Written by
John Spencer
John Spencer is the founder of Compare Expat Plans, focusing on clear, neutral information to help people find health coverage abroad.
Last updated: January 29, 2026
Quick Summary: Health Insurance in North Macedonia
- Temporary Residence requires health insurance proof—90-day visa-free stays have no mandate.
- FZOM public healthcare is underfunded—Skopje's private hospitals offer better quality.
- Private consultations affordable: MKD 1,500-3,500 (€25-55) at Sistina or Zan Mitrev Clinic.
- Lake Ohrid region has basic hospitals only—complex cases evacuate to Skopje, Belgrade, or Thessaloniki.
- International plans €35-90/month; evacuation coverage recommended given limited local capacity.
Do You Need Private Health Insurance in North Macedonia?
North Macedonia requires health insurance for Temporary Residence Permit applications. The 90-day visa-free entry for most nationalities has no insurance mandate, but coverage is essential given public healthcare limitations. The country is an EU candidate but not yet a member—EHIC cards are not valid here. For long-term stays, private international insurance or FZOM enrollment is required.
Insurance is required for:
- Temporary Residence applicants—mandatory insurance proof required
- Anyone staying beyond the 90-day visa-free period
- Expats seeking quality private hospital access in Skopje
- Lake Ohrid area residents—local facilities are very limited
- Those needing potential evacuation to Serbia or Greece for specialist care
Public vs Private Healthcare in North Macedonia
Public Healthcare
FZOM (Health Insurance Fund)
- Access: Macedonian citizens and registered residents with contributions
- Cost: ~7.5% of salary; minimum ~MKD 1,500 (€25)/month for voluntary enrollment
City Hospital Skopje (formerly Acibadem, now public) and Mother Teresa University Hospital are the main public facilities. Public healthcare suffers from underfunding, outdated equipment in some areas, and long wait times for specialists. Regional hospitals in Bitola, Ohrid, and Tetovo handle basic care but have limited capabilities. Many public doctors speak English, especially younger ones trained abroad.
Private Healthcare
International or Local Private
- Access: Open to anyone
- Cost: MKD 1,500-3,500 (€25-55)/consultation; MKD 15,000-50,000 (€245-815)/night hospitalization
Skopje has excellent private hospitals. Sistina Hospital is the largest private facility with comprehensive services. Zan Mitrev Clinic is renowned for cardiac surgery—patients come from across the Balkans. Alkaloid Hospital and Remedika are also good options. Private care in North Macedonia offers exceptional value—quality similar to Western Europe at a fraction of the cost.
Plan Options to Compare
Here are the most popular insurance options for expats in North Macedonia. Each has trade-offs depending on your situation.
Cigna Global
Best for: Worldwide coverage and strong customer service
Not ideal for: Budget-focused expats staying only in North Macedonia
Allianz Care
Best for: High-deductible savings and EU-based service
Not ideal for: Those wanting minimal out-of-pocket costs
BUPA Global
Best for: Pre-existing conditions and mental health coverage
Not ideal for: Those seeking the lowest premiums
IMG Global
Best for: Budget international coverage
Not ideal for: Those wanting premium service levels
Comparison Table: Top Expat Health Plans for North Macedonia
Compare the leading options side by side. Click "Details" to learn more about each provider.
| Provider | Best For | Coverage Style | Includes U.S.? | Notable Limits | Learn More |
|---|---|---|---|---|---|
| Cigna Global | Worldwide coverage and strong | International comprehensive | Higher cost than local options | Details → | |
| Allianz Care | High-deductible savings and EU-based | International comprehensive | Deductibles apply to savings | Details → | |
| BUPA Global | Pre-existing conditions and mental | International premium | Premium pricing | Details → | |
| IMG Global | Budget international coverage | International standard | 12-month pre-existing exclusion | Details → |
Common Watch-outs for North Macedonia
Keep these points in mind when choosing coverage:
- Lake Ohrid area has limited healthcare—Ohrid City Hospital handles basics, but complex cases go to Skopje (3 hours) or Thessaloniki (2.5 hours).
- Not in EU—EHIC cards don't work here. Don't assume European coverage applies.
- Currency is Macedonian denar (MKD)—ensure your policy handles non-euro currency claims.
- Mountain areas (Mavrovo, Pelister) have minimal facilities—ski and hiking accidents may require helicopter evacuation.
- For major trauma or specialized surgery, evacuation to Belgrade or Thessaloniki is common—ensure coverage includes this.
Frequently Asked Questions
Is North Macedonia's private healthcare really good value?
Yes, exceptional value. Zan Mitrev Clinic in Skopje is regionally famous for cardiac surgery—patients travel from Serbia, Kosovo, and Albania for procedures at 30-50% of Western European costs. Sistina Hospital offers a full range of services at similar savings. A specialist consultation costs €25-55, MRI around €100. Quality is comparable to EU countries at significantly lower prices.
What healthcare is available at Lake Ohrid?
Ohrid has a small city hospital handling emergencies and basic care. For anything complex—serious injuries, surgery, cardiac events—patients transfer to Skopje (3-hour drive) or Thessaloniki, Greece (2.5 hours). If you're retiring to Ohrid or staying long-term, evacuation coverage is essential. Summer tourists significantly strain local facilities.
Can I use EHIC in North Macedonia?
No. Despite being an EU candidate country, North Macedonia is not yet an EU member. European Health Insurance Cards are not valid here. You need separate travel insurance or expat health coverage. This is a common misconception—don't travel assuming EU healthcare rights apply.
How does evacuation work from North Macedonia?
For complex cases, patients typically evacuate to Belgrade (4 hours north) or Thessaloniki (2-3 hours south), both with international-standard hospitals. Air ambulance to Sofia, Vienna, or further is possible but expensive (€10,000-30,000+). Ground ambulance to regional capitals is more common. Ensure your insurance covers cross-border evacuation—this is essential for North Macedonia.
Is North Macedonia good for medical tourism?
Increasingly yes, particularly for cardiac procedures, dental work, and IVF. Zan Mitrev Clinic attracts regional patients for heart surgery. Dental tourism is growing—quality implants and cosmetic dentistry at 50-70% savings versus Western Europe. The combination of low costs, English-speaking medical staff, and good private hospitals makes it an emerging destination.
Related: Comparisons and Next Steps
Disclaimer: This guide is for informational purposes only. Healthcare policies, insurance requirements, and visa rules change. We are not insurance brokers, immigration consultants, or licensed advisors. Verify all information with official sources and insurance providers before making decisions.