Bulgaria is not the most popular destination for migrants compared to other EU countries. However, the trend is growing, and with it arises the question of providing medical services to these groups. As of July 1, 2025, new regulations came into force requiring holders of a Single Permit for Work and Residence not only to be eligible but obligated to participate in the Compulsory Health Insurance (CHI) system.

This measure was introduced due to the need to secure additional funding, as Bulgaria continues to rank among the EU countries with the lowest healthcare expenditure.

Despite this, the cost of medical services remains lower than in Central Europe, which attracts people visiting Bulgaria for medical tourism. In this article, we explain how Bulgaria’s healthcare system works and what medical services migrants can expect.

Contents:

  1. Structure of Bulgaria’s Healthcare System
    1. Health Insurance in Bulgaria
  2. Advantages and Disadvantages of Healthcare in Bulgaria
  3. Medical Service Costs in Bulgaria
    1. Dentistry in Bulgaria

Structure of Bulgaria’s Healthcare System

The Bulgarian healthcare system is based on two main sectors: public and private. The public sector is funded primarily through the National Health Insurance Fund (NHIF), which collects contributions from employed individuals, employers, and the government.

The system includes:

  • Polyclinics and outpatient clinics: primary medical facilities where citizens and immigrants can receive basic medical care.
  • Hospitals in Bulgaria: secondary and tertiary care, including specialized medical institutions for treatment of complex conditions.
  • Emergency care: a 24/7 system of urgent medical assistance.

Public healthcare is available through compulsory health insurance, meaning that a person must be registered with the NHIF to access services. Private healthcare supplements the public system. Although insurance generally does not cover private services, there are notable advantages:

  • Shorter waiting times.
  • Availability of services in foreign languages.
  • Modern equipment and technologies.

Health Insurance in Bulgaria

Health insurance in Bulgaria is mandatory for all citizens and legal residents. The system ensures that everyone living in the country has access to medical care. There are two types of health insurance: compulsory and private.

Compulsory insurance is processed through the National Health Insurance Fund (NHIF). All Bulgarian citizens are required to pay contributions, which are usually deducted from salaries automatically. Unemployed individuals and freelancers pay contributions themselves.

NHIF medical insurance in Bulgaria covers essential medical services, such as doctor consultations, hospitalization, emergency care, surgeries, and treatment in specialized medical facilities.

In addition to compulsory insurance, residents may purchase private health insurance. It is often used to access specialized services, diagnostic tests, or scheduled surgeries not covered by the basic insurance.

Healthcare in Bulgaria for expats from the EU and EEA is the same as for Bulgarian citizens, provided that they register with the NHIF and pay the required contributions.. The same rule applies to nationals of third countries. The only difference is that they must submit documents confirming their legal status in the country, such as a residence permit.

For persons entering Bulgaria on a temporary visa (e.g., tourists), health insurance is a mandatory visa requirement. They must purchase short-term medical insurance covering medical expenses during their stay. Such insurance can be issued either in Bulgaria or prior to traveling.

Cost of health insurance in Bulgaria:

Category

Average cost (€/month)

Employees

32–64

Self-employed / freelancers

22–26

Unemployed / expats without income

12–13

Pensioners (EU/EEA)

0 (EHIC) or 12–13

Children/students

Free of charge

Average cost of private health insurance in Bulgaria:

Type / Provider

Average cost (€/year)

Coverage

Basic local (Uniqa, Bulstrad)

120–240

Outpatient care + hospitalization up to €10,000–30,000 (no dental care)

Standard (Allianz, DZI)

240–360

Up to €50,000, including evacuation

Premium (Allianz Care, AXA)

360–600+

Full coverage, €100,000+

For visas/residence permit (Generali, Uniqa)

50–150

€30,000–60,000 coverage, valid for one year

Additional insurance from the employer

€60/month (up to €720/year)

Access to private clinics

Both public and private insurance allow purchasing medicines under insurance coverage. For private insurance, the list of eligible medications must be confirmed in advance. Public insurance covers medications included in the Positive Drug List (PDL), published by the National Council on Pricing and Reimbursement of Medicinal Products.

Advantages and Disadvantages of Healthcare in Bulgaria

The health system in Bulgaria has both strong advantages and significant systemic challenges. Some aspects are ambiguous; for example, the cost of medical services: it is considered high for local residents but comparatively low for individuals earning Western European salaries.

Advantages of Bulgarian healthcare:

  • Accessibility of basic services. Compulsory health insurance covers doctor consultations, hospitalization, emergency care, and preventive examinations.
  • Qualified medical professionals. Bulgaria has approximately 1.8–2 doctors per 1000 inhabitants, which is close to the EU average. Many physicians have degrees from reputable European universities and undergo additional training abroad.
  • Affordable private sector. A specialist consultation costs €20—40, and an ultrasound scan €25—50, which is 50–70% cheaper than in Western Europe.
  • Digitalization of procedures. The system includes electronic prescriptions and electronic referrals, simplifying access to specialists.
  • Medical tourism. Dentistry in Bulgaria is significantly cheaper than in most EU countries. The price of dental implants and orthodontic services is often 40–60% lower, which has led to the development of a dedicated medical tourism industry.

Disadvantages of Bulgarian healthcare:

  • High out-of-pocket spending. Due to lower local income levels, residents spend 34–37% of their income on medical expenses. Informal payments to physicians — in exchange for faster service or preferential care — may reach up to 60% of the service cost.
  • Regional inequality. Quality of care is significantly better in large cities like Sofia, Varna, and Plovdiv. Rural areas face outdated equipment, limited specialists, and longer waiting times.
  • Chronic underfunding of the system. Bulgaria spends only 4–5% of GDP on healthcare, the lowest or among the lowest in the EU. This results in outdated hospital infrastructure and challenges in ensuring full vaccination coverage in some regions.
  • Bureaucracy. All documents are issued in Bulgarian; hygiene standards in public facilities are often subpar; hospital meals receive frequent complaints. Foreign residents often face difficulties registering with a family doctor, and mandatory insurance payments do not always guarantee timely access to services.
  • Staff shortages. While the total number of doctors is sufficient, Bulgaria has a deficit of nurses and narrow-specialization doctors. Waiting times in public hospitals can extend to several weeks or months, especially outside major cities.

Medical Service Costs in Bulgaria

Public healthcare services are mostly free or require only minimal co-payments. Private healthcare is more expensive but offers modern equipment and fast service at prices significantly lower than in Western Europe.

Common price of medicine in Bulgaria:

Service

Average price (€)

Notes

General practitioner (GP) consultation

20–40

Free in the public sector.

Specialist consultation (cardiologist, gynecologist, etc.)

30–50

Ultrasound — an additional €25–50.

Blood tests (basic panel)

20–50

Full medical check-up — €100–200.

Ultrasound (single organ)

25–50

In Sofia, it can reach €60.

X-ray or MRI scan

50–150

CT scan — €100–250.

Hospitalization (per day)

50–100

Price includes a private room.

Surgery (cosmetic, e.g., facelift)

1200–2500

Implants (non-dental) — €2000–4000.

Vaccination (standard)

20–50

COVID/flu vaccines: free in the public sector.

If your insurance provider has a direct billing agreement with the medical facility, you may receive medical services without paying upfront. The clinic handles the paperwork, and the insurance company pays the provider directly.

However, if there is no direct billing contract, you must pay for the medical services yourself. Afterward, you collect all required documents (receipt, medical reports, prescriptions) and submit them to your insurance company for reimbursement.

For those without insurance, an important detail to consider is that private hospitals in Bulgaria require payment after services are provided (pay-on-service), while public facilities usually require payment in advance, before treatment begins.

Dentistry in Bulgaria

Dentistry is one of the most advanced medical sectors in Bulgaria, especially within the private healthcare system. Public services cover basic treatments (fillings, extractions), but for implants, aesthetic dentistry (veneers, whitening), prosthetics, and orthodontics, patients typically choose private clinics.

Average Bulgarian dentist prices:

Service

Average price (€)

Consultation + examination

20–40

Panoramic X-ray

30

Filling (composite)

30–60

Root canal treatment (per canal)

50–100

Tooth extraction

30–80, complex cases up to 200

Whitening (1 session)

150–300

Veneer

200–400

Crown (zirconia)

200–350

Implant (with crown)

450–800

Denture (removable, per jaw)

300–600, 800–1500 (fixed)

Full hygiene treatment

150–250

Popular dental clinics in Bulgaria:

  • Sofia Implant Centre (Sofia).
  • AllDental (Sofia).
  • Impression Dent (Sofia).
  • Medica 3 Dent (Varna & Shumen).
  • Bulgaria Dent (Sofia).