about the Ecuador credit card tax, but I'm aware of the similar scheme in Argentina, where it's a whopping 30% of international transactions. Naturally, one would prefer to avoid this.

If you decide to stay in Bulgaria, then I think you'll find a local bank account useful. They do multi-currency so you can keep Bulgarian Leva, USD, and Euros. Charges and exchange rates are reasonable. Banking is being tightened up because of EU oversight, but I believe it's still possible to find one or two that will open an account for you based on your passport alone, when you visit here. If not, then they will when you have your residence permit.

The "neobanks" are an interesting development, although I don't know how popular they are here. I have accounts with Revolut and Wise (formerly Transferwise). These have good exchange rates, support lots of currencies, and you can get a debit card for international use. I think they require your passport plus a proof of address (utility bill, bank statement, and so on), but usually account opening is pretty quick and painless. I prefer Wise, but I have a colleague who loves Revolut.

As long as you're out of the Ecuador/Argentina banking system, any of the above options will look pretty transparent and straightforward.

As usual, thanks a lot.

Have a nice week

cost of Bulgarian private health insurance

I just went through my inbox and found a recent quote for a private health insurance from Uniqa.

Private medical care typically gets more expensive based on your age and pre-existing conditions. I'm very healthy, but pretty old. I'd expect you to get a cheaper quote.

Outpatient treatment – BGN 696.88
Inpatient treatment – BGN 485.25
Medical products – BGN 217.50
Dental Care – BGN 439.62
Services related to conditions of life/other additional conditions – BGN 313.20

Total for everything is 2200 leva, per year.

That sounds like a lot, I suspect, but it covers a lot too. Just outpatient and inpatient (which would be the most important cover, I feel) would be just 1,200 leva or about 600 euros. (Also it's for non-insured in BG system. I guess it's less if you are.)

vs. expat international health insurance

Before Bulgaria, I did have a typical private international health insurance for expats. I was a few years younger, but the cost was still around $2,000 annually. This was for inpatient/outpatient only, and had a big $1,000 deductible. If you're a big earner, no problem, but as a digital nomad, I found nearly $200 of monthly insurance expense to be a significant drag on my quality of life.

vs. Bulgarian social security

I decided I would enroll in the Bulgarian social security system, and I pay my 25 leva a month (unemployed) contribution. ($200 -> $15, yay!) To date, I have not used any public health service, and I haven't found myself a GP, but it's good to know it's there if I need it. I just go straight to Pulmed (my local private hospital in Plovdiv) and they do whatever I need for pretty minimal cost.

medical cost examples

As I'm so healthy, I don't have a lot of cost anecdotes. But I did have a stomach concern where I was 98% sure (thank you Dr. Google) it was nothing, but I was in Plovdiv anyway so I thought I'd pop over the street to Pulmed to find out for sure. I went to the emergency room (it wasn't an emergency, but this is the easiest/quickest way to get a consultation with a doctor). We had a short chat and a cursory physical, and he was 99.8% sure it was nothing.  But he'd do some tests to be sure. So he did blood pressure... ultrasound exam... EKG... and a blood panel. In the USA, you'd pay thousands to show up in the ER... and all the tests would be massively expensive. I was out in 30 minutes and they charged 150 leva (and this is in a brand new private hospital).

I also visited Tokuda/Acibadem Hospital in Sofia recently, and it seems to be a very nice private hospital (I'd guess one of the best in Bulgaria). I was inquiring about knee and hip replacement surgery. It was 30 leva for an x-ray, and 100 leva for the consultation.

They confirmed that I would be covered by the Bulgarian health system for the standard hip/knee replacement packages (i.e. free, a good deal).

I wanted the deluxe option with a private room and rehabilitation... plus a top-of-the-line hip implant for athletes. This kind of implant alone is around 3k euros. They said I could pay for this implant, and for the VIP treatment package... and they would receive the standard Bulgarian allowances for the operation and the prosthesis. It netted out at an extra couple of thousand euros for me to pay. And obviously I could do it whenever I wanted.

For hip operations this is a very sweet deal.

The NHS (UK) will also give you a replacement (standard implant) for free, but will usually make you wait a long, long time (there's the time your doctor takes to decide that you really, really need the operation, which can be years... plus the wait time for the consultation with the fancy surgeon can be months... plus the wait time to schedule the operation can be months). Private UK hip replacement is around £15k without deluxe implants or fancy rehab. USA is the home of nutso medical prices, so it can be $25k to $100k. There's a fancy clinic in Lithuania (Nordorthopaedics) which will do the same implant for under 10k euros all-in (private room + implant + op + rehab).

[Post deleted]

As a German, living in BG, I can not comment regarding the standard, public health insurance. However, up to now I always payed medical treatment in cash, besides some dental work, for which my German insurance payed almost everything. As an example, I consulted an orthopaedic specialist at the Univeristy clinics in Burgas/Vetren, because of some pain in the knee. I payed 130 Lv. for X-Rays and consultation. The testing of my eyes for new glasses was 30 LV., which is a standard fixed price for doctors consultation, whereas 50Lv. to be payed for a "specialist", whatever the difference. 2 full ceramic crowns, replacing broken, old ones, were 1100 Lv.
So, I suggest to take the cheap, official Bulgarian health insurance for a few Lv., for emergencies, and just to pay cash.
The only general problem for a foreigner requesting medical treatment in Bulgaria might be the language. Fortunately, the Orthopedic did not speak English or German, so we had to communicate in Russian language.