Complete Health Insurance Services for Expats in Spain

Spain’s healthcare system is renowned as one of the best in the world, consistently ranking high in global surveys and healthcare rankings. A clear indicator of its excellence is Spain’s impressive life expectancy, averaging around 83 years, which is among the highest globally. This longevity reflects the quality and effectiveness of Spain’s healthcare services.

However, despite the high quality of public healthcare in Spain, it’s not without its challenges. One of the primary concerns is the lengthy waiting times to see specialists or schedule surgical procedures, particularly for elective or non-emergency treatments. As a result, many people in Spain are opting for private health insurance to complement the public system. This can significantly reduce wait times and the frustration of securing timely appointments with the right specialists.

Spain operates a universal healthcare system, ensuring that all citizens and residents have access to healthcare services. This system, known as the Sistema Nacional de Salud (SNS), or National Health System, was established in 1986, replacing the previous mandatory health insurance system tied to employment taxes.

While the Spanish Ministry of Health oversees performance and policy, the administration, management, and delivery of healthcare services are decentralized. This means that hospitals and care facilities are managed locally, with 17 regional health ministries responsible for healthcare in their respective areas. As a result, certain aspects of care may vary depending on where you are in Spain.

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

Under the SNS, all basic medical services are provided free of charge, including:

• Emergency hospital and doctor visits
• General doctor consultations
• Pediatric visits
• Midwife appointments and services
• Inpatient and outpatient care

However, some services, such as certain dental treatments for adults, are not covered. Additionally, while medications are not always fully covered, they are heavily subsidized, resulting in only a small fee for patients.

If you legally live and work in Spain and pay social security contributions, you are eligible to use the state-funded public healthcare system. However, eligibility and the registration process can vary depending on your specific circumstances.

For example, if you are retired or unable to find work immediately, you will need private health insurance when applying for a visa. This requirement ensures that you have coverage in case of an accident.

As an Employee
Your Spanish employer should automatically register you for social security contributions, which will grant you access to the public healthcare system. However, there are a few additional administrative steps to complete.

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

Next, you’ll need to obtain a medical insurance card (Tarjeta Sanitaria Individual or TSI). Depending on your region, you can apply for this online or at a local health center (Centro de Asistencia Primaria or CAP) with your passport, tax and social security numbers, and the residency certificates you receive during registration.

If You’re Self-Employed
For self-employed individuals, the process is similar to that of an employee, but you’ll need to register for your social security number independently. This can be done at a Spanish Social Security office (Tesorería General de la Seguridad Social or TGSS) with the necessary documents, including your passport and registration certificate from the town hall.

Awaiting Residency Status
If you’ve registered at your local town hall but haven’t yet met the requirements for permanent residency, you may be eligible for a state insurance program (convenio especial). This program, available after a certain period in Spain, provides access to public healthcare for a small monthly fee. The administration of this program varies by region.

If You’re Retired
For EU or EEA retirees, once you become a permanent resident in Spain, you are automatically eligible for coverage under the SNS.

If you are not an EU citizen, the process is more complex. If your home country doesn’t have a reciprocal agreement with Spain, you will need to either take out private health insurance or voluntarily register with the state insurance scheme (convenio especial).

For EU Citizens
If you are a citizen of an EU or EEA country, your GHIC card grants you access to free public healthcare for the first three months of your stay. However, if you plan to stay in Spain longer, you will need to register for Spain’s public health insurance or secure a private policy to ensure coverage beyond the initial three months.

Emergencies
In an emergency, you can call the European emergency number, 112, which is free from any phone. For specific services, you can dial 061 for an ambulance (ambulancia).

Pharmacies and Medication
To fill a prescription in Spain, visit any pharmacy (farmacia), which is easily identifiable by a large green cross outside. Pharmacies are typically open Monday to Friday from 9:30 AM to 2:00 PM and from 5:00 PM to 9:30 PM, with limited Saturday hours from 9:30 AM to 2:00 PM. Additionally, there are always some 24-hour pharmacies (farmacia de guardia) available for urgent needs.

Spain has a co-payment system for medications, meaning that while some are fully covered, others require a partial payment. The percentage you pay depends on your income and status. Working-age individuals might pay between 40% and 60% of the cost, while pensioners and those with chronic illnesses often pay around 10%.

Dental Care
In Spain, children under 15 receive free dental care. However, after this age, routine dental treatments are not covered by the SNS (Sistema Nacional de Salud). To cover dental costs, you may need to pay out-of-pocket or purchase additional dental insurance.

Eye Care and Optician Services
Basic and emergency eye care might be covered by the public healthcare system, but routine eye care is generally not included. Opticians usually offer a free initial eye test, but you will need to pay for glasses or contact lenses, as these are not covered by the SNS. Costs for eyewear can vary based on your selection.

When you first move to Spain, there can be a delay of several months before you are fully registered with the public healthcare system. This period includes registering at the town hall, applying for residency, and setting up your social security account. It’s important to account for this delay in your planning and to secure a suitable private health insurance policy to cover you during this time.

Many expats choose to take out private healthcare cover as a supplement to Spain’s public healthcare system. Private insurance can help reduce waiting times and provide access to services that may be less readily available to expats through the public system.

Additionally, if you are a retiree or if you are unable to find work immediately, you will need private healthcare coverage when applying for a visa. This requirement demonstrates to the Spanish authorities that you have adequate coverage in case of an accident.