How Bulgaria's healthcare system works

Healthcare · Last reviewed: 2026-08-16

Who counts as insured

Public funding flows through one fund, the National Health Insurance Fund (Национална здравноосигурителна каса, НЗОК). It behaves like an insurer: it contracts hospitals, outpatient centres and family doctors, and pays for treatment according to those contracts. Contributions are collected by the revenue administration — through the employer for employees, and by self-declaration for the self-employed. For students, pensioners and certain social groups the state pays the contribution.

The first term a newcomer needs is therefore health insurance status. An active status opens the public system. If contributions lapse, the status goes inactive and the same treatment is billed privately. Status can be checked online at the revenue administration using your personal identification number, and in the first months after moving it is worth checking regularly.

Choosing a GP (личен лекар)

The GP is the door to the system. An insured person picks one from the doctors contracted with НЗОК and signs a registration form. The choice is free, but in practice a doctor near your address makes life easier, because routine checks, repeat prescriptions and referrals all pass through that office. Switching doctors is possible; the regional fund office (РЗОК) announces the windows during which a change can be made.

The referral chain

As a rule you do not go straight to a specialist. Your GP issues a referral note (направление) and the appointment is made against it. Referrals are distributed under budget quotas and can run out towards the end of the month — a well-known bottleneck. Some covered services carry a small user fee, and certain groups are exempt from it. You may still see a specialist without a referral, but then the visit is billed at the full private rate.

EU citizens, the EHIC and settling in

• •During a temporary stay, a European Health Insurance Card issued in another EU country gives access to medically necessary care on the same terms as a locally insured person.
• •The card is not travel insurance: it does not cover planned treatment, private clinics or repatriation.
• •Once you move to Bulgaria and start working here, you are insured here, and local cover replaces the card.
• •If your pension comes from another EU country, cross-border forms decide which state pays; the institution issuing the form determines that, not the hospital.

What private insurance actually solves

Voluntary health insurance in Bulgaria does not replace the compulsory scheme; it sits on top of it. People buy it to shorten waiting times, to use private hospitals, and to get support in areas with thin public cover such as dentistry and eye care. Before signing, the question that matters is scope rather than price: which facilities are in the network, whether a referral is still required, and whether pre-existing conditions carry a waiting period.

Frequently asked questions

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