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Complete guide to obtaining health insurance in Spain as an expat

Approximately around 5 million expats live and work in Spain. Some of the most popular reasons why Spain is so popular with foreigners are the social security benefits, an outstanding work-life balance, the fantastic weather, and without a doubt, its highly effective healthcare system.

However, expats are often confused about how the Spanish healthcare system works, whether they qualify for public insurance, and whether they need to purchase private health insurance. So, before you join the rest of the 5 million expats living there, here is an overview of Spain’s healthcare system for expats.

How Does Spain’s Healthcare System Work?

Spain has a universal public healthcare system where every resident is offered free health insurance coverage. This type of system is made possible by a government fund where every employed resident pays a percentage of their salary towards social contributions in the form of taxes, covering healthcare costs. 

In addition to the public healthcare system, Spain has several private insurance options. However, in this case, you are in charge of selecting your provider and paying for the insurance plan you choose.

Does Spain Have Free Healthcare? 

Spain offers free basic public health care coverage. However, even though most of the medical procedures, tests, and services included are free, you may be required to pay extra costs in specific situations. For example, you may be required to pay an ambulance fee for non-life-threatening calls, in addition to paying extra for those services that are included in the public scheme.

Expat Health Insurance in Spain

Expats living and working in Spain have the option to choose one of the two following health insurance options:

  1. Private Insurance Provider.
  2. National Healthcare System (Sistema Nacional de Salud SNS).

Private Health Insurance for Expats in Spain

Even though it is not a requirement, many expats in Spain prefer private health insurance over state-funded insurance. That is because, with private health insurance, you have coverage in private hospitals and clinics, meaning shorter waiting times and access to English-speaking healthcare providers. 

Additionally, having a private healthcare provider means more services are included in your insurance plan than in the state healthcare system. For example, dental care is not covered by the SNS; therefore, expats opt for a private healthcare provider that covers a wide range of services.  

You must also have private health insurance when you first enter Spain until you apply for the SNS. If you choose not to register with the SNS, you can continue to pay for private health insurance. If you’re not sure which insurance provider to pick, Insubuy and International Citizens Insurance, will provide you with a number of companies and their insurance policies that will cover you in Spain. 

Private Health Insurance Companies in Spain

Here is a list of some of the best companies that offer international health insurance for expats in Spain: 

  • Axa 
  • Bupa (Sanitas) 
  • Cigna 
  • Allianz Worldwide

Average Cost of Private Health Insurance in Spain for Expats

The average price of private insurance for expats in Spain ranges from €100 to €200 per month. The price varies depending on your provider, which plans you pay, and your personal situation. The cost of a basic health insurance plan goes as follows:

  • For a single person in their 30s: €35 ($39)
  • For a family of four: €130 ($142)

If you opt for a more inclusive plan, your average costs can increase to €290 ($318) for a family. To help you choose the best plan for your stay in Spain, head on to Insubuy or International Citizens Insurance to compare different policies and pick the one that suits you. 

Healthcare for Retired Expats in Spain

If you’re a retired expat in Spain, you can still qualify for a public health care scheme known as ‘Convenio Especial.’ This is a national healthcare plan that you have to pay a monthly fee as follows to receive insurance coverage: 

  • For persons under 65 years of age: €60 ($65).
  • For persons over 65 years of age: €157 ($172).

The ‘Convenio Especial’ will also cover any pre-existing conditions. 

As a retiree, you can also pay for private insurance, instead of the Convenio Especial, if you wish. 

National Healthcare System (Sistema Nacional de Salud SNS)

As an expat living in Spain, you qualify for public insurance during your stay there if you meet the following criteria:

  • You are an employed legal resident in Spain (including freelancers and self-employed). 
  • You are living in Spain and receive state benefits. 
  • You live in Spain, and you recently divorced or separated from your spouse, who was registered with social security. 
  • You are a pregnant woman living in Spain. 
  • You are staying temporarily in Spain and possess a valid EHIC card. 
  • You are a family member of someone employed in Malta, who is entitled to healthcare. 
  • You are an international student under 26 studying in Spain (you may be required to use a private provider before entering the country— make sure you contact your university). 

The National Healthcare System in Spain, also known as the Sistema Nacional de Salud (SNS), is one of the best healthcare systems in Europe. So, you will be able to get insurance for most of your healthcare needs while you are living in Spain. 

What Is Included in the Spain Public Health Scheme?

The public health care system in Spain covers the following primary care services: 

  • All emergency services. 
  • Family medicine. 
  • Pediatric services. 
  • Nursing and midwives services. 

The SNS does not cover the following services:

  • Dental care (except for simple extractions)
  • Eyeglasses 

The SNS partially covers the following services:

  • Prescription costs at the pharmacy (your TSI card covers around 40%)
  • Surgical prostheses, orthopedic equipment, and wheelchairs.

How Do I Register for the Spanish Healthcare Plan?

After you enter Spain, you have to register with your local health center to qualify for the national healthcare plan (SNS) and receive your TSI (Tarjeta de Identidad de Extranjeros)— your Spanish healthcare card. To get your TSI, you need to follow the instructions below:

  1. Register your new address. 
  2. Get your social security number. 
  3. Prepare your documents. 
  4. Find your local health center. 

Note: During the initial settling-in period after you enter Spain, you must have valid private health insurance until you can qualify for the SNS. 

Register Your New Address

As soon as you enter Spain, you have to register your new address with your local town hall (padron) and get your registration certificate (empadronamiento). You will need your registration certificate to apply for your health care card. 

Get Your Social Security Number

To register for health insurance, you also have to provide your social security number, which you obtain from your employer. However, if you are self-employed or have not received your number yet, you must apply at your local social security office (Tesoreria General de la Seguridad Social (TGSS)). 

You can find your local social office here. 

Prepare Your Documents

Before you can visit your local health care center and apply for your TSI, you need to prepare the following documents:

  • Your residence card
  • Your TIE (Tarjeta de Identidad de Extranjeros)
  • Passport 
  • Your certificate of registration (retrieved from your ‘padron’)
  • A document proving your right to retrieve health care issued by the social security office. 

Find Your Local Health Center 

Finally, locate your local health care center (which varies depending on which region of Spain you’re living in). Bring all your documents and apply for a health care card. Once the social security office confirms that you qualify for public health insurance, you will receive your TSI card by post. 

This card proves that you can access health care services in Spain; you need to present your card whenever you want to make an appointment with your GP. If you’re going to see a specialist, you will need a referral from your family doctor. 

Keep in mind: Depending on where in Spain you live, the TSI card may be referred to differently. For example, if you live in Catalonia, instead of the TSI, you will receive a CAP card (Centre d’Atenció Primaria).

Facts About Spain’s Healthcare System

Here are some quick facts about Spain’s healthcare system: 

  • Around 90% of Spaniards use the public health insurance offered by the SNS. 
  • Around 19% use private health insurance. 
  • Spain is one of the countries that spend the most on its national healthcare system— around 10% of its GDP.
  • WHO ranked the Spanish healthcare system the 7th most efficient in 2000. 
  • All pregnant women in Spain receive healthcare services no matter their insurance situation. 
  • In 2018 the Euro Health Consumer Index ranked Spain’s health care system the 19th. 
  • Spain is the number one country for organ transplants. 

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