How healthcare works in Malta for foreign residents

Malta runs a public health service that is free at the point of use for people who are entitled to it, alongside a large private sector. For Americans, the key question is not how good the hospitals are but whether you are entitled to the public system, and from when. Entitlement in Malta is tied mainly to social security cover, and Americans usually start outside it. This guide explains how the public system is organised, who is entitled, what is free and what is not, and where private insurance fits.

How the public system is organised

The Office of the Deputy Prime Minister and Ministry for Health is responsible for health policy and the provision of care. It describes its role as providing free public health care services, including:

• acute care at Mater Dei Hospital in Msida;
• primary health care services;
• mental health services;
• medicines on the Government formulary.

### Primary care

The Primary HealthCare department delivers over 50 public primary care services across Malta and Gozo. They run mainly through health centres, community clinics, centres of excellence, a 24/7 telemedicine support centre, the National Screening Centre and the Occupational Health Unit. It says all its services are free of charge and publishes estimated waiting times for the GP walk-in clinics at its health centres.

Health centres listed by the European Commission's Malta page include Floriana, Gzira, Qormi, Paola, Cospicua, Mosta, Rabat and Birkirkara, with Victoria serving Gozo. Specialist care at Mater Dei normally starts with a GP referral.

### Hospitals

Mater Dei Hospital is Malta's main acute hospital and has the Accident and Emergency department for the main island. Gozo General Hospital is the only hospital on Gozo. It provides emergency, acute, inpatient and outpatient care, plus psychiatric and long-term care, and is open 24/7. It is linked to Mater Dei by 24/7 air and land ambulance services for emergency and specialised care.

In an emergency, call 112 or go straight to the Accident and Emergency department.

Who is entitled to free public care

The Ministry for Health's Entitlement Unit explains the routes into the public system. Free public healthcare is provided to entitled persons on presentation of valid documentation. The main categories are:

• People covered by Maltese social security legislation. If you are employed or self-employed in Malta and pay social security contributions, your residence card serves as proof of entitlement.
• Holders of a valid Maltese permanent residence document.
• EU visitors and residents with EU documents, through the European Health Insurance Card (EHIC) for temporary stays, or a registered S1 form and Certificate of Entitlement for longer stays.
• UK nationals under the Malta-UK reciprocal health agreement.

### What this means for Americans

The routes the Entitlement Unit lists are built on Maltese social security, EU documents and the UK agreement. None of them is a US arrangement, so for US citizens the question comes down to contributions and residence status. In practice:

• Employees and self-employed Americans who pay Maltese social security contributions are covered, and use their residence card as proof.
• Remote workers, retirees and people on special tax programmes who do not pay Maltese contributions are generally outside the public system and rely on private insurance. That is why their permits and programmes require it.
• If you do not present valid documentation, the European Commission's page says you will have to pay for services provided by public health care in Malta.

What is free and what is not

For entitled persons, the Entitlement Unit and the European Commission's Malta page describe:

• Medical services in public hospitals and health centres: free.
• Emergency ambulance transport to hospital: covered for people entitled to free public care.
• Medicines prescribed during an inpatient stay, or for the first three days after discharge: free. Medicines prescribed after that are paid in full and are not refundable.
• Emergency dental treatment at Mater Dei and health centres: free. Routine dental care is mostly private and paid by the patient, and those costs are non-refundable.

### Specialised treatments

People needing dialysis, oxygen therapy or chemotherapy during a stay should arrange appointments in advance with Mater Dei's renal unit or pharmaceutical services, or the Sir Anthony Mamo Oncology Centre.

What the Entitlement Unit expects from patients

The Entitlement Unit's page lists what people using the public system are expected to do:

• present valid entitlement documentation where it applies;
• carry identification when attending a hospital or health centre;
• book specialised treatments in advance where needed;
• pay any charges not covered by an entitlement scheme.

The European Commission's Malta page adds that you should present your Malta identity card whenever you use public services. The Entitlement Unit runs a Health Site Finder for pharmacies, health centres and district dispensaries in Malta and Gozo, and an MT Health Entitlement mobile app for requesting entitlement documents. If you paid for public care and believe you were entitled, the Department for Policy in Health's Health Care Funding section handles reimbursement queries.

Private care and insurance

Private clinics, private GPs and private hospitals operate across Malta. Private patients pay directly or through insurance. If you are not entitled to public care, or want faster access to some services, private insurance is the main route.

Identità's healthcare requirement, in force for new applications from 1 August 2024, asks employment-purpose applicants and family members for a policy with at least €100,000 of cover, including hospitalisation in Malta and, if necessary, other European countries, valid for the first year of the permit. Keep cover in place until your public entitlement is confirmed.

The EHIC: for Malta residents traveling in Europe

Once you are ordinarily resident in Malta and covered by Maltese social security, or hold a Maltese permanent residence document, you can apply for a Maltese EHIC. It covers medically necessary treatment in state systems during temporary visits to EEA countries and Switzerland. The Entitlement Unit says:

• the card arrives within five working days of a complete application;
• applications should reach it at least 15 working days before departure;
• cards have been renewed automatically one month before expiry since March 2023.

The Entitlement Unit's page notes that if you are not an EEA citizen, stateless person or refugee, you can use the EHIC in the listed countries except Denmark, Iceland, Liechtenstein and Norway. It complements private insurance; it does not replace it.

Medicare and Malta

Medicare.gov states that Medicare usually does not cover care outside the US. Retirees in Malta should not count on it for treatment there.

Getting set up

1. Confirm your entitlement route: contributions, permanent residence or private cover.
2. Keep your residence card and documents with you when attending care.
3. Find your nearest health centre and A&E.
4. Book specialised treatments before arriving.

Common questions

Is healthcare free in Malta for foreign residents? Public care is free for entitled persons, mainly people covered by Maltese social security. Americans who work in Malta and pay contributions use their residence card as proof.

Are remote workers and retirees covered by the public system? Generally not, if they do not pay Maltese contributions. They rely on private health insurance, which their permits require.

Are prescriptions free? Only those prescribed during an inpatient stay or for three days after discharge, for entitled persons. Later prescriptions are paid in full.

Can Americans use a Maltese EHIC? Residents covered by Maltese social security can apply. Non-EEA nationals can use it in the listed countries except Denmark, Iceland, Liechtenstein and Norway.