Bulgaria's public health system looks simple on paper and has one trap: it does not follow your EHIC. The right question is not "do I have a card?" but "which country insures me?". Answer that, and the rest of healthcare in Bulgaria falls into place: a form, a contribution, a doctor.
Which country's system insures you?
Under EU social security coordination, your insurance follows your economic situation and where you live, not your nationality. The NRA says that people to whom Bulgarian law applies under these rules are compulsorily insured in Bulgaria, as are foreigners authorised to stay long-term or permanently. People who must be insured in another Member State are not.
In practice:
- You work in Bulgaria: you are insured through work, and the employer declares you. Check with the employer or the NRA that this has been done.
- You are self-employed: you pay 8 per cent in 2026, entirely at your own cost, as part of your contributions.
- You are not insured on any other basis: you pay yourself, with the declaration known as Form 7.
- You are a pensioner, or posted from another country: you remain insured at home, and your S1 is registered in Bulgaria.
How do you register an S1 with the NHIF?
The National Health Insurance Fund (НЗОК, NHIF) explains the forms. Pensioners and their families use E121/S073; employed or self-employed persons residing in Bulgaria while insured elsewhere use E106/S073; family members living apart from an employed relative use E109/S073. You get the form from your home institution, then take it to the NHIF or a regional fund (РЗОК). Only then do you choose your GP.
What do you pay if nobody insures you?
The NRA gives the minimum for people who insure themselves for health only: 22.03 euros a month from 1 January to 31 July 2026, and 24.81 euros a month from 1 August to 31 December 2026. You file the declaration (Form 7) and pay by the 25th of the month after the one in which the obligation starts. If more than three monthly contributions are unpaid over 36 months, your rights are suspended; to restore them you must pay everything due for the previous 60 months.
Which of these routes is yours depends on small facts: where you work, which pension you draw, whether you also keep a job at home. Moovy can ask the right questions and tell you which form to request and where to file it. It does not register you; the forms are yours to sign.
How do you choose a GP in Bulgaria?
Choose a общопрактикуващ лекар (obshtopraktikuvasht lekar, general practitioner, also called the personal doctor) who has a contract with the NHIF. You fill in a form, on paper or online, and hand it to the doctor. According to the NHIF, this choice is what puts you on its patient list; without it you are not on the list. For a temporary stay of over a month with a proven health problem, the NHIF recommends a temporary choice. EURES notes that to register with a GP you need your LNCh from the Migration Directorate; see the Bulgaria LNCh number guide.
You can change GP from 1 to 30 June and from 1 to 31 December.
What are the patient fees for healthcare in Bulgaria?
The потребителска такса (patient fee) is set by decree. In 2026, according to the European Commission's guide, it is 1.48 euros per visit to a GP or dentist (0.51 euro for a pensioner) and 0.51 euro per day in hospital for the first 10 days of the year. The NHIF publishes the list of people exempt, including children and people with certain conditions.
Which healthcare in Bulgaria mistakes cost expats the most?
- Living on the EHIC alone. It covers a temporary stay only. The NHIF adds that the card is issued by the country where you are insured, not by Bulgaria.
- Not choosing a GP. You stay off the patient list.
- Letting contributions slide. See the 36-month rule above.
- Mixing up euros and leva. The NRA amounts are in euros since 1 January 2026.
What changes for Britons?
Britons are third-country nationals. The NRA includes foreigners authorised to stay long-term in the compulsorily insured group, unless an international agreement says otherwise. GOV.UK's guide says that a UK State Pension holder can request an S1 from NHS Overseas Healthcare Services. Those protected by the withdrawal agreement should confirm their rights with the NHIF. See moving to Bulgaria from the UK.
How does healthcare in Bulgaria work for a newly arrived employee?
If you work for a Bulgarian employer, the arrangement is the simplest of all. Your employer declares you and pays the contributions, with the national split between employer and employee: 4.8 per cent from the employer and 3.2 per cent from the employee in the standard case, of the 8 per cent total, according to the NRA for 2026. Your task is to check that you are declared, then to choose a GP.
The wrinkle comes if you also work in another EU country, or if your employer is foreign and sends you to Bulgaria. In those cases the coordination rules decide which country's system applies, and a certificate from your home institution may be needed. Ask your employer which one applies before the first payslip.
What if you pay for your own health insurance in Bulgaria?
Self-insured people pay in advance each month and file the monthly forms by the 25th of the following month. The NRA states that a person insured only for health has a base between 275.33 and 2,111.64 euros until 31 July, and between 310.10 and 2,300 euros from 1 August 2026, with a minimum contribution of 22.03 then 24.81 euros a month. Anyone who is also self-employed pays on a different, higher base for pensions and other risks; the NRA's page for self-insured persons gives the bases.
Pay on time. The interruption rule is strict, and restoring rights means paying all contributions due over the previous 60 months.
Does the EHIC still matter for healthcare in Bulgaria?
Yes, for visits. If you live in another EU country and come to Bulgaria on a holiday or a short work trip, the European Health Insurance Card covers medically necessary care during the stay. It is issued by your home insurer and valid for a temporary stay; it does not replace affiliation if you settle. EURES recommends that you get it before leaving.
If you are unsure which situation you are in, a test question helps: where do you live most of the year? If the answer is Bulgaria, you are not on a visit any more.
What should you know about private care and pharmacies?
The public system is organised around the GP, who refers you to specialists and hospitals within the NHIF network. Many people also use private doctors or buy private insurance, particularly during the first months, before the public registration is complete. We did not review private tariffs, so compare policies carefully, in particular what they say about pre-existing conditions.
For medicines, a prescription reimbursed by the NHIF costs less only in a pharmacy that has a contract with the fund; elsewhere you pay the full price. Ask the pharmacy before you buy.
How do you prepare for your first GP visit?
Bring your identity document, your LNCh and the confirmation of your registration with the fund. Expect to pay the patient fee at the visit, and ask whether the practice has an English-speaking doctor. If your Bulgarian is limited, a friend or a professional interpreter can help with the vocabulary of symptoms and medication, but the medical decisions remain yours and the doctor's. In an emergency call 112.
Where does health fit in your first weeks?
After residence and your personal number, and before long trips. The sequence is in the guide to moving to Bulgaria. Amounts and forms change, so check the NRA and the NHIF.