Home Healthcare Healthcare Basics Health insurance in Spain
Last update on November 12, 2019

All residents in Spain have access to the free public Spanish healthcare system, although private insurance may be necessary in certain situations.

This guide on health insurance in Spain covers the following topics:

  • The healthcare system and health insurance in Spain
  • Who needs health insurance in Spain?
  • Public health insurance in Spain
  • How to apply for public health insurance
  • Private health insurance in Spain
  • Health insurance costs and reimbursements
  • Health insurance for unemployed or low earners

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The healthcare system and health insurance in Spain

The Spanish healthcare system ranks among the best in the world and is funded by social security payments, meaning the majority of residents do not require private insurance to access Spanish healthcare.

Depending on your circumstances, however, some additional cover for health insurance in Spain may be required.

Who needs health insurance in Spain?

If you are living and working in Spain, you will generally pay income tax and social security that goes towards providing you with free state healthcare in Spain.

If you’re ineligible for health insurance in Spain, you can pay for treatment or take out private health insurance.

In some regions, you can register for a government-run scheme called convenio especial which provides social security cover for a basic monthly fee.null

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Public health insurance in Spain

Who is covered by public health insurance in Spain?

  • Employees: all employees and self-employed workers in Spain must make social security contributions. This, in turn, entitles them to Spanish health cover.
  • Self-employed, freelancers and business owners: if you are self-employed you are responsible for paying your own social security contributions towards public healthcare. You can apply for a social security number at your nearest Social Security Office.
  • Spouses and children: the spouse and children of workers are also entitled to healthcare in Spain, provided they also reside in Spain.
  • EU/EEA/Swiss nationals: EU, EEA and Swiss nationals who have reached retirement age in their home country are entitled to free healthcare in Spain. In order to qualify they must obtain an S1 form from their country of residence. Acquiring this form prior to departure is advisable and will help simplify the registration process in Spain. EU, EEA and Swiss residents staying in Spain on a temporary basis can use their European Health Insurance Card (EHIC) which entitles them to receive medical treatment at the same cost as a Spanish national.
  • Non-EU nationals: non-EU/EEA nationals may have to provide proof of private health insurance in Spain before being granted a Spanish visa. Some non-EU nations, however, have an agreement in place with Spain; it’s important to enquire about your entitlements with the consulate or embassy in your home country prior to arrival.
  • Students: EU nationals studying in Spain will be covered by their EHIC throughout their period of study. Non-EU students, however, might need a private health insurance plan prior to arrival. Your university can provide more detail.

What is covered by Spanish public health insurance?

The TSI health card covers care from doctors and at hospitals. It also covers 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. TSI also covers treatment at home, which can be particularly useful to the elderly and disabled.

Presenting a TSI card means you pay no fees when receiving treatment at hospitals or from a doctor in Spain. The prescription fee at pharmacies, however, must be paid by you at the time of purchase.

Dental work in Spain does not fall under the public care system and must be paid for in full by the individual, unless they have private health insurance in Spain.

Dentist fees in Spain are relatively inexpensive and the general quality of care is of a high standard, although private health insurance can halve the costs with dental insurance costing as low as €10–20 per month. Read more in our guide to dentists in Spain.

Guide to health insurance in Spain

How to apply for public health insurance

If you are a resident in Spain, you need to register your address on the padron at your local town hall.

Once you have done this, you will get an empadronamiento (certificate of registration) which you will need to apply for a healthcare card.

You will also need to make sure you have your social security number, which will be issued by your employer. If you haven’t received one, you can sort this out through your local social security office, called the Tesoreria General de la Seguridad Social (TGSS). You can find your local Social Security Office (Oficina del Instituto Nacional de Seguridad Socialhere.

Once you have your TSI card, you can register with an individual doctor or at your local health centre. With regards to doctors and paediatricians, you can select one from within your local healthcare district.

To see any other specialist practitioners, however, you must be referred by your GP. More is explained in our guide for visiting doctors and specialists in Spain.

Your TSI health card proves that you have health insurance in Spain. Present it whenever you use a public health service or purchase a prescription from a pharmacy.

Private health insurance in Spain

If you require additional health services, you can opt for private health insurance.

Spanish private health insurance companies offer a range of packages that cater specifically to your circumstances.

As ever, it’s important to thoroughly research your options and seek as much advice as possible before committing to a specific plan.

Foreigners should check if their package provides the same protection in Spain as it does back home.

EU nationals who travel frequently outside of the EU may also consider private health insurance; the EHIC card only covers travel within the EU.

The advantages of getting private health insurance coverage in Spain

While the quality of public healthcare is high, some residents opt for private healthcare. This helps patients avoid the sometimes lengthy waiting times associated with the public service.

This is an important factor to consider when weighing up the private care avenue; it’s particularly the case if you will require regular treatment. If this is the case, cutting down on waiting times may be a priority for you.

A private health insurance plan enables you to select a doctor with a strong grasp of English; this can be of particular importance to those who expect to be in regular contact with their GP.

Lists of English speaking doctors are often available from tourist offices and embassies.

How to choose a health insurance provider

You can compare private health insurance providers in Spain and get free quotes on our special Expatica health insurance page, and with the following tools: Acierto.com (in Spanish) and Rastreator.com in (Spanish).

Some of the largest private health insurance companies in Spain include:

Health insurance contributions and reimbursements

Spain’s healthcare system is funded by contributions to the country’s General Social Security Fund, known as Tesorería General de la Seguridad Social (TGSS).

Anyone working in Spain receives a social security number and makes monthly contributions.

These payments are automatically deducted from their wages, with employers also contributing a percentage to the scheme for each worker. This, in turn, entitles employees to free Spanish healthcare.

Spain’s healthcare system is funded by contributions to the country’s General Social Security Fund, known as Tesorería General de la Seguridad Social (TGSS). Anyone working in Spain receives a social security number and makes monthly contributions.

Your contributions towards health insurance in Spain are based on minimum and maximum contribution rates set by the government each year.

The current payment rates were set in 2017. General employees contribute 4.7% of their annual salary to the social security system; employers contribute the equivalent of 23.6% of the employee’s earnings (making a total contribution of 28.3%). Self-employed workers pay between 26.5% and 29.3%. Read more about Spanish social security.

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Health insurance for unemployed or low earners

Spanish authorities offer a pay-in scheme, known as the Convenio Especial (special agreement).

This is available to those who may have issues accessing the benefits of the system, such as those who become unemployed or are on low wages.

It is essentially a low-cost insurance scheme that provides cover in exchange for a low monthly fee. You can choose to pay a minimum, average or maximum contribution base.

The convenio especial is suspended during periods of normal employment where your contributions will be met through your salary.

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