Bulgaria runs a two-track system: a state-funded public scheme that is effectively free for legal residents, and a thriving private sector that most expats actually use. Here is everything you need to know.
The National Health Insurance Fund (NHIF), known locally as NZOK, is the backbone of Bulgarian public healthcare. If you are a legal, long-term resident, participation is mandatory.
Contributions are calculated at 8% of your gross income, paid monthly. How that 8% is collected depends on your employment status:
| Your Situation | Who Pays | Your Share | Employer’s Share | What You Need to Do |
|---|---|---|---|---|
| Employed by a Bulgarian employer | Split between you and employer | 3.2% | 4.8% | Nothing — your employer handles it automatically via payroll |
| Self-employed, freelancer, or business owner | You pay in full | 8% | — | Register with the National Revenue Agency (NRA) and make monthly payments yourself |
| Residing without working (retired, living off savings) | You pay in full | 8% | — | Register with the NRA. Contributions are calculated on a minimum reference income |
Missing three consecutive monthly contributions suspends your healthcare rights entirely. You will need to clear all arrears and then serve a further waiting period before your cover is reinstated. Set up a direct debit from day one.
Even with full public insurance, a small fixed charge — called a potrebitelska taksa — applies when you use services. Following Bulgaria’s adoption of the Euro in January 2026, these are:
Post-Brexit, British nationals cannot rely on an EHIC or GHIC for anything beyond emergency cover during temporary visits. Residents must slot into the local system — though UK State Pension recipients have a useful shortcut.
Your EHIC or GHIC card covers emergency treatment during temporary visits to Bulgaria. The moment you become a resident, you must transition to the local system. Carrying a GHIC as a resident does not give you the same rights as someone on holiday.
Once your insurance is active — or your S1 is registered with the local NHIF office — your first priority is choosing a personal GP. The process involves a charmingly Bulgarian administrative ritual.
Purchase a physical blue health insurance booklet (zdravno-osiguritelna knizhka) from any local stationery shop (knizharna). It costs almost nothing and is still a standard part of the process despite ongoing digitalisation.
Download the Permanent General Practitioner Selection Form from the NHIF website, or pick one up from the same stationery shop. It is a single A4 form in Bulgarian — your GP’s receptionist can usually help you complete it.
Bring the blue booklet, the completed form, and your foreigner ID card (which contains your LNCh personal number). The GP will stamp your blue booklet, officially adding you to their patient list. You are now registered.
Bulgaria has been digitalising its health records since 2024. You can access your electronic health record and history via the eHealth mobile application. That said, the physical blue booklet is still the standard starting point — get it first, go digital second.
You can register with your first GP at any point in the year. But if you want to switch to a different doctor later, Bulgarian law restricts changes to two specific windows. Outside these periods, you are stuck with your current doctor.
If you permanently move your registered residential address to a different city or town, you may switch GP outside of these windows. Temporarily staying elsewhere does not count — it must be a genuine permanent address change.
Public healthcare is technically free, but it suffers from chronic underfunding, staff shortages, paperwork exclusively in Bulgarian, and long waits for specialists. The majority of expats use the private sector instead — and at Bulgarian prices, it is remarkably affordable.
Book directly with any specialist — cardiologist, dermatologist, orthopaedic surgeon — without needing your GP to act as gatekeeper first.
Private clinics in Sofia, Plovdiv, and Varna routinely have English-speaking consultants. Communication is rarely a barrier in major cities.
Advanced diagnostic equipment, private en-suite rooms, and a level of comfort that compares well to private hospitals anywhere in Western Europe.
A private GP appointment in the UK typically costs £75–150. The same in Bulgaria costs €15–25. Annual private health insurance at €200–800 is a fraction of comparable UK cover. Most Brits who move here find they can access a genuinely good standard of private care for less than they spent on the NHS parking charges back home.
Dental cover falls into a grey area. Public provision is extremely limited for adults, but Bulgaria’s private dental sector is exceptional value — and increasingly popular with dental tourists from across Europe.
Complex procedures such as dental implants typically cost 60–70% less in Bulgaria than in the UK. Private Bulgarian dental clinics in major cities routinely treat British patients who fly in specifically for the work. If you are living here already, you are already in the right place.
In a genuine emergency, one number covers everything: police, ambulance, and fire. Know it before you need it.
Carry your NHIF registration number, any private health insurance card, and your foreigner ID card when you go out. In a non-emergency hospital situation, staff will ask for these before treating you. In a genuine life-threatening emergency they cannot withhold treatment — but having your details ready prevents unnecessary confusion and delays.
Your GHIC is still worth having in your wallet even as a resident, as it can help with emergency cover if you travel elsewhere within the EU. It does not, however, substitute for Bulgarian health insurance when you are living here. Think of it as a useful backup for trips abroad, not a replacement for getting properly registered.