This article covers how to get health insurance for pregnancy as a foreigner in Portugal, as well as all of the blood tests, ultrasounds, appointments, and medication you’ll need and where to get them.
The topics covered in this article are as follows:
- Public health insurance
- Private heath insurance
- Paying out-of-pocket
- My personal experience getting health coverage for pregnancy in Portugal
- A family doctor
- Confirmation of pregnancy ultrasound (before 11 weeks)
- First trimester analysis (9-10 weeks)
- First trimester ultrasound (11-14 weeks)
- Optional non-invasive prenatal test (NIPT/TRUST) (after 10 weeks)
- Second trimester ultrasound (20-22 weeks)
- Fasting Blood Glucose Test (22-24 weeks)
- Second trimester analysis (24-28 weeks)
- Third trimester analysis (around 32 weeks)
- Third trimester ultrasound (32-34 weeks)
- Final appointment (around 35 weeks)
- Medications and Vitamins
Is my pregnancy covered by health insurance?
1. Public health insurance and the numero do utente
To get public healthcare, you’ll need a numero do utente. Ideally you would also have a cartao cidade. If you don’t have a numero do utente, you can try going to your local centro saude and see if they will help you get one (at least a temporary one). In theory Portugal supports pregnant women, even immigrants, so they should help you do this, but you need to be very polite and patient because if you don’t have a cartao cidade (or at least an AIMA appointment), then this can be tricky, so you really need a nurse or doctor on your side. Some documents/numbers which might help you get a numero do utente would be the NIF or Seguranca Social.
2. Private health insurance (you need to have had the insurance for at least one year before becoming pregnant)
If you don’t have access to public health insurance, private Portuguese health insurance works for pregnancy too; however, you need to have had your private health insurance for at least one year leading up to your pregnancy, so even if you buy private health insurance after becoming pregnant, you won’t be covered. Ideally, if you are planning on becoming pregnant, you would buy private health insurance well in advance of trying to conceive.
3. Paying out-of-pocket
Finally, you can skip the public healthcare system entirely and pay for private healthcare out-of-pocket. The only downside to this option (aside from the cost) is that if you have a medical emergency, you’ll be transferred to a public hospital. In an emergency you will definitely be accepted into the public hospital although you’ll likely have to pay out-of-pocket afterwards. Depending on where you are from, this may still be cheaper than you’re used to. (Portuguese public and private healthcare are both generally cheaper than American healthcare, for example.)
4. My personal experience getting Portuguese health insurance
In my case, I had a NIF and proof that I had applied for Portuguese citizenship (although I did not have an AIMA appointment). It took many patient conversations with doctors and nurses at the Centro Saude, but eventually I was provided a temporary numero do utente. This wasn’t provided immediately and I was well into my second trimester when I finally got my numero do utente, so up until then I was paying for everything out of pocket.
What is a family doctor and what to do if you don’t have one
Now, if you are lucky enough to have a family doctor at a Centro Saude, then your doctor will likely keep track of all of your appointments and necessary analyses. If, like me, you do not have a family doctor (which is quite common even for Portuguese people as there is a shortage of family doctors), then you should try your best to keep track of the appointments yourself. Here are all of the appointments and analyses that you’ll need throughout your pregnancy.
What appointments do you need to make as a pregnant person in Portugal
The timing for many of these ultrasounds and appointments is extremely important, so if you are pregnant in Portugal, start looking for a doctor and/or a clinic now.
Confirmation of pregnancy ultrasound (before 11 weeks)
This ultrasound can be done at any public or private OBGYN. At this appointment the doctor will simply use an ultrasound machine to check that you are indeed pregnant and confirm how many weeks along you are.
The doctor might also give you advice about any vitamins you should be taking at this point in your pregnancy. In Portugal I’ve found that the main vitamins which doctors suggest for pregnant women are iron, iodine, and folic acid.
These vitamin recommendations can be quite different from the suggestions in other countries. For example, I gave birth to my first child in Asia and there the main recommendations were vitamin D and folic acid. Even if you have a prenatal vitamin, you should check the ingredients because the types of vitamins and minerals provided can vary drastically between different brands.
First trimester analysis (9-10 weeks)
This is a blood test which is done after a night of fasting as well as a urine sample first thing in the morning. You need a private or public doctor to provide you with a request for this blood and urine analysis. You can collect the urine sample at home (in a medical collection jar), then go to the closest clinic and have your blood drawn first thing in the morning. This first trimester analysis tests for glucose levels, toxoplasmosis antibodies, iron levels, and a laundry list of other infections and vitamin deficiencies.
You can go to whatever analysis clinic is closest to you. Unilabs is a super common clinic for analyses located throughout Portugal, but any local analysis clinic will do.
First trimester ultrasound and screening for fetal anomalies (11-14 weeks)
This ultrasound confirms the gestational age of the fetus, but more importantly, this ultrasound is performed to check for chromosomal disorders, heart issues, and other anomalies. The chromosomal disorders can only be confirmed between 11-14 weeks of pregnancy, making the timing of this ultrasound crucial.
Unfortunately, this ultrasound can only be performed by specific doctors. If you’re going through the Centro Saude, then your doctor will help you schedule this ultrasound with a specific doctor either in the Centro Saude or at a public hospital who can perform a first trimester ultrasound. If you are going through a private clinic or hospital, then you must call and make it clear that you need a first trimester ultrasound. You cannot make an appointment for a generic ultrasound at any OBGYN clinic. You have to make sure that the doctor doing the ultrasound is specifically trained in first trimester ultrasounds.
Due to the necessity for a specific doctor, it can be tricky to get this ultrasound done in a timely manner. For example, I didn’t know I was pregnant until I was 9 weeks along. I didn’t get my first appointment until I was 10 weeks along. By the time I knew I needed an ultrasound between 11-14 weeks, all of the local clinics and hospitals were completely booked for first trimester screenings and I missed my window of time for the first trimester ultrasound. My friend who is Portuguese was also unable to get her first trimester ultrasound done in a public healthcare setting due to overbooking (from what I understand, the public system really struggles to get first trimester ultrasounds done in a timely manner due to a lack of specialized doctors), but luckily for her she was able to find a private clinic with availability.
If you suspect you’re pregnant, don’t dilly-dally with scheduling your first trimester ultrasound because if you miss the 11-14 week window, then the doctor cannot check for certain abnormalities.
Make sure that when you do complete this ultrasound that you keep the results and take them with you to any upcoming appointments.
Your doctor might still recommend that you do this ultrasound even after the 11-14 week window just to do a general check of the fetus. In my case, the public hospital was finally able to fit me in for a first trimester ultrasound when I was about 20 weeks along, which personally felt a bit silly as I was already going in for my second trimester ultrasound at that point.
Optional non-invasive prenatal test (um teste pré-natal não invasivo or NIPT/TRUST) (Anytime after 10 weeks)
The NIPT, or in Portugal, um teste pré-natal não invasivo or TRUST, is a blood test that checks for trisomy 21, 18 and 13 in the fetus. The test can also tell you whether you are having a boy or a girl if you wish. This test is completely optional and costs 350-600 euros depending on the clinic. Do your own research before deciding whether to take the test. In my case, I opted to pay for the test due to missing the first trimester ultrasound and the fact that I’m an older mother with a history of miscarriage. It cost me 400 euros and I got my results back in about a week.
Second trimester ultrasound (20-22 weeks)
This is an extremely important ultrasound in pregnancy and is often called the anatomy scan or morphological scan. In this ultrasound the doctor will do a detailed check of the fetus from heart to brain to toes and facial features. The doctor will also do a detailed check of your womb including the placenta and amniotic sac. Once again, only certain doctors are qualified to do this check, so if you are scheduling this ultrasound yourself, make sure that you are very clear with the receptionist that this will be your second trimester ultrasound scan. The timing of this scan is very important.
In my case, I didn’t want to miss this scan after missing the first trimester ultrasound, so when I was about 15 weeks, I called several private clinics until I found one with a doctor qualified to do the second trimester ultrasound and I scheduled the ultrasound for exactly 20 weeks. It cost me 100 euros to do the scan privately. I could have gotten the scan done for free in the public hospital, but with long wait times for those scans in my area, I was nervous to once again miss the narrow window of time for this ultrasound.
If you do the scan privately, then be sure to bring the results with you to your next appointment with your “main” doctor at either your public or private clinic.
Fasting Blood Glucose Test (24-28 weeks)
This test is to check for gestational diabetes. Your doctor (public or private) will help you sign up to take the test and tell you where to go for it. In my case I went to the Centro Saude for a check-up and they gave me the paperwork to do the glucose test at the public hospital.
Portugal does the test a bit differently than other countries. In Portugal you must fast starting the night before, meaning you cannot eat or drink after dinner the night before. In my case I was told not to even drink any water leading up to the test. In the morning you will go to the location of the blood test and they will draw your fasted blood. Then you must drink a sugary drink (it tastes like a cold Gatorade or energy drink), and then you have to wait at the clinic for an hour before they draw your blood again. Then you have to wait one more hour before they draw your blood a third time. Then the test is done and you may leave and go get something to eat or drink.
Make sure not to schedule doing much of anything on the day of the glucose test because it took me about an hour to be seen for my first blood draw at the local hospital and then it took another two hours to complete the test, so if you’re working be sure to take the whole morning off of work as the test takes at least two hours to complete.
The upside of this version of the test is that it’s very accurate. The downside is that it makes some women very nauseous. If you throw up at any point during the test, then the test is void and you’ll have to come back and do it another day. If you throw up again on the redo day, then they will give you an alternative test, which is essentially keeping track of your blood glucose level on your own at home through fingerpricking and recording the results yourself.
In my case, despite having nausea off-an-on throughout my pregnancy, I actually felt fine throughout the duration of the test and passed no problem.
Second trimester analysis (24-28 weeks)
For the second trimester analysis, you will once again need to go to a public or private doctor first who will give you a paper to give to an analysis clinic which will tell the analysis clinic what tests they should run. In my case I had my blood drawn for my fasting blood glucose test and second trimester analysis at the same time at the blood analysis center in the local hospital. I got the paperwork for both the second trimester analysis and the fasting blood glucose test at the same time when I went to an appointment at the Centro Saude.
Third trimester ultrasound (around 32 weeks)
This is the final big ultrasound and once again it can only be done by a specifically qualified doctor. I opted again to do my third trimester ultrasound privately and it cost another 100 euros. This final ultrasound is just to double-check that everything is fine with the fetus and preganncy in general. This was the quickest of all my ultrasounds.
Be sure to keep the results at the end of the exam and take them with you to any upcoming appointments.
Third trimester analysis (32-34 weeks)
You will need to get the paperwork for this exam from a public or private doctor. This final analysis is mostly just to follow-up on any prior tests, so in my case, I’ve had low iron for my entire pregnancy and so my doctor wanted to check my ferritin levels. Take the paperwork with you to any nearby clinic, take your blood test, and then bring the results back to your doctor.
Final appointment before birth (around 35 weeks)
Around 35 weeks you will need to make an appointment with a doctor to discuss your birth plan and any other important details about your pregnancy and the upcoming birth. In my case I’ll be having this appointment at the hospital where I will be giving birth. Ask your doctor (public or private) where you should have this appointment and they will help you schedule it.
Additional notes about appointments
As I mentioned, if you are lucky enough to have a family doctor, then these appointments/analyses will mostly be handled by your doctor. If not, then you need to keep track of the appointments yourself. Pay particularly close attention to the timing of the ultrasounds and glucose test, which can only be done at certain times in pregnancy.
For most of my private appointments, I had to pay about 70 euros to have a basic appointment with a doctor and 100 euros to have a private ultrasound.
I had to pay for one public ultrasound before sorting out my numero de utente, and that ultrasound cost me 80 euros out of pocket. Before getting my numero de utente, I was paying about 30 euros per visit to the Centro Saude doctors.
Medication and vitamins
If you need medication or vitamins throughout your pregnancy, you can only be provided a prescription if you have a numero do utente. There are many vitamins and medications that are provided over-the-counter without a prescription, so if you don’t have a numero do utente, but need a specific medication, don’t panic. Check if you can simply buy the medication at the pharmacy yourself first.
Your second option if you don’t have a numero do utente and need medication is by seeing if a private or public doctor will write you an informal note saying that you need the medication. If the medication is something innocuous like iodine, the pharmacy may turn a blind eye and give you the medication without a prescription.
Finally, I’ve personally found it easier to get my vitamins and some medications at health supplement shops. For example, I couldn’t find any local pharmacies that had vitamin B6 (for first trimester nausea), but my local health food shop did. I also had a hard time getting a pharmacy to give me iron without a prescription, but a local health food and supplement store gave me iron pills without complaint, so you can try supplement shops as a last resort.
