Health insurance in Bulgaria for foreign expats

Bulgaria’s healthcare system is gradually improving after a long period of underinvestment, which means that many hospitals are overcrowded and in need of refurbishment. 

From  an expertise point of view, Bulgaria’s best doctors and clinicians  meet very high standards , but tend to be spread thinly across different places . A typical ward may have only two or three experienced doctors, who are supplemented by trainees or recent graduates without specialist expertise.

Bulgaria, like many countries, operates a mandatory health insurance based public healthcare system. That means everyone is required to make contributions into the National Health Insurance fund  to receive care and treatment at hospitals and doctors’ surgeries around the country.

The money that the Ministry of Health collects from those public health insurance payments   is then  given to the public hospitals, which are run individually and give management autonomy and flexibility to respond promptly patient needs. 

While the quality and quantity of care facilities can be good in major cities like Sofia and Plovdiv, they can drop off considerably in more rural areas.

What’s covered by the Bulgarian public healthcare system?

The public healthcare system in Bulgaria covers a wide range of treatments and care services, including:

• Primary and specialist outpatient care
• Inpatient hospital treatment
• Diagnostic tests
• Gynaecological care
• Basic dental care
• Vaccinations
• Emergency care and ambulance transport

Yes. If you’re a citizen of the European Union or the European Economic Area, then you can use your European Health Insurance Card (EHIC) to access public healthcare in Bulgaria. Similarly, UK residents can use their Global Health Insurance Card (GHIC) in the same way.

These provisions last until such time as you become a formal resident of Bulgaria, at which point you’ll access care through Bulgaria’s compulsory health insurance scheme like the rest of the population.

If you want to be able to access private healthcare in Bulgaria before you become a resident, then you will need to have an international health insurance policy in place.

Only in the event of an emergency urgent care in Bulgaria is provided free of charge. 

Like many countries, Bulgaria operates through a state health insurance system, administered by the National Health Insurance Fund. All employees in Bulgaria must pay into this system every month at a rate of 8% of gross salary.¹ However, employers cover 4.8% of this, meaning employees only pay in 3.2% from their own wages. 

On top of this, people accessing non-emergency medical services also have to pay a small supplementary fee.¹ For example, a GP visit costs 2.90 Bulgarian leva (approx. £1.25, $1.60), while a hospital stay costs 5.80 leva (approx. £2.50, $3.20) per day for the first ten days. Prescribed medicine also attracts an additional fee, variable according to the type of medication involved. 

The cost of private health insurance in Bulgaria varies substantially, depending on the scale of the cover involved. The types of   care you need, how long you intend to stay in the country, the quality of the care provided and whether you need cover for other countries at the same time will all have an influence.

There are many health insurance agents that operate in Bulgaria that can find you a policy, although this will come with an additional fee; it’s therefore best to look for and take out an international health insurance. 

Don’t forget, that  the cost of the private cover will come on top of the employee contribution of 3.2% of gross salary into the public healthcare fund¹.

Do I need private healthcare in Bulgaria and how do I use it?

It’s strongly recommended to take out private health insurance cover if you intend to live and work in Bulgaria for any length of time. 

Private cover is popular among expats and digital nomads as it improves the quality, scope and availability of the care that they can access. Many workers in Bulgaria can negotiate private health insurance from their employer as part of their overall earnings package, but it’s also common for individuals and families to take private cover out themselves, too.

What are the benefits of private health insurance in Bulgaria?

Taking out private health insurance in Bulgaria improves the level of healthcare you can receive on several different fronts, including:

• Better quality facilities: private hospitals and surgeries tend to have a much  better quality of facilities, in particular avoiding the crowded and stressful nature of some waiting rooms at public healthcare locations .
• Wider clinician choice: private cover gives you the ability to choose from a much  wider and more experienced range of doctors and clinicians, giving you more autonomy about the care you want to receive.
• Shorter waiting times: tends to be much faster waiting times in private facilities than when being admitted to a public hospital  .
• More comfort and privacy: there are some private rooms available in public hospitals,  but these are not subsidised by the government and come with a significant extra cost. In private hospitals, however, comfortable private rooms are common and can be covered   by your insurance policy
• Prescription cover: many private insurance policies cover the cost of prescription medication you require, which can represent a substantial saving if you are likely to require repeat prescriptions    

Would I need dental insurance in Bulgaria?

Basic dental work is covered within the public health insurance provisions of Bulgaria and is paid for by the contributions you and your employer make into the National Health Insurance Fund.  However, demand for these dental services are  high, and waiting times for appointments can be long.

Having additional dental cover within your Bulgarian health insurance can be particularly helpful  when specialist or emergency dental work is needed.

The emergency phone number for calling an ambulance in Bulgaria is 150. It’s important to remember that the use of public ambulance services is only free if urgent care is needed you may be required to pay if your condition isn’t considered serious enough. 

Ambulance cover can be better in some areas than others,  so you may find that in some cases, it’s easier and cheaper to make your own way to hospital.  There are also some private hospitals that operate their own ambulance services, which you may be able to access if you have private healthcare cover in place.

An alternative emergency contact option - one more likely to speak your language - is the EU-wide emergency line on 112.