It’s that time again for holiday greeting cards, gift shopping, eggnog, family get-togethers … and health insurance bills.

As one of those “seniors” who retired to Portugal almost six years ago, I’ve been walloped with a major 60% increase in my annual premium for the special plan negotiated between Afpop (the resident and visitor association), Medal (its insurance broker), and Allianz (the underwriter). Jumping from about €2,200 annually for my spouse (60) and me (74), the new plan increases co-payments and decreases reimbursements substantially.

Like many, I have participated in online conversations … sometimes as the original poster (OP) and other times as the Greek chorus (GC) about what’s happened.

I agree with many that the culprit is the insurance company, hiking its rates stratospherically and beyond proportion. Allianz certainly kicked the wind out of our sails with its terms, conditions, and rates.

But the powers that be should have seen it coming …

Allianz has a history of catering to large groups of people (i.e., association members) with extremely reasonable rates, then holding them hostage for ransom after several years. It’s happened before (i.e., in Spain) and it will happen again. Of course, Covid and the large percentage of Afpop members whose demographics skew toward the elderly and more likely to be infirm must be taken into consideration.

Afpop knew that. And so did Medal.

Rather than feverishly trying to cobble more sensible (and sensitive) alternatives at the last minute, they should have had a “Plan B” ready to roll. Just in case. They didn’t, trusting that Allianz would continue being good to them.

Considering the coverage offered by Allianz … or MGEN … and other health insurance providers, we were paying too much for too little.

Take, for instance, our emergency needs and getting to a hospital as quickly as possible. In our case, the hospital in Castelo Branco is 15 minutes from our house but, to be covered by health insurance, we’d have to drive 45 minutes to the nearest “network” hospital. Same thing in Elvas, where we’re located 10 minutes from the hospital but would have to drive to Évora – nearly an hour away – for our health care to be covered by private insurance.

Why? Because private insurance doesn’t cover public hospitals or clinics.

It didn’t matter so much that affiliated health care providers were few and far between if one lived outside the major expat havens—Lisbon, Porto, the Algarve, even Coimbra to a degree. Consulting with a non-network health care professional was reimbursed by Allianz after a small co-pay. Not anymore. As mentioned earlier, Allianz co-pays will be higher and reimbursements lower in 2024. The irony is that many of these health care professionals work both in public hospitals and private practices.

For those who considered MGEN as an alternative to Allianz, many were in for a rude awakening: for some, the annual premiums were higher while, for others, the range of services were fewer.

We began researching and investigating our options. Bear in mind that our ages (74 & 60) restricted us basically to health care networks – where you pay an annual fee for access to specific providers who’d agreed on specific discounts for group members – or annual premiums we couldn’t afford. In the case of Allianz-Medal-Afpop, our cost would jump more than €2,000 in 2024 alone. Living on US Social Security payments of $2,200 per month, the belt would be tightened too much. Other “international” insurers – Cigna, Bupa, April International, AXA, et al – quoted us premiums of €5,000, €7,000, even €10,000 or more!

So, here’s the skivvy on the givees for the “insurance” companies we considered. Please remember that each of the premiums listed are for a married couple ages 74 and 60 with no pre-existing conditions:

• Médis—As noted by Medal and Afpop, a real insurance plan isn’t available to those of us over the age of 70. Instead, Médis offers us a Vintage and Vintage Plus plan. For €919.06/year, its Vintage plan offers 2,500€ of hospitalization, €150 of outpatient care, one flu shot per year and assorted “assistance” services. The higher-priced (€1,364.88) Vintage Plus plan doubles hospitalization coverage €5,000 and increases outpatient care by €100 to €250 per year. But – and this is a very big but – all coverage requires a 50% co-pay! Need €5,000 for surgery? You’ll pay out of pocket €2,500. Simulate your costs and options at  https://www.medis.pt/seguros-de-saude/saude-medis/

• Tranquilidade AdvanceCare—Another health insurance plan, this one offers both “Light” and “Higher Value” plans. Only the more expensive one (€864.06/year) includes 5,000€ of health care cover annually, without any copayment. You’re also entitled to six consults from health care in its network, with a 15€ copayment. Also included are unlimited home-based consultations (€15 copay per consult) and a bunch of assorted goodies. For those younger than 55, Tranquilidade also offers cost-effective “More” and “Top” plans, with hospitalization coverage ranging from €75,000 to €500,000 … and all the extras. from Simulate online: https://www.tranquilidade.pt/particulares/seguros/saude/saude-individual

• Medicare—Believe it or not, this plan is FREE … at least for the first six months. After that, it increases to about €44 per month. For us, all of our medical team are providers on the Medicare network. Details: https://www.medicare.pt/

• “Age Doesn’t Count,” the Automobile Club of Portugal’s (ACP), accident and illness insurance for everyone. For the youngest, the best protection at the best price. For older people, health insurance with no age limit–70, 80, 90 or even older. This insurance covers expenses arising from hospitalization and/or surgery in a hospital environment, such as “hospital daily allowance for the insured person,” “medical and surgical fees.” and “other hospitalization expenses.” Offering total freedom to choose the hospital, or clinic, the plan provides annual coverage of €35,000 with 75% reimbursement of expenses and a deductible of €2,000. After a 365 day waiting plan, this ACP insurance offers coverage generally excluded in other health insurance plans including operations for varicose veins, cataracts, kidneys or gallstones. What’s more, coverage can be combined with other health insurance. Cost per month of this insurance is €20 for me (age 75) and €14 for my spouse (60), or a total of €34/month. That’s €408 per year for the two of us. “Prices below the market, says the automobile club, “because only ACP has the capacity to negotiate the best conditions for more than 290,000 members.

• Keepwells—Connected, somehow, to Continente, Keepwells offers a free plan as well as Keep Simple (@ €9.50/month per person), Keep More (@ €12.50/month per person), and Keep Top (@ €25.50/month per person) plans. Only the Keep More and Keep Top plans offer hospitalization insurance: €20,000 per year with Keep More and €50,000 with Keep Top. Surgeries and hospitalization under these two plans require a €500 copayment. All plans – including the free one! – come with unlimited outpatient visits to its network providers. All three paid plans come with discounts (as do most health plans), a large provider network, and 15% on your Continente card! Were we but a little younger, we would have qualified for the Keepwells Keep More plan. We did, however, sign up for the Keep Simple Plan, costing us 228€ for 2024. Great website with lots of information: https://keepwells.pt/

• Fidelidade 60+ Activcare 2—Offering online medicine, reduced price consults, access to its health care network, and a daily subsidy (25€) if you’re hospitalized, this plan also offers six outpatient consultations per year. This plan costs about €400 per year. Seniors who qualify for Fidelidade’s Multicare plans also receive €50,000 hospital coverage with a €1,500 copay (60+ Multicare 1) or €200,000 of hospital cover with a €2,000 copay (60+ Multicare 2). Check it out: https://www.fidelidade.pt/PT/particulares/Saude/seguros2016/60-mais/Paginas/60-mais.aspx

• Two other options to consider are OK!Seguros (https://okteleseguros.pt/seguros/saude) and Saúde Prime (https://www.saudeprime.pt/simulador-plano-saudeideal.html), both of which offer online simulations.

Which did we choose?

For starters, the free Medicare plan is a no-brainer. Even if only for six months. During that time, we’re each entitled to a complete dental exam and cleaning at no charge. To the Medicare plan, we added the Keepwells Keep Simple plan–just €114 for the two of us. Last but not least, we opted to add MGEN’s “Base” care (not the “Essential” care offered by Afpop and Medal). MGEN’s plan provides us with €30,000 in hospital coverage with a minor deductible, as well as outpatient care. The cost? €1,288.10. Upon joining the Automobile Club of Portugal, we dropped the Keepwells plan and joined ACP’s “Age Doesn’t Count” plan. Our total health care cover for 2024 is now costing us €1,856.10–including €112 for our ACP membership. That’s almost €400 less than we paid in 2023 for the Allianz plan bought through Medal at the Afpop member rate. All things considered — including the “fear factor” — we believe we have more than adequate private health insurance protection. In fact, we have better and more health insurance than we did earlier!

And we always have our SNS public insurance as backup, if needed.

Honestly, living in Portugal, we don’t think we need any more insurance than this. Many of us tend to forget the real value — and cost — of insurance, buying more than we actually need or will use. We’re not gamblers, but do realize when the deck is stacked in favor of the insurance companies.

In the end, perhaps what we really need is less insurance and more assurance.

When push comes to shove, I remind all those who are fiscal residents of Portugal that automatic participation in the country’s universal health care system (SNS) comes with the territory. Some people take issue with immigrants and expats using Portugal’s SNS national health care system because they feel it isn’t proper or appropriate for us to participate in it since we haven’t contributed. There are those of us, however, paying into the Portuguese system: both substantial annual income taxes and monthly Social Security payments whose pension benefits we will never see because of our ages.

Please don’t fault foreigners who move to Portugal because of its universal health care for all residents. Portugal is using its SNS to promote itself to would-be residents, expats, and immigrants … as well as peddling this point in its outreach promotions and advertising.