North Macedonia offers both public and private health insurance systems, each serving distinct segments of the population and offering different levels of service, flexibility, and coverage. Understanding their similarities and differences is essential for residents, expatriates, and travelers seeking appropriate healthcare solutions.
Public Health Insurance
The public health insurance system in North Macedonia is managed by the Health Insurance Fund (HIF), a state-run entity that oversees contributions, fund allocation, and provider contracting. Over 90% of the population is covered by HIF, making it a nearly universal system. The insurance is funded through mandatory social security contributions, state transfers, and co-payments.
The public benefits package is comprehensive, covering general practitioner visits, specialist consultations, hospitalizations, emergency care, surgeries, maternity services, rehabilitation, and basic dental care. Primary care is largely free at the point of service, though patients are responsible for co-payments when it comes to hospital stays, specialist outpatient services, and a significant portion of medications.
However, public healthcare in North Macedonia often suffers from long wait times, limited access to advanced treatments, and varying quality between urban and rural areas. Major institutions like the University Clinical Center in Skopje and regional hospitals such as Clinical Hospital Bitola and General Hospital Ohrid form the backbone of the public healthcare infrastructure.
Private Health Insurance
Private health insurance in North Macedonia is typically used by expatriates, tourists, and wealthier residents who seek faster access to care and higher service standards. Providers such as Cigna Global, AXA, Allianz, April International, and Bupa Global offer international insurance plans that cover inpatient and outpatient services, preventive care, emergency evacuation, and optional services like dental and optical treatment.
Private plans are highly customizable, allowing clients to tailor their coverage to specific needs. Many private policies offer access to top-tier private clinics in North Macedonia, including Acibadem Sistina, Zan Mitrev Clinic, and Neuromedica—facilities known for modern technology, multilingual staff, and short wait times.
These private policies are generally more expensive than the public system and may not be accessible to all. However, for those who can afford it, private insurance provides peace of mind through faster service, international coverage, and broader access to specialized care.
Similarities and Key Differences
Both public and private systems aim to ensure healthcare access but differ in execution. While public insurance is compulsory and broad-reaching, it often lacks the convenience and speed of private care. On the other hand, private insurance provides premium services, international portability, and greater flexibility, especially beneficial for expatriates or those with complex medical needs.
A significant commonality is that both systems require some level of out-of-pocket payments, though these are generally higher in the public system. As public sector co-payments and limitations persist, many residents opt for supplemental private insurance to bridge the gaps.
Top Public Health Insurances in North Macedonia
North Macedonia has a centralized and largely public-funded healthcare system. The primary institution responsible for public health insurance in the country is the Health Insurance Fund of North Macedonia (HIFM). Unlike many countries that have multiple public health insurance options, North Macedonia operates under a single-payer model. Therefore, while there is only one major public health insurer, HIFM, this entity plays a comprehensive and critical role in healthcare provision. Below is an in-depth overview of the HIFM, including its cost, coverage, access, financial structure, and consumer satisfaction.
1. Health Insurance Fund of North Macedonia (HIFM)(Official website: https://fzo.org.mk/en)
Cost
The HIFM is funded through mandatory payroll contributions. Employers contribute approximately 7.5% of an employee’s gross salary, and employees contribute 1.5%, making the total contribution around 9%. Self-employed individuals must pay the full amount themselves. Certain categories such as pensioners, unemployed individuals, and vulnerable groups are covered by state subsidies.
Available Services / Coverage Features
The HIFM provides comprehensive coverage that includes:
- General practitioner and specialist visits
- Hospital care and surgery
- Emergency services
- Prescription medications (with a co-payment system)
- Preventive services including immunizations
- Maternity and neonatal care
- Rehabilitation and physiotherapy
- Mental health services
- Dental services (basic coverage)
The scope of services is designed to ensure access to essential health care across the population, with a focus on universal health coverage.
Open for All or Limited
The HIFM is open to all citizens and legal residents of North Macedonia. It also provides coverage to registered asylum seekers and certain categories of foreigners residing in the country. Enrollment is mandatory for those employed, while others (e.g., unemployed, students, pensioners) must register separately or qualify through state programs.
Core Financial Features
The system is largely funded through:
- Payroll contributions
- State budget subsidies (for exempt groups)
- Co-payments and out-of-pocket fees for some medications and elective procedures
Despite being a publicly funded system, there is a moderate level of out-of-pocket expenses, particularly for brand-name medications, private consultations, and non-covered dental services. However, catastrophic health expenses are relatively rare due to the system’s structure.
Consumer Satisfaction Score
Public sentiment around the HIFM is moderately positive, with consumer satisfaction estimated around 65–70%. Key strengths highlighted in surveys include universal access and affordability, while criticisms often target long wait times, regional disparities in service quality, and the need for better infrastructure and modernization.
Patient advocacy groups have called for increased transparency, faster digital transformation, and enhanced patient rights awareness to improve satisfaction levels further.
Top 5 Private Health Insurance Providers in North Macedonia
North Macedonia offers several private health insurance options, primarily catering to expatriates, international travelers, and residents seeking enhanced healthcare services. These providers offer comprehensive coverage, flexibility, and access to a global network of medical professionals. Below is an overview of the top five private health insurance providers in the country:
1. Cigna Global(Official website: https://www.cignaglobal.com)
- Cost: Premiums vary based on coverage levels and personal factors. Plans are tiered into Silver, Gold, and Platinum, with increasing benefits and corresponding costs.
- Available Services/Coverage Features: Cigna offers customizable international health plans covering inpatient and outpatient care, mental health services, maternity, dental, and vision care. Additional options include medical evacuation and preventive health services. cignaglobal.com
- Open for All or Limited: Open to individuals and families worldwide, including residents and expatriates in North Macedonia.APRIL International+9Cigna+9Bupa Global+9
- Core Financial Features: Flexible deductible and cost-sharing options allow policyholders to tailor plans to their budgets.Cigna Global Health
- Consumer Satisfaction Score: Cigna is recognized for its extensive global network and 24/7 customer support, contributing to high satisfaction among international clients.
2. AXA Global Healthcare(Official website: https://www.axaglobalhealthcare.com/en)
- Cost: Premiums start at approximately $314 for international coverage, varying with plan specifics and personal factors. Insurancy
- Available Services/Coverage Features: AXA provides comprehensive plans covering routine and emergency healthcare, mental health support, and access to virtual doctor consultations. Optional upgrades include dental and optical care. AXA – Global Healthcare
- Open for All or Limited: Available to individuals, families, and businesses, including expatriates and travelers in North Macedonia.
- Core Financial Features: Offers flexible coverage with optional upgrades and excess choices to manage premiums.AXA – Global Healthcare
- Consumer Satisfaction Score: AXA is praised for its quick claims processing and comprehensive support services, leading to high customer satisfaction.
3. Allianz Care(Official website: https://www.allianzcare.com/en.html)
- Cost: Premiums vary based on coverage levels and personal factors. Allianz offers modular plans allowing customization to fit different budgets.Cigna Global Health
- Available Services/Coverage Features: Plans include inpatient and outpatient care, diagnostics, surgeries, and optional dental and optical services.
- Open for All or Limited: Open to expatriates, international students, and residents in North Macedonia.
- Core Financial Features: Modular plans enable policyholders to select coverage options and manage costs effectively.
- Consumer Satisfaction Score: Allianz is known for its reliable service and extensive global network, contributing to positive customer experiences.
4. APRIL International(Official website: https://www.april-international.com/en)
- Cost: Basic international health insurance plans start from approximately $500 annually, with comprehensive plans exceeding $10,000, depending on coverage and personal factors.
- Available Services/Coverage Features: APRIL offers flexible plans covering hospitalization, outpatient care, dental, maternity, and emergency medical evacuation. APRIL International
- Open for All or Limited: Available to individuals, families, and expatriates residing in North Macedonia.
- Core Financial Features: Customizable plans with various deductible options and the Easy Claim app for streamlined reimbursements.APRIL International
- Consumer Satisfaction Score: APRIL is commended for its transparency and efficient service, leading to high satisfaction among clients.
5. Bupa Global(Official website: https://www.bupaglobal.com)
- Cost: Premiums vary based on plan selection and personal factors. Bupa offers tiered plans—Major Medical, Select, Premier, and Elite—with increasing levels of coverage and corresponding costs. Bupa Global
- Available Services/Coverage Features: Comprehensive coverage includes inpatient and outpatient care, mental health services, maternity, dental, and access to a global network of specialists. Bupa Global
- Open for All or Limited: Open to individuals and families worldwide, including residents and expatriates in North Macedonia.
- Core Financial Features: Offers flexible plans with various deductible options and direct access to healthcare services without the need for referrals.
Consumer Satisfaction Score: Bupa is renowned for its premium services and extensive global network, resulting in high customer satisfaction.
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