Can I Keep My PSD Coverage If I Work Remotely for a Foreign Company?
Moving to the Baltics while keeping a high-paying remote job in London, New York, or Berlin is the ultimate expat dream, but the administrative reality often hits when you try to visit a doctor in Vilnius or Kaunas. Many remote workers fear they will fall through the cracks of the healthcare system because their employer doesn't have a Lithuanian entity. This guide explains exactly how to maintain your Privalomasis Sveikatos Draudimas (PSD) coverage while working for a foreign company, ensuring you never face a massive medical bill alone.
The Reality of Remote Work and Lithuanian Healthcare
When you first arrive in Lithuania, the excitement of the cobblestone streets in Old Town is often dampened by the realization that the healthcare system is strictly tied to your social security contributions. In Lithuania, health insurance is not just a "nice-to-have" option; it is a legal requirement for all residents. This is known as PSD (Privalomasis Sveikatos Draudimas). If you are employed by a local company, your employer handles everything. However, when your boss is sitting in an office five time zones away, the responsibility shifts entirely to you.
The most common frustration for foreigners is the "active status" on the Sodra (Social Insurance) portal. You might have your residency permit and your flat, but if Sodra doesn't see a monthly payment linked to your name, your status will quickly flip to "uninsured." This means you lose access to free family doctors and subsidized prescriptions. To avoid this, you must understand How Lithuania's Health Insurance Fund (VLK/PSDF) Works: A Full Overview to ensure your paperwork aligns with your actual living situation.
Many expats encounter a "waiting period" or a "grey zone" while their residence permit is being processed or while they are setting up their local tax status. During this transition, using a flexible provider like SafetyWing can provide a crucial bridge of coverage, especially if you haven't yet secured your local social security ID.
Scenarios for Keeping Your PSD Coverage Active
Your path to keeping PSD coverage depends heavily on where your employer is located and what kind of contract you have. The Lithuanian authorities generally categorize remote workers into two groups: those working for EU/EEA companies and those working for companies outside the European Union.
Working for an EU-Based Employer
If you are employed by a company in another EU country (like France or Estonia), you might be able to remain under their social security system while living in Lithuania. This is usually managed via the A1 certificate. This document proves that you are paying social insurance in another member state, which exempts you from paying Sodra contributions in Lithuania while still allowing you to access the public healthcare system here.
However, this is often a temporary solution. If you intend to be a long-term resident, the Lithuanian tax authorities (VMI) will eventually expect you to become a tax resident. At that point, you will likely need to transition to the local system. To stay covered during the months you are moving between these statuses, private alternatives like SafetyWing are often used by digital nomads to ensure they are never without emergency protection.
Working for a Non-EU Employer (USA, Canada, UK, etc.)
This is where it gets complicated. If you work for a company in the United States or the UK, they cannot simply pay into the Lithuanian Sodra system. To keep your PSD active, you essentially have to become your own "employer" in the eyes of the state. The most efficient way to do this is by registering for "Individual Activity" (Individuali Veikla).
By registering this status, you become a self-employed person in Lithuania. You will then be responsible for paying your own PSD contributions every month. This is a vital step because, without it, you cannot easily explain to the Migration Department or the healthcare fund where your insurance is coming from. For a deeper look at this process, check out Self-Employment in Lithuania: The Individual Activity and MB Guide for Foreigners.
Registering Individual Activity to Maintain Insurance
For most remote workers, "Individuali Veikla" is the golden ticket. It allows you to invoice your foreign employer and stay fully legal in the eyes of the Lithuanian government. Once you have this status, you are required to pay a monthly PSD contribution, which is currently calculated as 6.98% of the Minimum Monthly Wage (MMA).
Step-by-Step Registration
First, you must log into the VMI (State Tax Inspectorate) portal. You will need your personal code to do this. If you are still waiting on that, you should read How to Get Your Asmens Kodas (Personal Code) and Why It Matters for Healthcare. Once logged in, you select the option to start an "Individual Activity according to a certificate." You will need to choose a specific code that describes your work (e.g., computer programming or consultancy).
Once registered, you are automatically flagged in the Sodra system. However, the insurance only stays "active" as long as you pay. Most remote workers choose to pay the minimum PSD amount every month (around 64.50 EUR as of early 2024, though it fluctuates with the MMA) to ensure they can visit a "Poliklinika" at any time. If you neglect these payments, you will not only lose coverage but also accumulate a debt to the state that can lead to frozen bank accounts.
Handling the "Uninsured Gap"
There is often a lag between the moment you quit a previous job or move to Lithuania and the moment your Individual Activity registration is processed and your first payment is logged. During this gap, the public system will see you as "uninsured." This is a dangerous time to be without a backup. We often suggest that expats maintain a policy with SafetyWing during these administrative transitions. It provides global medical coverage that fills the hole until the Lithuanian bureaucracy catches up with your new status.
| Insurance Type | Monthly Cost (Approx.) | Primary Benefit | Best For |
|---|---|---|---|
| Public PSD | €64 – €70 | Full access to Poliklinikas & Specialists | Long-term residents/Self-employed |
| Private (SafetyWing) | $45 – $60 | Emergency & International Coverage | New arrivals/Digital Nomads |
| EU A1 Form | €0 (LT side) | Use foreign social security | Temporary EU transfers |
| Private LT Clinics | €50 – €150 (Per visit) | Fast access, English speaking | One-off urgent issues |
Managing Your PSD Contributions via Sodra
Once you are set up as a remote freelancer, the ongoing maintenance of your health insurance happens through the Sodra portal. This is a separate entity from the VMI. You will need to learn the rhythm of monthly payments. If you want to dive deeper into the specifics of these costs, read Understanding PSD Contributions Through Sodra in Lithuania.
The monthly PSD payment is due by the last day of the current month. If you are working for a foreign company, nobody is going to remind you to pay this. You have to set up a standing order or log in manually. If your payment is even a few days late, your name might disappear from the Understanding the E-Sveikata (E-Health) System in Lithuania portal, meaning a doctor won't be able to see that you are insured when they scan your ID card.
One common mistake I see is people thinking they only need to pay PSD at the end of the year when they file their taxes. While your final social insurance (VSD) is often calculated annually, the PSD health insurance component must be paid monthly to keep your "insured" status active. If you only pay annually, you will be considered uninsured for 11 months of the year, even if you eventually pay the full amount.
The Role of Private Insurance as a Remote Worker
Even with active PSD coverage, many remote workers choose to supplement their healthcare. The public system in Lithuania is excellent for major issues, but the waiting lists for specialists can be months long. Furthermore, PSD only covers you within Lithuania (and basic emergency care in the EU with an EHIC card).
If your remote work takes you on "workations" to other countries, your Lithuanian PSD coverage won't be sufficient. This is why a brand like SafetyWing is so popular among the remote community here. It covers you when you leave Lithuania and provides a layer of private care that the public system doesn't always offer, such as easier access to English-speaking mental health professionals or private hospital rooms.
When you are applying for your residence permit, the Migration Department (MIGRIS) will demand proof of health insurance. If your PSD isn't active yet because you haven't started your "Individual Activity," a private policy is often the only document they will accept to move your application forward. You can learn more about these requirements in Understanding Health Insurance Waiting Periods for New Residents in Lithuania.
Practical Steps to Take Right Now
If you are currently working for a foreign company and living in Lithuania, or planning to move soon, here is your checklist to ensure you don't lose your healthcare rights:
- Check Your Residency Status: Ensure you are officially "declared" at a Lithuanian address. Without a declaration of residence, you cannot easily enter the PSD system.
- Contact VMI: Log into the VMI system or visit an office to register your "Individuali Veikla." This is the legal basis for your insurance.
- Set Up Monthly Payments: Go to the Sodra website and find the specific bank account and "payment code" (įmokos kodas) for self-employed PSD. Set a reminder on your phone for the 25th of every month.
- Verify Your Status: Periodically check the VLK website (National Health Insurance Fund) to see if you are listed as "Draustas" (Insured).
- Get a Backup: Until you see that "Draustas" status in green, keep an active policy with a provider like SafetyWing. It's a small price to pay for the peace of mind that an unexpected appendicitis or accident won't cost you thousands of euros.
The transition to a foreign employment model while living in Lithuania is entirely possible, but it requires you to be proactive. You are essentially taking over the HR duties that a local company would normally perform. Once the system is set up, it’s quite smooth, but the initial hurdles regarding tax and insurance registration are where most expats get tripped up.
Disclaimer
This guide is intended for informational purposes only and does not constitute legal, financial, or professional medical advice. Lithuanian tax laws and social security regulations, including PSD contribution rates and residency requirements, are subject to frequent changes. Always consult with the State Tax Inspectorate (VMI), Sodra, or a qualified legal professional to confirm your specific obligations and rights based on your individual circumstances. Information regarding third-party services is based on general availability at the time of writing.
