Health insurance in Spain for foreign expats

The Spanish healthcare system is considered to be one of the very best in the world. It consistently appears high up on various surveys and world healthcare rankings, but one of the best indicators is the country’s life-expectancy statistics. Spain’s average life expectancy of around 83 years is one of the highest in the world and a testament to the quality of their healthcare services³.

But, while there’s no doubt that Spain’s public healthcare is of the highest quality, it’s not always perfect. One of the main issues is that there can be lengthy waiting times to see specialists or book a surgical procedure particularly elective or non-emergency procedures. Over recent years, an increasing number of people have chosen to take out private health insurance in Spain to supplement the public system. This can significantly reduce the amount of time and frustration involved in getting an appointment with the right specialist

Spain has universal healthcare, which guarantees all citizens and residents access to healthcare services. The healthcare system is called the Sistema Nacional de Salud (SNS) which simply means ‘National Health System’. 

It was set up in 1986, to replace a mandatory health insurance system that was connected to employment taxation. While performance and policies are overseen by the Spanish Ministry of Health, the administration, management and delivery of healthcare services are decentralised. This means that Spain’s hospitals and care facilities are run on a local level. There are 17 regional health ministries, so some elements of the care you receive could differ, depending on where you are.

The SNS is available to any Spanish citizen or resident that pays (or has paid) monthly social security contributions, as well as their partners and dependant family members. This includes expats, freelancers and the self-employed. 

Under this system, all basic medical services are free. These include:

• emergency hospital and doctor visits
• doctor consultations
• paediatric visits
• midwife appointments and services
• inpatient and outpatient care

There are some services that aren’t covered, such as certain dental treatments for adults. And there are other costs, like medications, which aren’t always fully covered but are heavily subsidised, so only incur a small fee.

When you legally live and work in Spain, and pay social security contributions, you’re eligible to use the state-funded public Spanish healthcare system. But everyone’s situation is different, so there are different factors that can affect your eligibility and the registration process. 

It’s worth noting if you’re a retiree, or you cannot find work right away, you’ll need to have private healthcare cover when applying for a visa. This is to show the Spanish authorities that you’re covered in case of an accident.

As an employee

A Spanish employer should automatically register you for social security contributions. This will eventually give you access to the public healthcare system, but there are a couple of other bits of administration to complete.

You’ll need to register your residency at your local city or town hall and get your residency certificate (certificado de empadronamiento or padrón). It’s advisable to do this as soon as you arrive in the country as you’ll need it to register for other services and permits.

You’ll then need to obtain a medical insurance card (Tarjeta Sanitaria Individual- TSI). Depending on which region you’re in, you can either apply for this online or by visiting a local health centre (Centro de Asistencia Primaria, or CAP) with your passport, tax and social security numbers as well as various certificates you’ll receive as part of your residency registration.

If you’re self-employed

The process for self-employed expats is similar to that of an employee, but you’ll need to register for your social security number yourself. You can do this by visiting a Spanish Social Security office (Tesorería General de la Seguridad Social, or TGSS) with relevant documentation, including your passport and certificate of registration from the town hall.

Awaiting residency status

If you’ve registered at your local town hall, but you’ve not yet met your region’s requirements for permanent residency, the Spanish government offers a state insurance program (known as convenio especial). You can apply for this after a certain amount of time in the country, and it’ll give you access to public healthcare via a small monthly fee. The administration of this insurance scheme varies depending on the region.

If you’re retired

If you’re an EU or EEA retiree, you’re automatically eligible for cover under the SNS when you become a permanent resident in Spain. 

It’s a bit less straightforward if you’re not an EU citizen, however. If your country of origin doesn’t have a reciprocal agreement with Spain, you’ll need to take out private healthcare cover or voluntarily register with the aforementioned state insurance scheme (convenio especial). 

EU citizens 

If you’re a citizen of an EU or EEA country, your GHIC card will give you access to free public healthcare for the first three months of your stay. If you’ll be staying in Spain for longer, though, you’ll need to register for Spain’s public health insurance or take out a private policy to ensure you’re covered after the first three months.

Emergencies

In an emergency, the standard European emergency number is 112; this will be free of charge from any local landline or mobile. Other emergency numbers include 061 for an ambulance (ambulancia) and 1003 for an emergency doctor.

Pharmacies and medicine

You can take your prescription to any Spanish pharmacy (farmacia). Pharmacies are easily identified by the large green cross displayed outside and are usually open Monday to Friday, 9.30am–2pm and 5pm–9:30pm, while on Saturdays they operate from 9:30am–2pm. There are also 24-hour pharmacies in operation (farmacia de guardia).

When it comes to medication, Spain operates a co-payment system for some prescriptions. So, while some medications are covered, others aren’t and you may need to pay a percentage of the cost. The amount you’d pay very much depends on your situation. For example, if you’re of working age, you could pay between 40% and 60% of the cost of certain medications, depending on your income. Meanwhile, pensioners and people suffering from chronic conditions or serious illnesses might pay 10% for the same prescription.

Dental care

Children under the age of 15 receive free dental care in Spain. After that, routine dental care isn’t covered by the SNS (Sistema Nacional de Salud). You’ll either need to pay for each visit or take out a separate insurance policy that covers dental care and procedures.

Eye care and optician appointments

While some specialist eye care and emergency treatments may be covered under the public system, general eye care tends to be separate. Opticians and optometrists will usually offer a free initial eye test, but the expectation is that you’ll then purchase glasses or contact lenses from them. These aren’t covered by the SNS, and the costs can vary depending on what you choose. 

When you first move to Spain, it can take a number of months to register for the public healthcare system while you register at the town hall, apply for residency and set up your social security account. You’ll need to take this into account when you’re planning your move and take out a suitable insurance policy to cover you in the meantime. 

Private healthcare cover is also popular among expats as a top-up to the public healthcare system in Spain. This is partly to help avoid longer waiting times, and partly because there are some healthcare services that are not as easily accessible for expats. 

And if you’re a retiree, or you cannot find work right away, you’ll need to have private healthcare cover when applying for a visa. This is to show the Spanish authorities that you’re covered in case of an accident.

Dental Insurance isn’t mandatory in Spain, but it can be beneficial depending on your circumstances. Unless you’re a child under 15 or need emergency treatment as an adult, you’ll generally have to pay.

Public dental care

The SNS (Sistema Nacional de Salud (SNS)) doesn’t cover most dental treatments. Only the basic services such as extractions and emergency care are included. For more extensive dental care such as fillings, cleaning, crowns or orthodontics, you’ll need to pay out-of-pocket.

Private dental care

Private clinics offer a wide range of services with generally shorter waiting times and more advanced treatments compared to public services. These can be expensive, especially for procedures. Having private healthcare insurance can significantly reduce out-of-pocket expenses and make it easier to access regular, preventative care and necessary treatments.

Spain’s public healthcare system is funded through social security payments by those living and working legally. Children, retirees, and unemployed permanent residents are exempt and have access to Spain’s public health insurance for free.

The cost of social security payments depends on how much you earn. In 2023, the general monthly contribution rates were 6.45% by employees and 30.40% by employers.³ This rate will vary between individuals due to differences in salaries, employers, and individual needs.

You’ll also be responsible for up to 60% of the cost for any health products such as prescriptions, orthotics, and prosthetics.⁴

It’s important to note that most dental and optical care is not covered by the public healthcare system.

If you’re a citizen of an EU or EEA country, your European Health Insurance Card (EHIC) or Global Health Insurance Card (GHIC) will give you access to free public healthcare for the first three months of your stay. If you’ll be staying in Spain for longer, you’ll need to register for Spain’s public health insurance or take out a private policy to ensure you’re covered after the first three months.

Please note EHICs and GHICs only cover you for state healthcare, so you’ll still be responsible for the costs of private treatment.