Technical article
The Public Health System and the Newcomer
Could they join the public health system where they land, and what would it cost each month?
Picture a couple named Frank and Linda. Frank is 67 and Linda is 63. They have good private insurance at home, and it will end when they leave. They want to know one thing. Could they join the public health system where they land, and what would it cost each month?
I looked for the official page in each country. Three had a clear answer, and two more are added below. The answers are quite different from each other.
What the pages say
| Country | How a newcomer joins | Cost shown | Condition on the page |
|---|---|---|---|
| Spain | Special agreement ("convenio especial") with Social Security | EUR 60 a month under 65; EUR 157 a month at 65 and over | One year of continuous residence in Spain; on the local population register; no other public cover |
| Mexico | Voluntary enrolment in the family health insurance of the social security institute (IMSS) | Yearly fee by age, MXN 9,300 (ages 0 to 19) up to MXN 22,150 (80 and over) | Page says the person must not have a social security scheme; says nothing about foreigners or waiting periods |
| Portugal | Holders of a valid residence permit can get a national health service user number | Same user charges as the general population | Without a permit and more than 90 days in the country, the full cost of care is charged, with exceptions for public health cases |
Spain
The health ministry page says the agreement is for people who need health cover to live in Spain and who have no other access to public cover. The words on the page: "cuota mensual de 60 euros" for those under 65, and "cuota mensual de 157 euros" for those 65 or older. My arithmetic: that is EUR 720 a year, or EUR 1,884 a year. The page also says residence in other EU, EEA, Swiss or UK territory counts toward the one-year requirement.
Mexico
The social security institute lists yearly fees, paid in advance. They apply from 1 March 2026. The page writes amounts with a "$" sign. This is a Mexican page, and I read the amounts as pesos.
| Age | Yearly fee (MXN) |
|---|---|
| 40 to 49 | 14,350 |
| 50 to 59 | 14,850 |
| 60 to 69 | 20,600 |
| 70 to 79 | 21,500 |
| 80 and over | 22,150 |
My arithmetic: MXN 20,600 for ages 60 to 69 is about MXN 1,717 a month. The page mentions no waiting period and no rules about conditions you already have. That could mean there are none, or only that the page does not cover them. The page does not settle which.
Portugal
The national health service page for migrants says foreign citizens with a valid residence permit can get a user number by showing proof of the permit at the health service in their area. They pay the same user charges as everyone else. A person who has been in Portugal more than 90 days without a valid permit is asked to pay the full cost, with exceptions for urgent care, infectious diseases and some others. The page carries no date, and its references go back to 2001 and 2009, so a more recent rule may exist.
Costa Rica, and Mexico's second route
- Costa Rica. The social security fund (CCSS) pages and regulations describe a system open to foreigners who are legally in the country. People without income from work, including foreigners, can join health and disability, old age and death cover as voluntary insured persons. Pensioners from abroad contribute on the amount of their pension, using the scale approved by the fund's board. Voluntary insured persons who are up to date have the right to health insurance benefits, but not sickness or maternity payments. The pages do not give the percentage (CCSS and legal database, read 11 October 2026).
- Mexico, self-employed route. The social security institute's page for foreigners in Mexico says foreign residents can join voluntarily as independent workers. They must give an address in Mexico, which may be in their name or a third party's, and they can register their legal beneficiaries as article 84 of the Social Security Law sets out (IMSS and consulate pages, read 11 October 2026).
What is left open
- The fee for the Mexican self-employed route, and the Costa Rican percentage. The institutions publish scales that change, so ask for the figure in force.
- Whether Spain's fee has changed since the page was written: no date was shown on the page.
- Panama, Colombia, Ecuador, Malaysia and Thailand are not covered here.
An accountant or lawyer who works with Americans abroad could confirm which route fits a specific permit, and whether Medicare would still apply.
You could…
- Check how many months you would need to cover before a public route opens.
- Ask the office in writing whether your permit type qualifies.
- Compare the yearly total of each route side by side, using your own age.
Which gap worries you more: the first year, or the years after 70?
Figures are estimates for planning, based on public data. Date read: 10 and 11 October 2026.
Sources
- Ministerio de Sanidad (Spain), sanidad.gob.es/servCiudadanos/internacional/convenioEspecial.htm
- Instituto Mexicano del Seguro Social, imss.gob.mx/faq/seguro-familia and imss.gob.mx/personas-trabajadoras-independientes/extranjeros-en-mexico
- Portuguese health ministry regional administration, FAQ on migrants' access to the national health service, arslvt.min-saude.pt (FAQ_Gabinete_Saude_CNAIM.pdf)
- Costa Rica, CCSS, Insured persons and pensioners, read 11 October 2026, ccss.sa.cr/pensionados
- Costa Rica, Reglamento del Seguro de Salud (legal database), read 11 October 2026, pgrweb.go.cr/scij/Busqueda/Normativa/Normas/nrm_texto_completo.aspx?param1=NRTC&nValor1=1&nValor2=43463&strTipM=TC
- Mexico, IMSS, foreigners in Mexico, read 11 October 2026, imss.gob.mx/personas-trabajadoras-independientes/extranjeros-en-mexico
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