Healthcare and Health Insurance in Spain for Expats

If you are moving to Spain as an expat, you have the opportunity to access both public and private healthcare, or even combine both to make sure all your needs are covered in the most comprehensive and affordable way.

Healthcare and health insurance for expats in Spain
Understanding healthcare and medical insurance in Spain

This guide will tell how to get access to the Spanish Public Healthcare system, what you need to do before you leave the UK, why and when you might want to look at private health insurance and how to choose the most suitable cover; how to obtain a health card in Spain and register with a GP.

Health insurance in Spain 

There are 3 options to secure health insurance when you move to Spain:

  1. If you are receiving a UK state pension, you need to apply for an S1 form from the Department for Work and Pensions. This will allow you access the Spanish Public Healthcare System, which will be paid for by the UK government;
  2. If you are not eligible for an S1 form, you can join a special scheme that allows you access Spanish Public Healthcare for a monthly contribution;
  3. Another option is to buy private health cover either from a local provider or an international insurer.

We will discuss these options in detail.

Public healthcare in Spain

Spain has a universal healthcare system – the Spanish National Health System (“Sistema Nacional de Salud” or SNS). It’s actually one of the best in the world. 

Each of the 17 autonomous regions in Spain is responsible for their healthcare. It means the quality of care, access to specialist doctors and equipment can vary from region to region.

Madrid and Barcelona can boast the best hospitals and specialists, which lead to internal health tourism and, consequently, if you go privately, you will find that prices in those cities are higher than elsewhere in the country.

Both Spanish citizens and foreign residents who work in Spain have the right to use the SNS. 

Foreigners can use the SNS if they work in Spain, pay social security taxes or are retired (over the retirement age). Emergency treatment is available to anyone regardless of their status in the country. 

The SNS covers most procedures free of charge. However, if there is surgery involved, you need to stay overnight in a hospital, or receive extensive prescriptions, you will be charged a reasonable fee. 

EU retirees are automatically eligible for the SNS coverage when they become permanent residents in Spain. This includes UK citizens (for now). 

There are a few things you need to do before you leave the UK and when you arrive in Spain to ensure your access to the SNS. 

Before you leave the UK:

  • Obtain your UK issued European Health Insurance Card (EHIC);
  • Apply for an S1 Form from the Department for Work and Pensions.

For more information on obtaining an S1 form and an EHIC read our Healthcare Abroad page.

When you’re in Spain:

  • Register your S1 form with the local authorities;
  • Apply for the locally issued EHIC for your travels around the EU (including back in the UK);
  • If registering your S1 form requires obtaining residency, you can cover yourself for this period through local private healthcare companies. Local private health insurance is cheaper than international.

EHIC

Presuming you have already applied and received your UK issued EHIC, use this for your initial period of settling down in Spain in case you fall ill or have an accident. 

For dental and optical care, or for routine medical services during this period, you will have to pay out of pocket or use private health cover. 

S1 for accessing state healthcare in Spain

S1 form gives you access to the Spanish National Healthcare System (“Sistema Nacional de Salud” or SNS). It is ranked seventh in the world by the World Health Organisation and generally provides good quality services to Spain’s residents.

Once you’ve been issued with an S1 form in the UK, you can register it in Spain.

Registering your S1 form in Spain

Register your S1 form at the nearest INSS (Instituto Nacional de Seguridad Social), which is a National Institute of Social Security. They will keep a copy of it for themselves and return a copy to the DWP (Department for Work and Pension).

Important to remember:

  • You are not covered for healthcare in Spain until your S1 form has been registered at your local Spanish sickness insurance office;
  • You should first apply for the Residents Certificate (Certificado de Residencia) and register at a Padron in your Town Hall before registering your S1 form. Read how to do it in our ‘Spain Residency, Registration On A Padron, NIE And Other Paperwork‘ guide.

Once you’ve been issued with and registered your S1, you can apply for a Spain-issued EHIC to use for travelling around Europe and your TSI card (Tarjeta Sanitaria Individual), which you need every time you use medical facilities in Spain.

Applying for a Spanish Health Card (TSI)

To apply for a TSI card, you need the following documents:

  • A valid passport
  • Residency certificate 
  • Empadronamiento (certificate confirming your registration on a Padron from your local Town Hall)
  • Proof of pension
  • An S1 form
  • Your Birth Certificate translated into Spanish (sworn translation) bearing the Apostille of the Hague

Visit your nearest medical centre to apply for your health card. The medic will fill in a form with your details, get you to sign a copy and then the health card will be posted to the address on your empadronamiento. You will then be assigned a doctor as well.

You TSI health card proves that you have health insurance that can be used in Spain and should be presented whenever you use a public health service or purchase a prescription from a pharmacy. 

The TSI covers care from doctors and at hospitals, as well as 40-60% of the cost of prescription drugs depending on your earnings (90% for pensioners). Although individuals are liable for the remaining cost, prescription drugs in Spain are relatively cheap. Treatment at home is also included, which can be particularly useful to the elderly and disabled.

If you are not eligible for S1

If you are under 65 and are not eligible for S1 form,ot if you are a non-EEA national, you can register for a government-run scheme called Convenio Especial.

Convenio Especial provides social security cover for a basic monthly fee of €60 (£53) for the under 65s and €157 (£134) for over 65s.

To be able to apply for this service, you will need to have been a Spanish resident for at least one year immediately before applying for a TSI card and have the following documentation:

  • A valid passport
  • Residency certificate 
  • Empadronamiento (certificate confirming your registration on a Padron from your local Town Hall)
  • An S1 form
  • Your birth certificate translated into Spanish (sworn translation) bearing the Apostille of the Hague
  • Direct debit form ordering the Convenio Especial payment of the monthly amount due

Participating in Convenio Especial entitles you to a TSI card and everything it covers, which basically means you have the same access to Spanish SNS as any local resident or a British citizen covered by their S1 form.

Private healthcare in Spain 

There’s always an option to buy health insurance from either a local health insurer or an international provider. 

When private health insurance can be a good option:

  • If you want the security of a more extensive health cover;
  • You want a top-up to your SNS; 
  • You are not eligible for S1 form and need cover for the required one year of residency before you can access the SNS under Convenio Especial;
  • You need health cover to obtain a residency.

It’s always worth researching what local providers can offer you first, as very often they will be cheaper.

The largest local private healthcare providers in Spain are Sanitas, Adeslas, and Asisa. 

They can provide you with a top-up plan if you use the SNS for a better or extended level of care and service. As a rule, top-ups are much cheaper and, in most cases, will cover all co-payments and additional services.

If you are not eligible for the SNS, you can have a look at private plans from these providers.  Try to get privately insured as early as possible – that is, before you turn 65. After that, it’s both difficult and expensive. And do make sure your insurer won’t bump you off their health insurance the moment you turn 65.

A basic plan for a person from these providers can cost between €51 and €200 (£45-174)depending on your age and health conditions. 

If you are privately insured, make sure you’re using doctors and medical centres that are approved by the insurance company; otherwise, your insurance won’t be accepted.

Dental care in Spain

General dental care in Spain is not included in the SNS. You either pay for each visit or take out insurance for them. The average cost of dental insurance in Spain is around €10-20 (£9-18) per month. 

Dental implants in Spain are cheaper than in the UK and can cost you about €800 – 1400 (£700 – 1200), and the first consultation is often free of charge. Tooth filling prices can vary greatly depending on the location and the work required. You can get one for as cheap as €46 (£40) in Almeria or pay up to €140 (£120) in Palma de Mallorca.

Opticians in Spain

Just like in the UK, in Spain many opticians offer a free eye exam if you buy your glasses or contact lenses from them. If you just want the test, the cost is usually between €20 and €40 (£18-35).

The cost of glasses can vary greatly depending on whether you go to a small independent store or a chain. Specsavers operate in Spain now, and their prices are consistent across the country.

If you have a complex eye problem or you need treatment for an eye condition, you can get treatment from the SNS. Your Spanish GP must refer you to an ophthalmologist or optometrist. This could be for things such as a cataract tests, prescription drugs or eye surgery.

Pay-as-you-go healthcare costs in Spain

If you are not covered by any health insurance, here’s what you might pay when visiting a doctor in Spain. Prices may vary greatly depending on the location of the hospital, so the below is an average estimate only:

A&E visit:  around €200 (£180-190)

GP visit: around €70-115 (£60-100)

Xray: around €80 (£70)

Ultrasound: €52-205 (£45-178)

Consultation with a specialist: €70-115 (£60-100)

A day in a hospital: around €230-460 (£200-400)

Claiming treatment in the UK with your Spain registered S1 form

Your S1 form that you have registered in Spain gives you the right to receive medical treatment back in the UK just as any UK resident would. 

To access the NHS when back in the UK, you might need to show a copy of your S1 or ask the health care provider to contact the Department for Work and Pensions Overseas Healthcare Team to verify the status of your S1.

You can register with a GP as a temporary patient as long as you are in the area for more than 24 hours but less than three months. Through the GP you can then get a referral to a hospital for any specialist treatment you might require.

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About the author: Ola Degteva is the overseas retirement research director at Expatra. Coming from a teaching and research background, she has been working in online publishing since 2010 when she became an expat. Having done 3 major international moves herself, Ola knows exactly what relocation and settling down in a new country involves and how important it is to plan ahead to make moving abroad less stressful.