Before you start

An EMBG or foreigner's identification number
Employment with a Macedonian employer, for payroll-based cover
Otherwise private or international insurance, which the residence permit requires anyway

Step-by-step

1
Confirm how you are covered before you need it
If a Macedonian employer pays you, health contributions are withheld with the rest and your cover follows the employment. If you are self-supporting, freelance or on a non-work permit, you are not automatically in the public system.
Via employerWho: Your employer, or you
2
Register with the Health Insurance Fund and get the electronic health card
Cover is evidenced by the electronic health card rather than a paper booklet, and it is the card the clinic scans.
In personWho: You
3
Choose a primary doctor
You register with one 'izbran lekar' — a chosen GP — who is the gateway to specialists. Choosing one near where you live rather than near where you work is the standard local advice, because you will be back.
In personWho: You
4
Use Moj Termin for appointments and referrals
The national e-health system carries referrals, specialist appointments and prescriptions, and the Ministry of Health links it from its front page. Your GP books through it; you can see the record.
OnlineWho: You and your doctor
5
Know your private options in advance
Acibadem Sistina, Zhan Mitrev Clinic and Remedika are the large private hospitals in Skopje. Self-pay consultation prices are a fraction of Western European equivalents, which is why many residents simply pay rather than queue.
In personWho: You

Documents you’ll need

Passport and residence permit
EMBG or foreigner's identification number
Employment contract, for payroll-based cover
Electronic health card once issued
Private or international insurance policy, if you are not in the public scheme

Things most newcomers don’t know

The contribution rate is fixed nationally and there is no cheaper region.

7.5% health plus 0.5% injury, on a base that cannot be below 50% of the national average wage and is capped at sixteen average wages for employment income. Unlike Sweden or Italy, nothing about this varies by where in the country you live.

Source: Public Revenue Office

Air quality is a health issue here, not an environmental footnote.

The winter inversion regularly pushes PM10 past the 100 µg/m³ information threshold and sometimes the 150 µg/m³ alarm threshold. If anyone in the household has asthma or a cardiac condition, the choice of neighbourhood and floor is a medical decision — and the Ministry of Environment publishes live station readings so you can make it on data.

Source: Ministry of Environment and Physical Planning

The private sector is the default for foreign residents, and it is affordable.

Skopje's private hospitals draw patients from across the region, including medical tourism from the EU. For a consultation or a scan, paying privately usually costs less than the equivalent insurance excess in Western Europe and removes the referral chain entirely.

Source: community-reported

Common mistakes to avoid

Assuming the residence permit's insurance requirement is satisfied by travel insurance for the whole permit period. Check what the Ministry of Interior accepts before you buy.
Skipping the chosen-doctor registration because you feel fine. Without one there is no referral route into the specialist system.
Treating the winter air as a nuisance rather than a factor. It is the single largest environmental health issue in the city and it is seasonal, predictable and measurable.
Expecting the Health Insurance Fund's own website to be readable from abroad — it sits behind a challenge page for many overseas connections. Ask your employer's HR to pull the forms.

Some of this may be out of date. Spotted something inaccurate? Help us keep it right for the next newcomer.