What This Page Covers
- • How the Spanish healthcare system is structured (public and private)
- • How your visa type affects healthcare access
- • Registering for public healthcare if eligible
- • Private health insurance options and considerations
- • Common mistakes expats make with healthcare setup
Where to Start
Healthcare access in Spain depends heavily on your visa status. If you haven't addressed these foundational topics, consider starting here:
Healthcare System Overview
Spain has a dual healthcare system with both public (Sistema Nacional de Salud) and private options. The public system is regionally administered—each autonomous community (like Catalonia, Madrid, or Valencia) manages its own health service, which means procedures and specifics vary by location.
The public system is generally well-regarded, offering comprehensive coverage for those entitled to it. Wait times for specialists and non-urgent procedures can be longer than in private care. Private healthcare offers faster access, more choice of providers, and often English-speaking staff—but at significant cost.
Public System (SNS)
- Free or low-cost at point of service
- Funded through Social Security contributions
- Comprehensive coverage including hospitals, specialists, prescriptions
- Administered by regional health services
- Assigned primary care doctor (médico de cabecera)
Private System
- Requires insurance policy or out-of-pocket payment
- Faster access to specialists and procedures
- Choice of doctor and hospital
- More likely to have English-speaking staff
- Often used alongside public system
Healthcare Access by Visa Type
Your route to healthcare depends significantly on how you're legally in Spain. The following outlines typical access patterns—individual circumstances may differ.
Employed residents (work visa, EU workers)
Employment in Spain triggers Social Security (Seguridad Social) registration. This generally provides full access to the public healthcare system for you and your dependents.
Typical access: Full public healthcare through Social Security contributions. Private insurance optional but common for faster access.
Self-employed (autónomo)
Registered self-employed workers pay Social Security contributions and generally access public healthcare through this route, similar to employees.
Typical access: Public healthcare through autónomo Social Security contributions. Registration and contribution start dates matter—coverage begins after registration.
Digital Nomad Visa holders
The visa requires private health insurance for the application. Access to public healthcare may become available if you pay into Social Security (convenio especial), but private insurance is typically the primary coverage.
Typical access: Private insurance required initially. Public system access possible through voluntary Social Security agreement (convenio especial) at additional cost.
Non-Lucrative Visa holders
Private health insurance is a visa requirement. Since you cannot work, you don't contribute to Social Security through employment. Public healthcare access is limited unless you opt into a voluntary agreement.
Typical access: Private insurance required throughout. Convenio especial available but involves monthly payments without employer subsidy.
EU citizens
Access depends on your status. Employed EU citizens access public healthcare through Social Security. Pensioners may use the S1 form from their home country. Others may need private insurance or the convenio especial.
Typical access: Varies by status—employment provides public access; retirees use S1 form; others may need private coverage or convenio especial.
Retirees (pensioners)
EU pensioners with an S1 form from their home country can access public healthcare. Non-EU pensioners on Non-Lucrative Visas typically rely on private insurance, though convenio especial is an option.
Typical access: EU pensioners: S1 form arrangement. Non-EU: Private insurance or convenio especial.
Accessing Public Healthcare
If you're eligible for public healthcare, you'll need to register with the regional health service in your area. The process varies by region but generally follows this pattern.
Registration process
- Obtain your Social Security number — If employed, your employer handles this. Self-employed register at the Tesorería General de la Seguridad Social.
- Get your empadronamiento — Municipal registration proves your address and is typically required for health service registration.
- Register at your local health center (centro de salud) — Bring NIE, Social Security document, empadronamiento, and passport. Some regions allow online registration.
- Receive your health card (tarjeta sanitaria) — This card identifies you in the public system. May be called different names by region (tarjeta sanitaria individual, CatSalut card, etc.).
- Get assigned a primary care doctor — Your centro de salud assigns a médico de cabecera who handles routine care and referrals.
What's typically covered
- Primary care consultations
- Specialist referrals and consultations
- Hospital care, surgery, and emergency services
- Prescriptions (with copay in some cases)
- Maternity care
- Mental health services
- Pediatric care for dependents
Convenio especial (voluntary agreement)
If you're not covered through employment, you may be able to access public healthcare through a voluntary agreement with Social Security. This involves monthly payments based on your age.
Requirements typically include: Legal residency in Spain for at least one year, empadronamiento, not entitled to healthcare through other means, not having public or private coverage. Monthly costs vary by age bracket and change periodically.
Private Healthcare Options
Private health insurance is required for some visa types and popular among those who want faster access or English-speaking providers. The Spanish private healthcare market has multiple providers and plan types.
Types of private coverage
Full private insurance (seguro privado completo)
Comprehensive coverage similar to what the public system offers, but through private providers. Access to private hospitals, specialists without referral, shorter wait times. Monthly premiums vary by age, coverage level, and provider.
Copay plans (póliza con copago)
Lower monthly premiums but you pay a portion of each service (typically a fixed amount per visit or procedure). Common in Spain; can be significantly cheaper than no-copay plans.
Reimbursement plans
Pay for services out of pocket and submit claims for reimbursement. More flexibility in provider choice but requires managing paperwork and upfront costs.
Choosing a provider
Major Spanish private insurance providers include Sanitas, Adeslas, ASISA, DKV, and Cigna Spain. International providers like Allianz Care and Cigna Global also offer plans for expats.
Factors to consider
- Network of doctors and hospitals in your area
- English-speaking provider availability
- Coverage for pre-existing conditions
- Waiting periods for certain treatments
- Premium increases with age
- Whether it meets visa requirements
Visa requirement specifics
- Must be from insurer authorized in Spain
- No copays for some visa types
- Coverage must be comprehensive (not just travel insurance)
- May need to show minimum coverage period
- Repatriation coverage sometimes required
Common Pitfalls
Healthcare setup catches many expats off guard. Being aware of these common issues can help you plan better.
Assuming EU citizenship means automatic coverage
EU citizens aren't automatically covered. If you're not employed or a pensioner with an S1, you may need private insurance or the convenio especial. The European Health Insurance Card (EHIC/TSE) is for temporary stays, not long-term residence.
Gaps between arrival and coverage
Public healthcare registration takes time. Employment-based coverage begins when you start contributing, not when you arrive. Plan for interim coverage—travel insurance, international health insurance, or private coverage during the transition.
Choosing insurance that doesn't meet visa requirements
Not all private insurance qualifies for visa applications. Requirements include: Spanish-authorized insurer, comprehensive coverage, no copays (for some visas), minimum coverage period. Verify before purchasing.
Pre-existing condition exclusions
Private insurers in Spain commonly exclude or limit coverage for pre-existing conditions, especially in the first year or two. Understand what's covered before you need care. Some conditions may face permanent exclusions.
Not registering at your local health center
Even if eligible for public healthcare, you must actively register at your assigned centro de salud. Coverage isn't automatic—you need your tarjeta sanitaria to access services (except emergencies, which treat everyone regardless).
Language barriers in medical settings
Public healthcare staff often don't speak English, especially outside major cities. Private healthcare is more likely to have English speakers but not guaranteed. Consider having a Spanish-speaking companion for medical appointments, or choose private providers known for English service.
Underestimating age-based premium increases
Private insurance premiums in Spain increase significantly with age, especially after 55-60. What starts as affordable coverage can become expensive over time. Factor this into long-term financial planning.
Next Steps
Healthcare connects to other aspects of establishing yourself in Spain. Consider these related topics:
Spain Overview
Return to the country hub for a complete setup checklist
Visas & Residency
Your visa determines your healthcare access route
Banking
Insurance payments require Spanish banking setup
Cost of Living
Budget for healthcare costs by city
Barcelona
City guide including healthcare notes
Madrid
City guide including healthcare notes
Valencia
City guide including healthcare notes
Sources Consulted
Official Health Sources
- Ministerio de Sanidad – sanidad.gob.es – Ministry of Health
- Seguridad Social – seg-social.es – Social Security administration
Regional Health Services
- SERMAS (Madrid) – comunidad.madrid/servicios/salud
- CatSalut (Catalonia) – catsalut.gencat.cat
- Conselleria de Sanitat (Valencia) – san.gva.es