Family of four moving to Bulgaria - NHIF, private insurance, or both?

The short answer most expat families land on: NHIF as the legal and hospital backbone, plus private care paid as you go or via a modest private policy. Here is how it maps to your family. NHIF basics: contributions are 8 percent of income. Your wife is sorted - employees split the 8 percent with the employer and it comes off payroll automatically. As a freelancer you will pay contributions on your declared income, with a minimum insurable base of 620.20 euro per month from August 2026, so your minimum health contribution is around 50 euro a month as part of your overall self-insured contributions. Your children are covered by the state - kids in Bulgaria are insured without contributions until adulthood. Once insured, each of you registers with a GP, and you get referrals, hospital treatment and subsidized medicines with small copays. What NHIF is good at: emergencies, hospital care, and being cheap. What frustrates people: queues, referral bureaucracy, and variable facilities. That is why most middle-class Bulgarians and nearly all expats add a private layer. Private options: paying per visit is remarkably affordable - a GP-level consultation at a private clinic runs 25-40 euro, specialists 30-60 euro, and the big private hospitals in Sofia (Acibadem City Clinic, Sofiamed and others) offer English-speaking doctors and same-week appointments. Alternatively, local private insurance packages from insurers like Bulstrad, DZI or Uniqa cost roughly 300-700 euro per adult per year and bundle outpatient care, tests and dental extras; employer packages sometimes extend to family members cheaply, so check her employer package first. With two young kids, I would do NHIF for all, confirm the employer package, and pay privately for pediatric visits when speed matters. Full breakdown in our guide at /guides/health-insurance-healthcare-bulgaria.