We're Moving To Europe

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Episode Description

Thinking about moving to Portugal and wondering how healthcare works? In this episode of We’re Moving to Europe, host Casey Kelly talks with Dr. Michael Averbukh, CEO and Managing Partner at Serenity, a healthcare concierge service for expats and immigrants in Portugal. They discuss how Portugal’s public and private systems compare to the US, what Americans should prepare for, managing medications, navigating bureaucracy, and access to care for trans people.

Whether you’re planning a relocation or already settling in, this conversation will help you understand how to prepare for your medical needs and make the most of Portugal’s healthcare system.

0:00 Introduction & guest intro

1:30 Dr. Averbukh’s journey to Portugal

2:55 Founding Serenity and its mission

4:24 Comparing US and Portuguese healthcare

6:19 Public vs private systems explained

9:20 Insurance and access differences

12:07 Medication availability & preparation

14:10 Navigating Portugal’s healthcare bureaucracy

19:15 Healthcare access for trans people

22:03 Tips for preparing medical care before moving

27:10 How to manage care after arrival

35:24 Final advice: Be prepared

Production team

Host and Researcher: Casey Kelly – We’re Moving to Europe

Producer and Editor: Magdalena Laas – Unscripted Creatives

Sound library

B-Roll
Additional royalty-free footage curated via Pixabay and Pexels

Creators and Guests

Host

Casey Kelly

US > PT immigrant | mom to US > SE and US > NL immigrants | founder, We're Moving To Europe

Producer

Magdalena Laas

I’m a storyteller at heart with a passion for crafting content that resonates—whether it’s through the written word, audio waves, or visual narratives. I thrive on bringing stories to life through sound. With a proven track record in multi-track editing, sound design, and audio enhancement, I ensure episodes are polished and impactful. Whether it’s collaborating with hosts, refining interviews, or balancing audio quality, I’m all about delivering a listening experience that leaves a lasting impression.

What is We're Moving To Europe?

A podcast for Americans who are curious and serious about relocating to a European country. For more resources and to join the conversation, find us on Substack at We're Moving to Europe.

Welcome to We're Moving to Europe.

It's a podcast for you if you're an American who's curious or serious about moving to a country in Europe.

I'm Casey Kelly.

I moved from Texas to Portugal a little over 2 years ago after my young adult kids moved to Sweden and the Netherlands, and now we're helping other Americans research and plan their moves to different countries in Europe without stressing out, wasting money, or losing time.

If you want to move somewhere in Europe and you aren't sure yet how to make it happen, you're in the right place.

Today, we're talking with Doctor Michael Averbukh.

He is the CEO and managing partner at Serenity, which is a healthcare concierge service for expats and immigrants living in Portugal.

His company helps clients navigate Portugal's public and private healthcare systems and overcome the language barrier for setting appointments.

And full disclosure, I've been a Serenity client for more than 2 years, and I've often wished that there was a similar service for people dealing with the healthcare system in the US.

So welcome Doctor Averbukh, and thank you for making time to talk with us.

Happy to be here.

Yeah, thank you so much.

So do you want to tell us a little bit about your professional background?

And then how you came to Portugal to live and then how you came to set ups Serenity.

On the long story or the short?

Maybe the short story and, yeah, the short story is relatively simple.

I am a medical doctor and seen for many, many years in Israel, specialized in internal medicine and mainly prevention of cardiovascular diseases, and then.

The life and the professional life actually took me abroad, so, interesting parts of Africa, actually.

Equatorial Guinea and then Angola, where I managed Israeli-owned hospitals.

And the last one in Angola got me acquainted with many of the Portuguese.

Was always healthcare management.

Actually, the systems in Angola and in Portugal are quite similar.

One front of the of the hospital was Portuguese, and this is my acquaintance kind of with the Portuguese health systems, insurers, regulations, you name it.

At the end of the COVID pandemic, we decided to do something of a different nature.

In Europe, the acquaintance with Portugal was already kind of there.

I spoke the language and that at the time and decided to opens Serenity in Portugal together with my partner and co-founder Rita.

She is Portuguese, so it was kind of easier for her for sure.

, started Serenity in 2021.

, practically.

I know a very small office in a co-working space.

Apparently we are aiming for the right market.

I think that we managed to identify the needs of people, actually, I think.

The fact that we lived abroad and the fact that we understand how complicated it is for somebody that comes to a new country.

Does not dominate the language, does not dominate the culture, doesn't understand the system and yet.

As some health related needs.

This understanding of how difficult it is, how Sometimes You know, it's tremendous art thing, it's a tremendous challenge to find.

The name of your medication in a new country.

I think that this understanding gave us a bit of a jumpstart to create the right series for the right people.

This is how it all started, any 21.

Nice.

So during the pandemic, when I think a lot of people were maybe looking to relocate once travel restrictions were lifted, and obviously there was a lot of interaction with the healthcare system worldwide at that time.

I believe so, yeah, I mean, people might have been thinking better about their health care, I mean the the pandemic, it was years after all.

Nice.

So, as someone who has experienced the Portuguese healthcare system as, I guess, a newbie for the first time, and as someone who works with, I guess, a lot of American clients, do you want to talk about like the big differences that Americans should know about and prepare for?

If they're gonna move here, cause it's, it is very different, yes.

It is lame me very blurry.

Specifically for the American clientele.

When it comes to healthcare, actually, when it comes to, to a different country, for sure, European country come with an open mind.

So the the chances are that everything can be treated here can be solved.

And yet, it's not gonna look exactly like the mistakes because.

Your primary care physician isn't going to behave and for sure not to be the one that you're acquainted with in the states.

The medications, the names will be different, which is natural, but as well, the way you purchase medications will be different.

The way that you see a specialists and practitioners is different.

The way that you schedule is different, the way that your medical history, or your encounters are piled and registered will be different.

Great.

That matters.

When they left them when you need forward to these physicians.

Everything will be this and if you come open minded but reassured your treatment would not be harmed.

You starting in a good starting point.

If you can't expecting that it's actually.

I'll just do the thing.

I'll just do a copy paste from the states.

Forget it, ain't gonna happen.

Right.

And actually another very important thing, be very open-minded to the distancer switching from a totally private system in the states based on insurance, very insurance-driven system.

Yeah.

To a system that's totally differently.

We have two-headed system here, public and private.

Public is actually universal healthcare system provided by the state.

Private is kind of payment driven but not necessarily insurance driven.

Yeah.

So just look at it with a different perspective, with an open be ready to absorb new wedge and to accept it.

And then I believe that take care of being well prepared, well educated, well informed before.

Right.

So, yeah, as part of that information, I get a lot of questions from people who are like, so are you in the public health care system, or are you in the private healthcare system?

And I'm like, well, both because I have private health insurance, but the private healthcare system in Portugal doesn't Address every medical concern, right?

Like if you have a critical injury or a serious condition, you wanna explain the nuances of that a little so people get it.

Sadly, well, actually, you're, you're totally right.

31 in Portugal.

Actually, that, that would be an overstatement.

The majority of Portuguese, Portuguese percent not only expatriates.

would end up using public and private systems in parallel according to their district needs, according to the finding, because on one hand, everyone is entitled to have the access to the public system.

It's a constitutional right, and as I said before, it's a universal healthcare system that treats everyone.

On the other hand, this public system doesn't really Behave well in terms of timelines, in terms of waiting times to see a specialist, in terms of waiting times for an elective surgery or a major intervention.

It treats very well, very complex medical situations, and yet fails quite substantially when it comes to the routines, to the everyday needs, and this is where people would use private system that is much faster, much easier to access, much easier to manage your way in terms of you can go everywhere, you can choose your physicians.

It's it's a much more of a flexible place to get attended.

So again, even Portuguese, not, not to speak of expatriates would use private system quite often.

You mentioned that you use private system with insurance or whatever.

Very important to say that insurance is not a a condition.

To use private system here, actually, the only thing you need to have in order to be treated on a private setup is the ability to pay for.

Insurance is one of the tools that you might use in order to pay, simply stating.

And again, this is a very, very big difference from from the US based system.

Yeah, yeah.

I have a sibling with complex medical issues, and he went through a period with no insurance for a while and providers would just hang up when they would call and try to make an appointment.

There was no real self-pay option.

So, yeah, the fact that you can do both, and the fact that health insurance is much less expensive here than it is in the US and it occurred to me when I was prepping for this interview, I'm like, I haven't had to get on the phone and fight with my insurance company.

Since I came here, it's, you know, I'm not a heavy user of the health care system, you know, knock wood that will continue, but like when something happens in the private system, they pay, I pay my copay and they pay the rest, and there's no back and forth.

It's not like a They're not trying to wear me down, they just do their job and I get my healthcare, and it's great.

You were lucky because of the.

At the end of the day, look, insurers all over the world, this is a global thing, insurers all over the world, they will provide the the contracted coverage, but naturally they would look for a way to pay less or not to pay at all for for any possible treatment.

So it's not all.

Rainbows and and unicorns here.

Right.

You're totally right that it's much cheaper, yes.

And actually that all the pricing structure was totally different, right?

But again, insurance is much cheaper, yes, still not be a topic system, you know, it will not always be as easy and will not always pay for everything you dreamt of.

Yet again, you just need to understand.

What does it entail?

What does it cover?

Not to create false expectations and later on be frustrated, right?

As soon as you understand that or as soon as you have somebody to explain or just to support you with your decisions, you know, becomes much, much easier to cope with.

Yeah, it's, it seems less stressful.

It has been in my experience, and I haven't heard too many people here complain about, you know, the wait times for sure in the public system, but I think that's a global problem as well.

There were a couple of issues that we talked about in our, you know, pre-interview conversation.

And one is Americans who may have medications that they need that aren't available here like say Adderall for ADHD.

, do you want to talk about like, how can an American transfer their health care and also maybe At the same time, be managing getting a different treatment.

For their condition.

At the end of the day, people find here either the same treatment under the same name, or the same treatment under a different name or a Tylenol treatment that is not called the same, but has the same effect or better or as good as.

So, something the proper treatment at the end of the day is a non issue in almost any possible pathology, any possible.

Treatment protocol, but there are several, very few, by the way, medications that, for example, are approved in in the states under the FDA approval, but have not been approved by the European Union as well.

That's one of them.

So when we is taking another oath for ADHD would not sign it here and just not approved.

And yet, the psychiatrist or the neurologist treating ADHD.

will always find a substitute and the treatment and get you to the condition you have you have to be in.

So you will find a proper treatment.

Another good example is treating for thyroid problems or or bovi-invasive if I'm not mistaken, thyroid preparations approved for usage in the states aren't approved to you.

Again, there are solutions.

You just need to know, ask us or anyone else before coming and have it arranged.

Some treatments, this is a good and bad and bad news, some treatments.

provided here in Portugal under the public system only.

And that would be treatments, those would be treatments that are very expensive, by the way, like biosimilars or prolonged chemotherapy treatments, mainly, medications, either oral or injectables or intravenous that are tremendously expensive and one would have thought the insurance companies in the states to get it.

Here, you will get it totally free of charge, but only after being registered with the public healthcare system.

So people and many times to you only the free of charge.

So, yeah, I'm getting there and I, I know, get my treatment with no need to fight an insurance, great.

And then a nurse.

They come here and then they start, it's free of charge, but there's a process to it.

process takes time.

And if you're not prepared, you find yourself.

Just with no treatment available, not because you couldn't afford it, not because it's not here, just because you forgot there's a bureaucratic process that takes time to get there.

If you're not well prepared.

You find yourself in a very, very awkward situation.

You came here, somebody told you that healthcare here is for free or very accessible, which is true.

Mhm.

But Somebody as well forgot to mention that it just takes time.

Right.

So again, this kind of treatment available treatment even for free, but not immediately when you get off the plane.

It is for free.

So this is another part of a medications or treatment is only available.

Either cheaper or with no payment at all, but there's some kind of a process aside, and if you forget about this and you come down.

You know the problem, not the line if I may, it's just a matter of preparedness.

It's just a matter of talking to somebody.

Asking the correct questions not only about how's healthcare in important.

But how healthcare in healthcare in Portugal is a good starting point.

And then you need to talk to somebody that can advise about your personal condition.

It's not only healthcare is great, or healthcare is free.

How do I get to be treated with ABCD?

And only when you have this sorted out, you are.

In a, in a way better prepared.

Right.

And what I'm trying to say just just to finish that.

Mhm.

are meeting people, hundreds of people that just come with the basic knowledge that they got from Facebook groups, social media and YouTube channels, whatever, naturally.

It can give you a very good a general very good understanding of.

Our things But specifically when you speak about healthcare, you need, you need to ask your specific questions.

How is my situation.

, going to be treated.

How do I get to be treated in this and that?

How do I get my healthcare transition?

Right.

Well, and preparing for that bureaucracy, for that to navigate the bureaucracy to access the public health system, I mean, that's, that's Portugal for everything, right?

For your driver's license, for your residency card, for buying or renting a place, opening a bank account, you just kind of have to learn to navigate bureaucracy, no matter what, and you have to plan for it cause it's slow.

So, Absolutely, that's, that's that's the thing, bureaucracy is everywhere here, and again, there are some kind of more tangible areas.

Right.

Yeah, don't just show up and expect everybody to, I guess, don't do a trust fall with your healthcare and expect the system to catch you.

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One other sort of, I guess, specialized area of health care that you and I had spoken about before was a healthcare access for trans adults and trans youth.

What is that like here?

OK.

, different but positively different.

First, and, and I think the most important thing, you will forever come across a great patience on the side.

of the providers, on the side of the, of the treating physicians, nurses, etc.

etc.

There's a great patience, there's a great acceptance, great tolerance.

I mean, no problems when you face your caregivers, then whoever they are.

This is important to say.

And yet, Portugal in general is a relatively conservative country.

So some of the measures, some of the, again, treatment protocols might be not with a kind of a razor an eyebrow.

For example, not from everyone.

Mhm.

but kind of in general, for example, hormone treatment for children, etc.

etc.

not everyone.

It will be very convenient with just renewing prescriptions, etc.

Nobody will, again, it will not be met with the resentment.

Mhm.

For the everyday routine treatment, no problem finding primary or secondary care physicians, but if you need specialists, they exist.

They are fewer than what you might find in the states, but they do exist.

We refer our clients to those specialists that provide great care.

The latest knowledge, the quality of care and the quality of, of follow-up and whatever, do not fall behind anything that you have experienced back in the States.

I'm just saying you will not find here hundreds of special, specialists of trans transgender medicine for adults, for sure not for children, but just you that are here are very good.

You just need to know how to reach to those you that are really Specialize in those fields and provide the needed support and care.

OK, great.

So, That's, that's good, that's reassuring.

I guess what I wanted to ask now is for someone who is thinking about moving to Portugal or planning a move, how early in their planning process should they start looking into what they need to bring with them in terms of like health records, maybe insurance, arranging for the transition of care.

Like how early should they start that?

So whenever you just stop thinking thinking about it, look for reliable information.

Talk to people and if possible, talk to us because with us as medical professionals, you can really share your medical background, something that I wouldn't do over Facebook or whatever.

Right.

Yeah.

Share your medical background and ask us, even in a general question, would I have problems?

And we will always say yes, no, or yes, there's a challenge, a specific challenge that, that you need to know and address in due time.

This is 12, actually 2 depends on 1.

If you don't have any specific type of challenges, no specific treatment that needs to be arranged in advance, etc.

a good time to really put your hands onto Starting this transition period is around the submission of the, of the visa request.

The application for a visa, meaning the application for a visa now like if you apply, it takes around, I know, 8, 10 weeks to get, to get a response, more or less, and then you have your time until arrival, so it allows you to start your preparations.

34, maybe 5 months ahead of time, which is normally enough time for everything to be arranged.

, starting with the specific, insurance that you need for the visa application, the Schengen travel insurance, then starting kind of with the preparation of what do I need to bring with me?

Do I need to talk a bit over my meds, over my prescription medication in the states or not?

Sometimes yes, sometimes no.

If I need some kind of continuous care, if I need to already schedule my follow-up appointments, be it with specialists or dental or whatever it is in Portugal, so this allows you the time to prepare for that which you need to arrange for special medications.

It allows the time to arrange for these and then I mean, when the time comes for you to fly over, you're well prepared.

In terms of medical records, it's a common repetitive question that we are, we are asked like how do I transition my medical records?

So, It's a bit of a problem challenge.

Portugal doesn't have a unified system that would post your medical records in whatever way, digital, non-digital, whatever.

We just don't have it here, sadly, by the way, in the public system, the information is shared only partially and in the private system, it's much more of a problem because each and every private facility would have your medical record.

only on their own platform, so they don't speak with each other normally accordingly.

If someone wants to bring the whole history of medical records from the states, they say you know let's say normally extracts of hundreds of pages of Information just nobody will read it.

And nobody can host it for.

So what, what we would normally advise to our clients is bring the relevant information, we understood what is your Your package, your, your luggage of healthcare that you're bringing with you, we will tell you to bring this, but don't bring the other.

Bring only the last results of your mammogram, for example, or whatever blood test because this will be relevant.

When we continue treating.

Right.

Yeah.

We're now creating a small app of ours where our clients can store their medical records from the past, from the, from the, from the present and from the future, don't matter where they were treated.

Maybe it will be only a partial solution for so this challenge.

That could be good, yeah, I, as an American, like my health care records from the states are so fragmented anyway that I kind of did have to do what you suggested and just bring over my most relevant issues.

Looking for for the paper trail that could be a challenge.

Yeah, yeah, exactly.

So one, I guess one final question that I had is for Americans who are coming over.

And they're newly arrived, what do you recommend they do in terms of getting their, you know, getting their healthcare routines on track, making the most of the access they have, because if they're like me, I know there are a lot of Americans who continually put off healthcare because of the expense or the hassle, what should they be doing to kind of catch up on deferred maintenance and building relationships with care providers here?

, good question to which, which I have, again a general value because again at the end of the day it's very, very personal in a general way, costs of healthcare in Portugal.

Even if you pay out of pocket are way, way, way more affordable than what you even think of.

Comparing to, to the US insurance, not insurance, whatever, you will find that.

Again, for sure, the, the routine, the annual exams, preventative medicine, etc.

all of that is much more affordable.

So even if you don't have insurance, don't neglect.

2 Primary care, in theory, through traditional primary care physician is supposedly gonna be in the public system, but only supposedly because unless you live in a very rural area or some small village and you are lucky enough to have a primary care physician in your village, the chances of getting into, to the public care with an assigned.

Primary care physician, your primary care physician are literally you.

So primary care should be done through private system, but remember again, primary care here in general is very, very different from what you know in the states.

Primary care physicians, even in the in the private sector, if they are sicker, then the bigger hospitals will have very limited time for, for the interaction.

Don't expect, with all due respect to everyone, do not expect them to follow up and follow through with their lab tests or whatever they send you to.

They won't.

Right So you'll have to come back again to see them with the results in your hand, which creates a bit of a, of, of a kind of nagging situation every time you have to come back again and again and again.

It's a bit of a problem.

They do not expect primary care physicians for sure again in the private sector to answering your emails.

If they do, you found yourself, you kind of hate the job.

So it's a bit of, of a Of the problem.

Again, just put your expectations in line with the everything.

and yet again, If you need A better management of your care in terms of again, preventative med, having somebody available, etc.

etc.

is exactly the reason that we exist.

Great.

Because you, you, it, it's rare, relatively rare to find.

So like like it used to be once.

In Portugal, just because the system is built differently, and just because it is theoretically the place of the primary care physician of the public system that you can't get because the public system is so overwhelmed.

Right.

Yeah, like, I have a I have a public system primary care physician, but I've never met her.

It's just like they gave me a chart and said pick one whose hours align with yours, and every now and then I'll get an email from her office saying, hey, if you've had XYZ procedure already done in the private system, please send us a copy of the records, and that's the extent of it.

So there's so you've got like because at least they have so many sound renades.

It doesn't happen so often.

I mean, there are around 2 million Portuguese, not Por citizens without an assigned primary care physician.

Right.

Yeah.

Mhm.

The account with a certain ongoing medical situation.

, but, we sent, she, she lives up north, and we sent to a very good physician that we know that we, we, we share a lot of clients to, we have very little doubt about the capabilities and knowledge, the quality of care.

And this physician examined our client and said, you know, I would very much like to run a certain series of tests and after those tests, I will decide what prescriptions we will use straight in.

And she was very happy with how the consultation went and she did all those tests and then she was like, With the tests on her hands.

He wrote to us saying, Well, guys, like, I've been waiting, it's like a week now or something since I had my tests, and I'm still waiting for this document that you guys sent me to.

, to send me the prescriptions.

And it's in a way.

rang a bell as well for us and he said, wait, wait, just a second.

What's, what's supposedly was to happen is that when you walked out of the office of this physician, he was supposed to ask for a follow-up appointment.

He said, well, I don't remember him saying that in any way, maybe I didn't understand, but I did not schedule, but he told me after the tests you were prescribed and we said, yes.

What, when a Portuguese physician says, I'll see what we do after the tests.

The underlying text is, do the tests when you have them come back to me.

I'll see it in a 2nd 2nd consultation and we I'll decide what are the prescriptions.

For the American year is, OK, I'm sending you to those tests.

I will get them back because this is how the system works in the States.

Many times the referring physician sees the test and then he calls you or said, oh, OK, I got your test.

Here is the prescription.

Doesn't work like that in Portugal.

Yeah.

Yeah, and, and this is, this is exactly the thing of how.

The same wording has totally different meaning.

In the US we're here and if you're not acquainted with that, you'll just be sitting home saying, oh, I hate this physician now because he promised me, but, but he.

Great.

I ran into that too.

It was my GP in the private system ordered some tests for me and I went and took them, and then I, I got emails from the test providers saying, here are your results.

And I remember, I think I contacted my case manager at Serenity.

I'm like, I think they sent this stuff to the wrong people.

I'm not supposed to have these results, they're supposed to go to my doctor and she's like, no, no, in Portugal, they're your results, they're your healthcare records.

You get to keep it, and I was like, as an American, I was like, am I even allowed to look at this, you know, because we're always taught that no no, that's that's for the doctor.

But yeah, realizing, and actually it's not it is for the doctor as well, but he never gets it.

Right, it's up to you to share it.

Or you exactly.

It's up to you to share it.

It's, it's again, good and bad things.

It's up to you to manage your care, although you're not trained for that.

It's a bit, it's a bit of a raccoon, so you need somebody to assist you with it.

And again, supposedly it's your GP in the public system.

If you don't have one, to lay in this story, and this is again where we come from.

Right, yeah, that was the biggest adjustment for me, was like just having them give me results.

And I was like, OK.

Yeah, now what?

So, and then I then I realized, OK, now I have to go back and talk to the doctor about it, which is fine.

It's a different way of doing things, and I like like having access to my healthcare records.

It, you know, like somebody, one of the medical professionals spoke to said, well, of course, because this is your care, it's about you, you should have this, and just that mindset shift was.

It was big.

I like it now.

At first it felt very transgressive and weird, but now I'm, I'm kind of OK with it.

So, Doctor Averbukh, thank you so much for taking time to talk with us today.

Is there anything else that you would recommend that people look into or consider or know if they're thinking about?

Health care and moving to Portugal.

It's saying that the keyword is be prepared, that's it, plan, plan well.

And not necessarily by reading general information on social media or or online because your healthcare, unless you're 20 Only healthy, your healthcare is your healthcare.

You need to ask very very specific questions accordingly, you need to have the the information from a reliable source that can relate to your specific backgrounds and I'll just repeat what I said before.

There's no too early of a time to ask those questions at least understand what to expect or when to make the next move.

-huh.

That's it.

If you're wealthy parent, the chances that she will come over to port and and be negatively surprised with something of very little or do not even exist.

And this is the most important thing with peace of mind.

Be prepared, be ready.

OK, great.

Well, thank you so much.

I appreciate it.

Thank you so so much for having me.

That's all for now.

Thanks for listening and please drop your questions in the comments.

Remember to like, share, and subscribe for more tips about planning your move from the US to a country in Europe.

Our producer and editor is Magdalena Laas at Unscripted Creatives.

Our music was composed by Sage Barton, and I'm Casey Kelly.

See you again soon at we're moving to Europe.

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