Complete guide to getting health insurance in Spain for American expats

Over a million US expats live in Spain, having made this sunny European country their home. As a US citizen, there are several things to keep in mind and consider when moving to Spain— one of the most important being health insurance, considering the healthcare system is entirely different from America’s. 

Do US Expats Need Health Insurance in Spain?

US expats living in Spain need to take out private health insurance if they don’t qualify for the Spanish national healthcare insurance scheme. If you’re an American expat planning on staying in Spain short-term, you can opt for travel insurance instead. But make sure you purchase a travel insurance policy with a good medical coverage option. Also, keep in mind that health insurance and travel insurance are not the same— if you want to move to Spain and live long-term, you need global health insurance. 

What Are the Best Health Insurance Options For American Expats in Spain?

American expats in Spain have two main options to obtain health insurance while living in Spain: 

  1. Purchase international health insurance with global coverage. Purchasing an international health insurance policy is one of the best options for US expats in Spain. Because healthcare, in general, is not as expensive in Spain as in the US, an insurance policy won’t cost too much. The greatest advantage of having private insurance in Spain for expats is that it offers quicker services in a private hospital with English-speaking providers. 
  2. Register for the national healthcare insurance scheme in Spain. Another great insurance option for US expats in Spain is registering for the national healthcare scheme (SNS). You won’t have to pay for most services with the national scheme since social contributions fund the SNS program. 

You can purchase an international health insurance policy that offers global coverage for American expats at Insubuy or International Citizens Insurance.

Best Health Insurance Plans for US Expats in Spain

Here are some of the most suitable international health insurance providers US expats in Spain: 

You can also use a comparison marketplace like Insubuy or International Citizens Insurance to find and purchase your plan. 

Cost of Healthcare for American Expats in Spain

If you’re registered in the national healthcare system, the contributions from your salary are used to fund the healthcare scheme— the current rate for general workers is 4.7%.  Your employer also contributes 23.6%, making the total contribution 28%. 

On the other hand, if you purchase a private health insurance scheme, the price varies from several hundred to thousands of dollars. Keep in mind the following factors:

  • What is the amount of maximum limit for medical coverage you want?
  • Do you want to include extra benefits such as travel coverage for lost or damaged items? 
  • How much do you want to write down as your deductible? 
  • Do you want to include coverage when you’re back in the US for visits? 
  • Does your insurance have coverage for pre-existing conditions? 
  • For how long do you want to purchase your insurance? 

Use comparison markets like Insubuy and International Citizens Insurance to find the cheapest plans for US expats in Spain. 

Can an American Get Free Healthcare in Spain?

American expats can access Spain’s universal national healthcare system if they work and pay taxes in Spain. A part of your monthly salary goes to taxes, which fund the national healthcare system. This way Spain offers almost free medical care to all those who qualify; you still have to pay for services that the federal healthcare scheme does not cover, e.g., dental and eye care. 

How Can American Expats Register for Free Healthcare in Spain?

Depending on your employment status, here is how you can register for free healthcare in Spain as a US expat : 

  • If employed, your employer will provide you with a social security number and proof of your address in Spain. You have to submit your documentation to a local health center, register, and wait until you receive your healthcare card proving your right to healthcare in Spain. 
  • If self-employed, you need to apply for your social security yourself and follow the same instructions as an employed individual, i.e., submit your documents to a local health center for registration. 
  • If unemployed, you pay directly into the national healthcare system. You still need to retrieve your social security number and proof of residency to register for the healthcare scheme. 

Does Medicare Cover Americans in Spain?

Medicare won’t cover you while you are outside of the US and living in Spain. There are only a few very specific cases where Medicare might cover you while you are outside of the US. You have to find an alternative insurance plan while you are in Spain. 

Difference Between the Health Systems In Spain and America

Here is a highlight of the main differences between the healthcare system in the US and Spain:

Spanish Healthcare SystemAmerican Healthcare System
Type of healthcareSpain offers state-funded healthcare insurance for its citizens, i.e., the healthcare system is public and funded by taxes. The American healthcare system is mostly private, and citizens have to buy private insurance or pay out of pocket for medical services. 
Cost of medical servicesSpain has lower cost prices for medical services than the US. For example, a one day at the hospital will cost you $200 without health insurance. Payment for medical services out of pocket without insurance in the US is higher than in Spain— one day at the hospital costs an average of $2,000.
Who qualifies for healthcare?Anyone who is considered a resident in Spain qualifies for national insurance. Refuges are limited to emergency services only. Employers mostly provide health insurance in the US to their employees, which means not all of the population has access to health insurance.
Are pre-existing conditions covered?Spain’s national health care system doesn’t usually cover pre-existing  conditions, dental, or eyeglasses; these are services you have to pay out of pocket. Since healthcare is mostly private in the US, you can choose a plan covering your pre-existing conditions and any additional add-ons. 
Did you find this page helpful?
Yes No
Scroll to Top