Health Insurance in North Macedonia: A Guide for Foreign Workers

North Macedonia runs a mandatory social health insurance system through a single national fund, and for an employee the contribution comes straight from salary, opening access to a family doctor and the public network. Around nine in ten people are covered. For a foreign worker, the route in is usually employment, which brings the contribution and the right to public care. This guide explains how the system works, what it covers, what it costs, and what foreign workers and professional drivers need, including how cover ties in with residence. North Macedonia is not in the European Union, though it is a candidate for membership, and it does not use the euro; its currency is the Macedonian denar.

The short version: mandatory health insurance is run by a single body, the Health Insurance Fund, under the Ministry of Health, which is the only purchaser of publicly financed care. It is funded mainly by payroll contributions, with help from the pension and unemployment funds and the state budget for those not in work. Care starts with a family doctor — all primary-care practices are private and contracted to the Fund — who refers you onward to mostly public hospitals. Out-of-pocket spending is high by European standards, so many residents use the private sector, and because the European Health Insurance Card does not apply here, private cover matters for travel.

How health insurance in North Macedonia works

North Macedonia uses a mandatory social insurance model that consolidates public financing under a single entity, the Health Insurance Fund, which is the only purchaser of services provided under the scheme; the Ministry of Health oversees the system. Funding comes mainly from payroll contributions, supplemented by transfers from the pension and unemployment funds for retired and unemployed people and by the state budget for others not in work. Care is organised around the family doctor: all primary-care practices have been privatised and operate under contracts with the Fund, paid largely by the number of patients enrolled, and the family doctor is your first point of contact and the gateway to specialists. Secondary and tertiary care remain mostly in public ownership, though private hospitals and clinics have grown.

The types of cover you will come across.

A few kinds of cover sit side by side in North Macedonia. Mandatory health insurance through the Health Insurance Fund is the statutory layer for residents who contribute. Private health insurance, from local insurers, is used for private clinics and faster care. International health insurance covers you inside North Macedonia and abroad, which matters because some specialised treatment is sought in other countries and needs the Fund’s approval. Travel insurance is short-term cover for visitors only. Because North Macedonia is not in the European Union, the European Health Insurance Card does not apply in the same way as in member states. Hence, foreigners without the national insurance pay for private care or rely on an international policy, while foreign workers join the mandatory scheme through employment.

Who actually needs health insurance?

Mandatory health insurance covers around nine in ten of the population, and for most foreign workers the route in is employment, which brings the contribution and the right to public care; foreign nationals employed by foreign firms doing temporary work or studying in the country are also covered by the compulsory insurance. The state and the pension and unemployment funds cover those not in work, such as pensioners, the registered unemployed and others. Family members can be covered as dependants. People who are resident but not insured pay for their care or hold private cover. Visitors with health insurance abroad can use emergency and essential services based on bilateral forms. The clearest message for a newcomer is to confirm how your particular status connects you to the Fund.

What the public system covers

For insured people, cover is broad: primary care through your family doctor, specialist consultations by referral, hospital treatment, prescribed medicines from the Fund’s list, sick-leave compensation and maternity care. Some specific programmes — such as maternal and child health, certain infectious-disease care and blood services — are financed directly from the state budget. The system’s defining feature for newcomers is its high out-of-pocket spending: the share paid directly by patients is well above the European Union average, reflecting charges for medicines and services and the use of the private sector. Treatment abroad, where a service is not available at home, needs approval from the Fund’s committee. Emergency care is provided through the public system, and these out-of-pocket pressures are what send many residents to private clinics.

What it costs

For employees, there is no separate premium — cover follows from a payroll contribution, a defined percentage of gross salary deducted automatically, with the employer handling registration. The state and the social funds cover the contributions of those not in work. Once insured, public care is provided through the system, though out-of-pocket charges for medicines and some services are higher than in many European countries. On top of the public system, private clinic consultations are relatively affordable, while comprehensive international plans cost more, depending on age and benefits. All amounts are in Macedonian denars, since the country does not use the euro. You should budget for medicine and service charges and for an international policy if you travel.

Why do most foreign workers add private cover?

Mandatory insurance covers the basics of care, but high out-of-pocket charges, waiting times, and the desire for more comfortable, sometimes English-speaking service lead many foreign workers to use the private sector, which has grown in primary care, specialist, and inpatient treatment. Private cover, or paying for private consultations, buys faster access and modern facilities. International plans add treatment abroad and medical evacuation, which matters because the European Health Insurance Card does not cover people here and because care abroad otherwise needs the Fund’s approval. When you compare options, look at what is covered for a hospital stay, whether treatment abroad and evacuation are included, the outpatient limits, any waiting periods, and whether pre-existing conditions are excluded. Find out what your employer already provides before buying your own.

Health insurance for your residence permit

Foreign nationals who want to live and work in North Macedonia need a residence and work permit, and cover generally follows employment: those employed and contributing join the mandatory scheme, including foreign nationals working for foreign firms, while others rely on private cover. Proof of health cover is generally part of the residence process. Residence and migration matters are handled through the Ministry of the Interior. Because the rules connect your insurance to your residence and employment status and can change as North Macedonia aligns with European Union standards on its path towards membership, always confirm the current requirements with the Ministry of the Interior and the Health Insurance Fund before you act, and arrange your cover as part of settling in.

Health insurance for truck and transport drivers

Professional drivers carry more health risks than most workers — long hours at the wheel, time away from home and the constant risk of a road accident. North Macedonia sits on the corridor linking Greece’s port of Thessaloniki to Serbia and central Europe, and on east-west routes towards Bulgaria and Albania, so many drivers cross borders regularly. Because the European Health Insurance Card does not cover people here, cross-border private cover matters more than in European Union countries: check on-road emergency cover along the routes you actually drive, accident and injury cover including hospitalisation and rehabilitation, treatment and evacuation in neighbouring countries, and the occupational-health provisions for the medical examinations a professional licence requires. A solid international policy, alongside the mandatory national insurance, is the practical answer for drivers who travel widely.

Using your insurance day to day

Day to day, you register with a family doctor, who is your first point of contact and the gateway to specialists; a referral is needed to move to specialist care. You show proof of your insurance when you seek care, and prescribed medicines from the Fund’s list are dispensed under the scheme, with charges for those outside it. The Fund offers electronic services through its web portal. If you use the private sector, you book directly and pay the clinic or claim through a private policy. In an emergency, call 112, the European emergency number, or the ambulance service on 194. Hospitals and specialists are concentrated in Skopje and the larger towns. The official languages are Macedonian and Albanian; English is more common in private clinics than in smaller public facilities.

Choosing a private insurer

For private or international cover, check that the insurer is authorised to operate in North Macedonia and look closely at what the policy covers. Confirm the benefits for a hospital stay, whether treatment abroad and medical evacuation are included, the outpatient limits, and which clinics are in the network. Look closely at the exclusions — pre-existing conditions are where cover usually stops — and check the waiting periods that apply to planned treatment and maternity. Because the European Health Insurance Card does not cover people here and care abroad otherwise needs the Fund’s approval, cross-border and evacuation cover is worth having if you travel. Weigh any policy against the cover your employer may already offer. We name no specific insurer here; the point is straightforward guidance so you can choose well.

For professional drivers in North Macedonia

If you are relocating to drive in North Macedonia, make sure your employment connects you to the Health Insurance Fund, register with a family doctor, and consider private or international cover for faster access and cross-border protection. Every employer on our platform complies with the country’s labour and social insurance law, including the contributions that give you access to the public health system.

• Browse driver vacancies in North Macedonia.
• Register a driver profile.
• For employers — guidance on employment package requirements

Health insurance by North Macedonian region

North Macedonia is divided into eight statistical regions, and the rules are the same in each — mandatory cover, private care on top — but facilities and distances differ. Here is the picture region by region.

Skopje

The capital region and the country’s main centre for advanced treatment, home to the clinical centre, most specialists and the busiest transport hub. Driver jobs in the Skopje region.

Polog

The north-western region around Tetovo and Gostivar, near the Kosovo border, with a regional hospital. Driver jobs in the Polog region.

Northeastern

The region around Kumanovo on the main corridor towards Serbia, a key transit area with a regional hospital. Driver jobs in the Northeastern region.

Eastern

The eastern region centred on Štip, near the Bulgarian border, with a regional hospital serving the east. Driver jobs in the Eastern region.

Southeastern

The south-eastern region around Strumica, near the Greek and Bulgarian borders, with a regional hospital. Driver jobs in the Southeastern region.

Vardar

The central region around Veles, on the main north-south corridor, with a regional hospital. Driver jobs in the Vardar region.

Pelagonia

The southern region around Bitola and Prilep, near the Greek border, with regional hospitals serving the south. Driver jobs in the Pelagonia region.

Southwestern

The south-western region around Ohrid and Struga by the lakes, near the Albanian border, with a regional hospital. Driver jobs in the Southwestern region.

How health cover works in North Macedonia — the essentials

North Macedonia sits outside the EU and EEA, so the European Health Insurance Card does not apply and there is no automatic reciprocal cover for most visitors. Public healthcare may exist but is often limited for foreigners or charged, and standards can vary between the capital and rural areas, which makes private health insurance the practical route for visitors and new arrivals alike.

If you are moving to North Macedonia to live or work, expect to arrange private health cover or join any local scheme available to foreign residents, and to show proof of insurance for a visa or residence permit. For a short visit, comprehensive travel health insurance that covers private treatment and repatriation is strongly advised, since you will generally pay for care yourself.

Related guides

• Health insurance in Europe — overview
• North Macedonia residence permit guide
• North Macedonian citizenship guide

Official government sources

• Health Insurance Fund of North Macedonia — mandatory health insurance.
• Ministry of Health — health policy.
• Ministry of the Interior — residence and the status of foreigners.
• Institute of Public Health — public health information.
• National Bank of North Macedonia — currency and the denar.

Information only — not legal, medical or insurance advice. Contributions, covered services and rules can change. Always confirm current details with the official North Macedonian authorities above before you act.