Bulgaria (BG)

Bulgaria is the oldest state in Europe (founded 681 AD), a member of the European Union since 2007, and one of the most affordable countries for expats in the EU.

Capital: Sofia

Region: Europe

Language: Bulgarian

Currency: BGN (лв)

Cost of living: Very affordable (index 37)

Emergency: 112

Healthcare in Bulgaria

Bulgaria operates a mixed public-private healthcare system. The public system (Задължително здравно осигуряване — mandatory health insurance) is administered by the National Health Insurance Fund (НЗОК — Nationalna Zdravnoosiguritelna Kasa). Coverage is available to all insured persons. While public healthcare is affordable (copayments only), quality varies significantly — Sofia hospitals are better equipped than rural facilities. Many expats and middle-class Bulgarians supplement with private insurance or pay out-of-pocket for private clinics and hospitals. Private healthcare in Bulgaria is excellent value compared to Western Europe.

Bulgaria ranks 40th–50th in European healthcare rankings. Quality is improving but still below Western European averages. Private hospitals (Acibadem City Clinic, Tokuda Hospital, Heart and Brain Hospital) offer high-quality care with modern equipment and often English-speaking staff.

Public healthcare: National Health Insurance Fund

НЗОК — Национална здравноосигурителна каса

Eligibility:All employed persons (automatically enrolled), self-employed persons paying contributions, retirees receiving pension, unemployed persons paying voluntary contributions. EU citizens with EHIC have emergency coverage. Non-EU citizens must have valid health insurance (private or register with NHIF if qualifying).

Monthly cost:3.2% of gross salary (employee share). 4.8% of gross salary (employer share). Self-insured: 8% of minimum insurable income (~86 BGN/month in 2026).

What's included:

GP (personal physician) visits — 2.90 BGN copay per visit
Specialist consultations with referral — 2.90 BGN copay
Diagnostic tests with medical referral
Hospitalisation (co-pay 2.90 BGN per day, max 10 days/year)
Emergency care (free)
Preventive care and vaccination
Maternity care and childbirth
Dental care for children under 18
Partial prescription medicine coverage (50–100% subsidy depending on medicine)
Mental health treatment through referral
Rehabilitation services

Not included (or co-pay required):

Private room in hospital
Adult dental care beyond emergency extractions
Cosmetic procedures
Most glasses and contact lenses
Many specialist medications not on NHIF list
Ambulance transport (small fee applies)
Private GP visits without NHIF registration

Co-payments:Copayment (потребителска такса): 2.90 BGN per GP visit, per specialist consultation, and per day of hospitalisation (maximum 10 days/year, so max 29 BGN/year for hospitalisations). Prescriptions: variable copayment depending on medicine. Emergency care: free.

How to enrol:Employees: enrolled automatically by employer — employer registers employee with NHIF and pays contributions. Self-employed: register at NRA and pay monthly health insurance contributions directly (8% of insurable income, minimum based on minimum wage). EU job-seeker/tourist: EHIC provides emergency coverage. Non-EU: must maintain continuous contributions.

Waiting period:6 months of contribution payment to access non-emergency specialist care. Emergency care is available immediately. New employees are covered from day one of employment.

Private healthcare: Private Healthcare (Частни клиники и болници)

Who can use it:Available to anyone — no insurance required for cash payments

When it makes sense:Faster access to specialists (no GP referral needed). Modern private hospitals with shorter waiting times. English-speaking doctors. Elective procedures. Dental care. Mental health. Second opinions. Diagnostics (MRI, CT faster at private facilities). Many expats use private clinics for routine and specialist care due to language barrier in public system.

Monthly cost:Private health insurance: 30–80 BGN/month (comprehensive). Basic top-up plans: 15–30 BGN/month. Available from Bulstrad Life, Allianz Bulgaria, DZI, Generali.

Major providers:

Acibadem City Clinic (international hospital chain, Sofia)Tokuda Hospital (Japanese-owned, international standards, Sofia)Heart and Brain Hospital SofiaUMBAL Alexandrovska (largest state hospital, Sofia)Medica (private clinic network)Vita Clinic (private clinic network)

Accessing care

GP system

Every NHIF-insured person must register with a personal physician (личен лекар / ОПЛ — общопрактикуващ лекар). Your GP is your primary point of access to the public system. You can change GP once per quarter. To register: visit the GP's office with your NHIF card (if employed) or proof of payment. GPs typically have morning and afternoon hours. Walk-in slots usually available for same-day minor issues.

Specialist referral

Public system: GP referral (направление) required to see a specialist through NHIF. One referral valid for up to 1 specialist visit per month. Specialists often have waiting times of 1–4 weeks in Sofia, longer in rural areas. Private clinics: no referral needed — direct booking, results same day or next day.

Emergency care

Emergency departments (Спешно приемно отделение / СПО) in all district hospitals. Call 112 for ambulance. Emergency care is free regardless of insurance status. Sofia's main emergency hospital: Pirogov Emergency Medicine Institute (УМБАЛСМ "Н. И. Пирогов") — 24/7, best equipped trauma centre in Bulgaria.

Out of hours

Emergency medical points (Спешна медицинска помощ) operate 24/7. For non-life-threatening issues outside GP hours: call 150 (ambulance service), visit the nearest 24-hour emergency centre. Some private clinics also have 24-hour emergency service.

Prescriptions

Prescriptions (рецепти) issued by GP or specialist. NHIF covers medicines on the official list at 50–100% (patient pays copay). Prescriptions valid 1 month from issue date. Pharmacies dispense all prescribed medicines; no prior authorisation needed for routine prescriptions. Some medications available over the counter in Bulgaria that require prescription elsewhere.

Dental

Public dental care is very limited — emergency extractions only under NHIF for adults. Private dental care is excellent and affordable: checkup 40–80 BGN, filling 80–150 BGN, crown 400–700 BGN. "Dental tourism" to Bulgaria is popular among EU citizens — same quality as Western Europe at 40–60% lower cost.

Mental health

Mental health services are underdeveloped in the public system. Psychiatrists through NHIF with referral. Private psychologists and psychotherapists: 60–150 BGN/session. English-speaking therapists available in Sofia. Crisis helpline: 0800 18 624 (free, 24/7). Online therapy platforms increasingly available.

Maternity

Maternity care fully covered under NHIF. Prenatal check-ups: monthly GP visits + 3 specialist ultrasound examinations. Childbirth at state hospital: free (small administrative fees). Private maternity hospitals available in Sofia (Tokuda, Acibadem): 2,000–5,000 BGN for private birth. Maternity leave: 410 days (including 45 days prenatal) at 90% of salary from social insurance.

Expat-specific advice

First steps on arrival:

Ensure you have continuous NHIF health insurance contributions — register as self-insured at the NRA if not employed
Register with a GP (личен лекар) through the NHIF portal (zdravniosiguryavane.bg) or visit a GP office directly
Get an NHIF card (здравноосигурителна карта) — issued automatically to insured persons
Consider supplementary private health insurance for faster access and English-speaking service
Save phone numbers: 112 (emergency), 150 (ambulance), your GP, nearest 24-hour clinic

Finding English-speaking doctors:English-speaking doctors are available in Sofia, especially at private hospitals (Acibadem, Tokuda) and international medical centres. Expat Facebook groups maintain up-to-date lists of English-speaking GPs, specialists, and dentists. Some public hospital doctors also speak English, particularly those trained abroad or in younger generations.

International insurance:International health insurance (AXA, Cigna, Bupa, Allianz Care) is accepted at Acibadem and Tokuda hospitals and most private clinics. Useful for frequent travellers or those planning to leave Bulgaria. Coordinate with insurer on direct billing vs. reimbursement.

Emergency card info:Carry a card with: blood type, allergies, emergency contacts, current medications, and health insurance details. The EHIC (European Health Insurance Card) is valid in Bulgaria for EU citizens — it provides access to public healthcare on same terms as Bulgarian citizens.

EHIC notes:EU EHIC is valid in Bulgaria — ensures access to public healthcare at same rates as Bulgarian citizens (copay 2.90 BGN per visit). Apply for EHIC from your home country's national health authority before departure. UK citizens use the new GHIC (Global Health Insurance Card) instead.

Pharmacies (Аптека (Apteka))

Hours:Most pharmacies open Mon–Fri 08:00–20:00, Sat 09:00–18:00, Sun closed. Major chains (Remedium, Arums) in malls have extended hours. 24-hour pharmacies available in Sofia at main hospitals and key locations.

After-hours / emergency:24-hour pharmacies (нощна аптека) — call 150 or check apteka.bg for nearest 24-hour location. All hospitals have a pharmacy open 24/7. The NHIF publishes a list of duty pharmacies (дежурни аптеки) by city.

Prescription rules:Prescription medicines require a valid doctor's prescription. Some medications available OTC in Bulgaria that require prescription elsewhere in Europe (antibiotics often dispensed without prescription at pharmacist's discretion — though this is changing). NHIF prescriptions have a coloured prescription pad — must be presented for subsidised pricing.

Available over-the-counter:

Pain relief: Paracetamol (Panadol), Ibuprofen (Nurofen), Aspirin
Cold and flu: Coldrex, Theraflu, Strepsils
Vitamins and supplements — large selection
Antihistamines (various brands)
Antacids and digestive aids
Antiseptic creams and first aid supplies
Contraceptives

Typical costs

GP visit (with insurance)	2.90 BGN copay
GP visit (private pay)	50–100 BGN (private)
Specialist visit	2.90 BGN copay (with referral, public) \| 80–200 BGN (private)
Emergency visit	Free (public emergency)
MRI scan	200–500 BGN (private, no referral)
Prescription average	5–30 BGN copay (NHIF)
Dental check-up	40–80 BGN (private)
Baby delivery	Free (public hospital) \| 2,000–5,000 BGN (private clinic)

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