Can a Foreign Resident Use the Public Health System? (2026): Who Gets Free or Subsidised Care Abroad, Country by Country
Published on: June 16, 2026
For anyone thinking about retiring or relocating abroad, healthcare is often the quietest but most decisive question. The marketing you see is almost entirely about private insurance, because that is what brokers sell. What is much harder to find is a clear answer to the question retirees actually ask: once I am legally resident, can I use the country's public health system, and is it free?
The honest answer is "it depends on three things": your residency status, whether you contribute (through work, pension agreements, or a pay-in scheme), and the country. Some systems give legal residents broad public access; others tie it tightly to employment or contributions; and a few (notably the Gulf) have no universal public option for foreigners at all, making private cover mandatory.
This guide explains, country by country, who actually gets public or subsidised care, and where private insurance remains essential.
Important. Healthcare eligibility is one of the most rule-bound and frequently changing areas in this whole field, and it depends heavily on your exact status (worker, EU pensioner, non-EU retiree, golden-visa holder). Use this as orientation, then verify your specific situation with the country's health authority or an immigration lawyer before you rely on it.
At a glance
| Country | Public system | Typical access for foreign residents |
|---|---|---|
| Spain | Seguridad Social / regional health | Workers & EU pensioners (S1) yes; non-EU retirees often via pay-in convenio especial |
| Portugal | SNS | Legal residents can register at a health centre; broadly accessible |
| Italy | SSN | Residents enrol via ASL; some non-EU residents pay an annual fee |
| Greece | ESY / EOPYY | Tied to AMKA number and contributions |
| France | Assurance Maladie (PUMA) | Legal, stable residents of 3+ months; top-up (mutuelle) usual |
| Turkey | SGK (GSS) | Residents can opt in by paying a monthly premium |
| Cyprus | GESY | Contributing residents get access |
| UAE / Dubai | No universal public system | Private insurance mandatory |
| United Kingdom | NHS | Residents with valid status; visa holders pay the health surcharge |
Spain, access depends on how you qualify
Spain's public healthcare is excellent and largely free at the point of use, but access for foreigners depends on your route. Workers paying into Seguridad Social and their dependants are covered. EU pensioners transfer their entitlement using the S1 form. Non-EU retirees typically need private insurance to obtain their residency in the first place, but once legally resident and registered (empadronamiento), most regions offer a convenio especial, a pay-in scheme with a modest monthly premium that buys public-system access. So Spain is rarely "free for everyone," but it is broadly accessible once you understand your category.
Portugal, among the most accessible
Portugal's SNS (Serviço Nacional de Saúde) is one of the more welcoming systems for foreign residents. Once you are legally resident, you can register at your local health centre (centro de saúde) with your residency document, NIF and social security number, and use the public system at low or no cost, many user co-payments (taxas moderadoras) have been abolished. This accessibility is a genuine reason Portugal ranks so highly with international retirees.
Italy, enrol via the ASL
Italy's SSN (Servizio Sanitario Nazionale) covers residents who register with their local health authority (ASL). EU citizens use the EHIC or S1; non-EU residents can enrol, in some cases voluntarily by paying an annual fee that scales with income. Once enrolled, you get a health card and access on the same terms as Italians. Italy is therefore very usable for foreign residents who complete the enrolment step.
Greece, tied to your AMKA and contributions
Greece's public system (ESY, administered via EOPYY) is linked to the AMKA social-security number and to contributions through employment or pension entitlements. Employed residents and EU pensioners (S1) are covered; the picture for non-contributing residents has historically been more limited, though reforms have widened access. If Greece is your plan, confirm exactly how you will obtain your AMKA and what your contribution route is.
France, broad access through PUMA, with a top-up
France operates PUMA (Protection Universelle Maladie): anyone in stable, legal residence for three months or more can access the public health system (Assurance Maladie). EU pensioners use the S1. The system reimburses roughly 70% of standard costs, so most residents, French and foreign alike, carry a complementary top-up insurance (mutuelle) to cover the rest. France is genuinely accessible to foreign residents, but budget for the mutuelle.
Turkey, opt in to GSS
Foreign residents in Turkey with a residence permit can opt into the General Health Insurance (Genel Sağlık Sigortası, GSS) under SGK by paying a monthly premium, which gives access to the public system. Employees are covered via their employer. Turkey also has a large, high-quality and comparatively affordable private sector that many foreign residents use alongside or instead of public cover. For residency applications, private health insurance is commonly required.
Cyprus, GESY for contributors
Cyprus's GESY (General Healthcare System) provides access to residents who contribute. Once you are in the system as a contributing resident, you can use public and participating private providers. Confirm your contribution route based on your status (worker, pensioner, self-employed).
UAE / Dubai, private insurance is mandatory
The Gulf is the clear exception. The UAE has no universal free public health system for expatriates. In Dubai and Abu Dhabi, health insurance is mandatory and is typically provided by your employer; if you are not employed (for example, a property-based or retirement resident), you must arrange your own private cover. Budget for private health insurance as a fixed, non-optional cost of UAE residency.
United Kingdom, NHS with a surcharge
The NHS covers ordinarily resident people, including foreign residents with valid immigration status. Most visa holders pay the Immigration Health Surcharge as part of their visa, which then entitles them to NHS care largely as a UK resident would receive it. Once settled, access is broad.
How to think about it before you choose a country
If healthcare access matters to your relocation, and for most retirees it is decisive, weigh three things per country:
- Your category. Are you a worker, an EU pensioner with an S1, or a non-EU retiree? The same country can be "free," "pay-in," or "private only" depending on which you are.
- The pay-in option. Several systems (Spain's convenio especial, Turkey's GSS, Italy's voluntary enrolment) let non-contributing residents buy into the public system. This is often the most cost-effective route.
- The top-up reality. Even where public access is broad (France), residents usually still carry private top-up cover. "Public" rarely means "you'll never pay for insurance."
Frequently asked questions
Can a non-EU retiree get free public healthcare abroad?
Rarely "free" automatically, but often accessible through a pay-in scheme once legally resident (e.g. Spain's convenio especial, Turkey's GSS). Portugal's SNS is among the most openly accessible once you register.
What is the S1 form?
A form that lets pensioners from one EU/EEA country transfer their public healthcare entitlement to the EU country where they live. It is the key to public access for many EU retirees.
Do I still need private insurance if the public system covers me?
Often yes, for residency applications, for the portion the public system doesn't reimburse (France's mutuelle), or for faster access and English-speaking providers.
Which countries require private insurance outright?
The UAE most clearly, private cover is mandatory and there is no universal public option for expats. Several countries also require private cover at the residency-application stage even where public access becomes available later.
Where this connects to private cover
Public access and private insurance are not opposites, for most international residents the smart answer is understanding both, because the right mix depends entirely on which country and which residency route you choose. A non-EU retiree in Spain, a self-employed resident in Portugal, and a property-based resident in Dubai face three completely different decisions.
JanusHermes approaches relocation as a whole picture, not a single listing: the property, the residency route, and the healthcare reality that comes with it, market by market. Where private cover is the right or required answer, we point you to it; where the public system is accessible, we tell you how residents actually get in. Explore listings and country intelligence on JanusHermes.
Healthcare eligibility rules are complex, vary by residency category, and change frequently. This is general orientation, not medical, insurance, or legal advice. Verify your specific situation with the relevant national health authority or a qualified professional before relying on it.
