Portugal SNS User Fees (Taxas Moderadoras) for Americans and Britons

Portugal’s public health service (SNS) charges its user fee, the taxa moderadora, only when you use a hospital emergency department (urgência), and not even there if the SNS sent you or the visit ends in admission. There is no fee for the rest of the SNS, and several groups never pay it at all.

We read the pages cited below on 21 October 2026. The legal text is the consolidated Decree-Law 113/2011 on the Diário da República, whose last amendment is Decree-Law 37/2022 of 27 May 2022, in effect from 1 June 2022. The most recent dated page we used is the SNS 24 service page on the hardship exemption, marked “Atualizado a 22-09-2026”, which is why this guide carries that update date. This is general information, not legal or medical advice.

When do I pay a taxa moderadora?

Article 2 of Decree-Law 113/2011, as amended, says SNS-funded care “implicam o pagamento de taxas moderadoras apenas nos serviços de urgência hospitalar”: fees apply only in hospital emergency departments. The decree-law that made the change says in its preamble that it provides for fees “apenas no atendimento em serviço de urgência”, except where there is a prior SNS referral or the visit leads to admission. It also repealed article 7-A, which the consolidated text now shows only as revoked, with effect from 1 June 2022.

Article 8 adds the waiver: even in an urgência, the fee is not collected where there was a prior referral by the SNS, or where the visit results in admission to hospital through the urgência. The ACSS fee guide (February 2025) names the referral channels as primary care, the SNS contact center and INEM. Our guide to emergency care, 112 and SNS 24 walks through the routes.

The ACSS guide is older than the 2022 change in places: it still describes fees for consultations and tests, with primary care waived. Where it differs from the consolidated law, follow the law.

If someone else is legally or contractually responsible for the care, for instance after an assault or a road, work or sports accident, the health regulator (ERS, supervision alert 6/2025 of 18 December 2025) says no fee is due from you or from that third party. The third party is billed the full price of the care instead.

How much is the fee?

Article 3 says amounts are set by ordinance, reviewed every year, with automatic inflation updating, and may not exceed one third of the SNS price list. The ordinance in force is Portaria 306-A/2011 as amended by Portaria 64-C/2016 of 31 March 2016, which the Diário da República’s legal analysis shows as its latest modification. The ACSS FAQ of February 2025 prints the table for emergency departments, from ACSS circular 8/2016:

Portaria 64-C/2016 sets a ceiling of 40 euros for each emergency visit, adding the fees for tests done during it. The annex tables themselves are images on the Diário da República, so we took the three amounts from the ACSS FAQ. We found no newer table on the pages we read, so confirm the amount with the hospital. The ordinance also says ACSS publishes updated tables on its website.

Who is exempt, and how do I prove it?

Article 4 lists the groups that pay no taxa moderadora at all. The ACSS fee guide says how each is recorded; the proof is shown at the health center of your area of residence, which registers the exemption against your user number (see our SNS registration guide).

The law also lists permanently incapacitated military personnel and several groups of young people in child protection, which we leave out. The ACSS guide also lists separate waivers (“dispensas”) for specific services, such as family planning and some chronic and mental health care. Because fees are now limited to emergency departments, ask the hospital whether any waiver applies to your visit.

Two warnings from the law and the guide. Wrongly obtained benefits cost you the right to the exemption for 24 months. And an exemption from the fee does not remove other charges: the ACSS guide says “taxas sanitárias” under Decree-Law 8/2011, such as a multipurpose disability certificate, still apply.

How do I ask for the economic hardship exemption?

The law treats a household as in hardship when its average monthly income is at or below 1.5 times the IAS, the social support index. The 2026 IAS is 537.13 euros (Portaria 480-A/2025/1 of 30 December 2025), so the threshold is 805.70 euros a month by our arithmetic, taking the ACSS guide’s method of dividing the household’s gross annual income by 12 and by the number of tax filers heading the household.

The SNS 24 page sets out the request. You can make it at any time, and only once:

1. Through the SNS 24 portal: sign in, open “Documentos e certificados”, then “Taxas moderadoras”, the “Pedido” tab and “Pedir isenção”, fill in your details and your household, and confirm.
2. Or by phone on the SNS 24 line, 808 24 24 24, or in person at your health center or an SNS 24 desk.

The page says the tax authority (AT) assesses the request and that you have a decision, approved or refused, within 10 working days. You can correct or delete the request within 24 hours. Every 30 September the AT reassesses you automatically, so a refusal one year does not bar you the next; you disagree with a decision through “Reclamar pedido” in the same service. The ACSS guide adds that household details should be current at the health center and the tax office.

The pages do not explain how a newcomer without Portuguese income history is assessed. For the tax-number side, see our guide to the Portuguese NIF.

How do I pay the fee?

Article 7 says the fee is collected when the care is given. Portaria 306-A/2011 says it is due on admission to the urgência or when a test is done, and that SNS facilities must provide card payment terminals and, exceptionally, a bank payment reference. If it is not collected on the day, you are notified and have 10 days to pay. A fee already paid is refunded only if you were absent for a reason not your fault.

You can see proof of payment for tests at providers in the “Exames Sem Papel” project in the SNS 24 portal, under “Taxas moderadoras” and “Comprovativo”. The fine for not paying, once in article 8-A, is marked repealed by Law 42/2016 from 1 January 2017.

Medicines are separate: see our guide to pharmacies and prescriptions.

What should Britons and Americans know?

The pages we read set no different fee by nationality: the decree-law text has no nationality rule, though that is our reading of what it does not say. A Briton or an American with a complete SNS record follows the registration steps in our SNS registration guide.

For Britons, GOV.UK’s guide for UK nationals living in Portugal says residents “pay standard user fees (taxas moderadoras)” and that an S1 holder with a registered S1 is entitled to state healthcare “on the same basis as a Portuguese citizen”. It sets no separate fee for S1 holders, and neither do the Portuguese pages we read. Its examples, 5 euros for a GP appointment and 15 euros for A&E, and its exemption for a child under 12 come from a page last updated on 14 October 2021, before Decree-Law 37/2022. For the S1 and GHIC themselves, see GHIC, S1 and healthcare for Britons.

For Americans we found no Portuguese page treating them differently. If you are not registered as an SNS beneficiary, the regulator ERS says you may be billed the full cost, but only if you are not identified as an SNS beneficiary, you do not name a third party legally or contractually responsible, and you give no proof within 10 days of the request to pay that you hold or applied for the SNS user card. Whether a private policy changes this is a question for the insurer; see private health insurance and the visa and Medicare and US insurance abroad.

What did we read, and what did we not?

On 21 October 2026 we read: Decreto-Lei 113/2011, consolidated version, last amendment 27 May 2022; Decreto-Lei 37/2022; Portaria 64-C/2016 and the consolidated Portaria 306-A/2011 with its legal analysis on the Diário da República; Portaria 480-A/2025/1 on the 2026 IAS; the ACSS fee page and its FAQ (February 2025); the SNS 24 page on fees (updated 22 September 2026); the ERS supervision alert 6/2025; and the GOV.UK guide for UK nationals (last updated 14 October 2021).

We could not read the annex tables of the 2016 ordinance (images on the Diário da República) and did not find a current 2026 table. We did not read the Portal SNS pages on fees, which are script-rendered.