Healthcare and health insurance in Spain for expats

Healthcare is free for all residents who contribute to social security and have health insurance in Spain. Find out how to get your health insurance in Spain as an expat.

Shreya

7 minute read

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Updated on 12 Aug 2024

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Living

As a new expat in Spain, having access to a doctor and arranging for your health insurance might be on top of your list. After all, nobody likes to be unprepared for emergencies or be given a huge bill.

Did you know that Spain ranks as the 8th best healthcare system in the world?

So without further ado, let’s get you started on how you can access the healthcare system in Spain using your public or private health insurance.

Spain takes healthcare very seriously. The constitution guarantees the right for every resident to have access to basic universal and preventative healthcare. This includes coverage for any pre-existing conditions.

So if you’re deciding to move to Spain, know that you’ll be in good hands as you’ll be benefitting from one of the best healthcare systems in the world.

But to access this healthcare system inexpensively, you need to have health insurance. What type of health insurance you need depends on your individual circumstance.

A very common question expats have is “Do I need health insurance when living in Spain?” or “Can I live in Spain without medical insurance?”

The short answer is no, not in all cases. But as an expat resident, the smart thing to do would be to get health insurance. Your health insurance can save you thousands of Euros on medical costs and is therefore highly advisable.

Health insurance for Non-EU citizens

As a non-EU citizen moving to Spain for the first time, it's a requirement to get travel insurance to enter the Schengen area.

As an expat working and contributing to social security in Spain, you'll get access to free doctor appointments and subsidised prescriptions by presenting your Tarjeta Sanitaria Individual or TSI- your Spanish Health Card. Your legal spouse and children under the age of 15 will be entitled to healthcare as well.

The only exception's for pregnant residents in Spain who will get access to healthcare regardless of their insurance status.

If you are a non-EU student, you will need to arrange for international health insurance prior to your arrival in Spain.

Health insurance for EU or EEA citizens

If you are an EU/EEA working citizen or an expat migrating to Spain from another EU country, you can make use of your EHIC or European Health Insurance Card. This will get you free access to healthcare in Spain during your first 3 months.

If you are planning to live and work in Spain for more than 3 months, it’s better to get Spain’s public health insurance to avoid delays in getting non-emergency treatments.

As an EU student below the age of 26, you will have free access to Spain’s public health insurance.

To ensure that everyone in Spain can access basic universal healthcare, the healthcare system in Spain's funded by the social security contributions made by all workers, including freelancers and expats.

The social security system's a set of schemes that provides suitable protection to the individual, and their family, for carrying out professional activities.

As a result, every working resident who's contributing part of their wages to the social security system will get guaranteed free access to the National Health System in Spain. This ‘free’ access includes:

• Free doctor and hospital visits for you and your (separated) spouse and children of up to 15 years of age.
• Discounted prescription costs: 40% to 60% for salaried employees and 90% for pensioners.

Yes, we know what you’re thinking. It is not exactly ‘free’ as you're indirectly paying for access with your social security contributions. But the contributions you make are relatively small compared to the benefit you can derive from free healthcare access for you and your dependent family.

If you are an unemployed EU citizen or want to voluntarily opt-in for public health insurance as a non-EU resident, you can ask for assistance from the government. The Spanish government has a low-cost pay-in scheme called Convenio Especial that can cover standard treatments in exchange for small monthly payments. Depending on your situation, you can pick your level of contribution. Important to note's that this doesn’t cover prescription costs or specialised treatments.

If you aren't working in Spain or are an unemployed non-EU citizen, you are not eligible for getting free access to healthcare in Spain. In this case, you will need to arrange for private health insurance and pay a premium each month.

In Spain, you can access both public and private hospitals and health centres. Which healthcare system you visit's dependent on which type of insurance you decide to get. And whether you opt for Spanish public health insurance and/or private health insurance depends on your medical needs and language proficiency. Let’s break it down.

More than 90% of Spaniards use Spain’s National Health System, also known as Sistema Nacional de Salud or SNS. And why wouldn’t they? After all, all working residents contribute to social security.

It’s also no surprise that such a high percentage of residents use SNS as the quality of healthcare in Spain is top-notch. The staff and medical professionals are highly skilled and knowledgeable, making SNS the first choice for most expats and residents.

With your public health insurance, you can visit any public national health system (SNS) and all your (emergency) visits to the doctors or the hospitals will be free.

Your first point of contact will always be the general practitioner at the health centres (Centro de Asistencia Primaria or CAP). If you want to visit a hospital for non-emergency treatments or concerns, you will need a referral from your general practitioner. Keep in mind that the wait times are usually long.

When it comes to medication, you'll need to co-pay your bill at the pharmacies. Depending on how much you earn, your health insurance will cover 40-60% of your prescription costs. If you suffer from chronic conditions or are a pensioner, 90% of your prescription costs will be covered. Sounds good, doesn’t it?

Here’s the catch. While the public health insurance is great, you might want to consider getting private health insurance as a top-up.

Here’re the top 5 reasons why it’s a good idea to get private health insurance in Spain:

1. For everyone above the age of 6-15, your dental costs aren't covered with your public health insurance unless you need emergency treatment The typical rates for common treatments include €20 for a regular check-up, €30 - €90 for an extraction, and €50 - €80 for any fillings. Private insurance can cost €10 - €20 a month, making it a better choice.

2. While Spain's known for its inexpensive and high-quality healthcare, it is also infamously known for its month long wait times for non-serious or elective treatments. Getting private insurance can mean a comparatively shorter wait time as most residents use the SNS.

3. If you can’t converse in Spanish at a basic level and need to frequently visit the doctor, it's better to get private health insurance. Unfortunately, not all doctors or staff at public health institutions speak English, especially in the suburbs or towns.

4. If you want access to a medical specialist, alternative treatments, or additional coverage for medications, you need private health insurance as not all conditions are covered by public health insurance.

5. If you travel abroad frequently, it's better to get private health insurance that covers the countries you frequently visit. This way, you are covered both abroad and within the EU.

The only thing you need to pay attention to when getting private insurance's confirming if your hospital or pharmacy accepts your private health insurance. If not, you will need to pay for all medical costs yourself.

Our verdict: As a resident contributing to social security, you already have access to the public health system. So make use of your public health insurance and top it up with private health insurance to get coverage for conditions that are relevant to you.

Public Health Insurance

Step 1: Register for a social security number. If your employer hasn’t already provided you with this, you can get one from the Spanish Social Security office or TGSS (Tesorería General de la Seguridad Social).

Here’s how to apply for a social security number at the TGSS:

• Carry a valid passport or NIE
• Fill out form TA1.
• Bring your certificate of registration (empadronamiento) obtained from your local Town Hall (not more than 3 months old).
• Proof of employment or a signed internship paper in case you are a student.

Once you’ve submitted these documents, you will receive 2 things. 1) Your social security number and 2) A certificate stating you are entitled to healthcare in Spain.

Step 2 : Apply for your personal health card or TSI (Tarjeta Sanitaria Individual)

Depending on the region of Spain you are living in, the process to apply for TSI can be either done online or offline. (TSI is known as SIP in Valencia).

To apply for your TSI, head over to a local health centre or CAP (Centro de Asistencia Primaria). You can easily find a local health centre by browsing through the catalogue of primary health care centres and hospitals. Bring the following documents with you to the health centre:

• Passport and NIE
• Certificate of registration obtained from your local Town Hall not more than 3 months old.
• The certificate stating you are entitled to healthcare.
• Social security number.

You'll be asked to fill up a form and submit these documents when you visit your local health centre. Once they process the information, you will receive your TSI card by post in a few weeks.

Private Health Insurance Provider

If you decide to get personal health insurance, it’s good to know some of the popular insurance providers.

• Allianz Care
• Cigna Global
• Globality Health
• Sanitas
• AXA

The premium you pay will depend on your age, pre-existing conditions, maximum out of pocket payment, area of coverage (worldwide or local), maternity, dental coverage, repatriation, etc. It’s highly recommended to get a free quote from your shortlisted providers and decide which plans right for you.

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