Guide to health insurance in Spain

healthy life

Relocating to a new country is always stressful since it requires a lot of research on the local healthcare system, and this is especially tricky without speaking the local language.

In this guide we answer the most important questions related to insurance:

  • What is the difference between public and private health insurance in Spain?
  • When is incoming health insurance required to get the Spanish Visa?
  • How much does it cost health insurance in Spain?
  • How can I choose the right insurance as an expat that will fit my needs throughout my stay / lifetime in Spain?

At Feather we want to make things simple and, here, we’ll talk about the basis of what you need to know about the healthcare system when moving to Spain.

1.- The Spanish public health insurance

The Spanish National Healthcare System (Sistema Nacional de Salud - SNS) is ranked as one of the best and most efficient around the world, offering universal healthcare to everybody working and paying taxes in Spain. The public healthcare system also covers the direct family of a beneficiary -such as spouses or dependents under 26 years of age-, if they legally reside in Spain, while unemployed Spanish citizens can all access healthcare for free even when they themselves don’t pay social security. Emergency treatment is available, by law, to anyone regardless of their status in the country, but you will be required to pay a fee for the treatment in some cases.

Public healthcare in Spain is not just related to medicare but also provides a lot of care services such as family medicine, pediatrician, emergency services, diagnosis test, rehabilitation…and access to specialist doctors, always referred by the family doctor or pediatrician. However, public healthcare does not usually cover dental care (except for basic extractions) and you are also responsible for the costs of some pharmaceutical, orthotic, prosthetic, and other health products. In these cases, you may pay a part of the full price, depending on your level of income and your age and it is important to note that the costs of public healthcare may vary between autonomous regions in Spain.

To benefit from public healthcare system, you will need a legal residency, be registered in the National Institute of Social Security (Instituto Nacional de la Seguridad Social) and get the public health card (Tarjeta Sanitaria Individual) that you must show every time you use the public healthcare system.

Any foreign resident who works in Spain as an employee or self-employed is required to pay mandatory social security payments each month (based on the gross salary) to cover the access to the public healthcare system, as any other citizen. In case you are an employee, your employer will manage all the paperwork required while you should do it on your own if you are self-employed

On the other hand, EU retirements are automatically eligible for the Public Healthcare System when they become permanent residents in Spain. This is also the case for UK citizens who obtained a UK issued Global Health Insurance Card (GHIC) and applied for an S1 form. Non-EU citizens have to apply and qualify but, in case you don’t meet the criteria for any type of public healthcare, the Spanish Social Security offers a special pay-in scheme (Convenio Especial de la Seguridad Social) that allows access to the public healthcare system for a monthly fee, normally if you have been a Spanish resident for at least one year immediately before applying for it.

Finally, while the Spanish public healthcare system is generally of high quality, lack of coverage of some treatments, along with the waiting times for surgeries, procedures, and access to some specialist doctors are the main setback of public healthcare in Spain and often leads insured people to complement public services with private health insurance. In the case of non-Spanish-speakers expats, ensuring access to a healthcare system in English is another issue to consider, as public healthcare is normally only delivered in Spanish or any of the local languages in hospitals or care centers

2.- Private health insurance in Spain

As said before, there are some reasons to get private health insurance in Spain, even being part of the Spanish public healthcare system: quicker access to some of the best specialist doctors, more extensive treatments, more comfortable hospital, more advanced medical centers and in case of expats the possibility of choosing English-speaking healthcare providers are some of them.

If you are not eligible for the public system, then, private health insurance is your best choice to access the healthcare system in Spain, without paying out of your pocket an undetermined amount of money for each treatment.

Basically, anyone living in Spain can get private health insurance, and there’s an option to get health private insurance from either a local or an international health insurer, depending on your needs or expectations. You can find many insurance types and plans to choose from, being advisable to make the right decision based on the coverage provided by each plan, not only on the cheapest one, if you want to avoid problems. 

There is a large variety of plans available in Spain, from low-cost plans with a few services or relevant deductibles, to an extensive health insurance coverage “all-included”. With most private plans, you will be asked to make small co-payments for some services (like psychology, for example) and you also can be asked for waiting periods for some coverage (like maternity, for example) if you don’t come from a previous private health insurance.

It’s also important to say that, even when monthly payments are allowed in most of the plans, the insurance contract is usually annual (12 months) although the first year may only be just until the end of the year (31st December), depending on the insurance carrier. Once renewed it is considered an annual plan in most of the cases, so you can’t cancel until the end of the period. If you don’t want to renew it, you must notify the insurance company within 30 days of its renewal date.

The cost of a health private insurance plan will depend on your age, gender, localization, type of coverage and  pre-existing conditions (in this case, you can be rejected by the insurer in the application). The average cost of private health insurance in Spain is typically from 50 to 150 EUR per month, which is not so much if you think that specialist doctors in the private sector usually cost between 75 and 150 EUR just per consultation. In all cases using private healthcare, you must pay 100% of the costs of your prescription medication.

3.- Incoming health insurance for expats in Spain

It is not possible to be uninsured in Spain so you need health insurance to enter into the country. That’s the reason why there is a third option, designed for all of those expats that are not eligible for the public healthcare system or are not living in Spain yet to get a private health plan but required to have full coverage insurance to meet specific visa and residency requirements by consulates.

We’re speaking about Incoming Health Insurance, also known as Expat Health Insurance, and provides full coverage in case of an emergency or acute health problems. It covers costs associated with accidents or unexpected injuries, including inpatient hospital stays and related (doctor-ordered) visits to medical professionals, emergencies, consultations, diagnostic tests, surgeries -inpatient and outpatient- hospitalizations… 

Even when the requirements for the Incoming / Expat health insurance may vary from one case to another, it generally refers to the types of policies that are considered full-coverage for Spanish residents: a) unlimited medical coverage; b) no copayments or deductibles and c) no waiting periods. Travel insurance is never valid for visa or residency applications.

Keep in mind that Expat health insurance does not usually cover medical needs related to pre-existing conditions or chronic illness. So, while your insurance will reimburse you for costs associated with a broken bone or a sinus infection, it will not cover treatment for pre-existing illnesses like diabetes or hypothyroidism if it is not accepted before. On the other hand, Expat health insurance does not cover children or other dependents, so additional family members will need to get their own plans.

The cost of an incoming / expat health insurance will depend on your age and localization in Spain with an average price between 60 and 120 EUR per month. In some cases, you could be required to make an upfront payment for the first year of coverage to get the approval of the consulate, not always. Any case, you will need to present a Certificate of Insurance (with the wording in Spanish) as a proof of insurance to get the visa, so we highly recommend you manage Incoming / Expat health insurance in advance of your arrival in Spain.

Finally, even when you can renew your expat health insurance after the first year, we sometimes recommend going on private insurance after the first year in Spain.

As a conclusion, there are several options to take care of your health in Spain and also meet all the legal requirements. At Feather we help our customers by offering honest, simple insurance through a digital platform, in addition to trusted human advice, all in English. A lot of our customers have nothing but great things to say about us (4,9/5 on Trustpilot