Home Healthcare Healthcare Basics Health insurance in Spain
Last update on October 13, 2020

Moving to Spain? Make sure you and your family are covered for every eventuality by reading our guide to health insurance in Spain.

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:

Cigna Global

Cigna Global is a world-leader in providing premium international health insurance. Their specifically designed expat-friendly policies offer access to a worldwide network of over 1 million healthcare specialists and providers. So, whether you’re moving to Seville or Santander, you’ll get the right health cover for you.

The healthcare system and health insurance in Spain

The Spanish healthcare system ranks among the best in the world. Social security payments fund the system, meaning that most residents don’t require private insurance to access health services.

The 2019 Health Care Index ranks Spain seventh out of 89 countries on overall healthcare, behind only Austria and Denmark in Europe.

While the Spanish state system is excellent, some expats choose to take out additional private coverage, which can cut waiting times and make it easier to see an English-speaking doctor.

Who needs health insurance in Spain?

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

If you’re ineligible for health insurance, you can pay for treatment yourself or take out a private health insurance plan. In some regions, you can register for a government-run scheme called convenio especial which provides social security cover for a basic monthly fee.

Public health insurance in Spain

Who does public health insurance cover in Spain?

  • Employees: all employees and self-employed workers in Spain must make social security contributions. This then entitles them to Spanish health cover.
  • Self-employed, freelancers and business owners: freelancers in Spain 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 any children of workers are also entitled to state healthcare, as long as 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. Preparing this form before moving helps simplify the registration process. EU, EEA and Swiss residents staying in Spain on a temporary basis can use their European Health Insurance Card, 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 before getting a Spanish visa. Some non-EU nations, however, have an agreement in place with Spain. It’s important to know what you’re entitled to, so check with the consulate or embassy in your home country before 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 does Spanish health insurance cover?

The TSI health card covers care from doctors and hospitals. It 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.

TSI covers between 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.

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.

Dentist fees are relatively inexpensive and the general quality of care is of a high standard. However, private health insurance can halve the costs, with dental insurance costing as low as €10–20 per month.

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). You’ll need this 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 Social) on the government’s website.

Once you have your TSI card, you can register with an individual doctor or at your local health center. You can select doctors and pediatricians from within your local healthcare district. To see any other specialist practitioners, however, you must be referred by your GP.

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 healthcare 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 health insurance 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, as 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 coverage. This helps patients avoid the lengthy waiting times often found in the state system.

This is an important factor to consider when weighing up the private care avenue, and is particularly important if you will require regular treatment.

A private health insurance plan enables you to select a doctor with a strong grasp of English. Lists of English speaking doctors are also 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 health insurance quotes. In addition to this, you can also use 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 (Tesorería General de la Seguridad Social).

Anyone working in Spain receives a social security number and must make 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.

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 2019. 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 18.75% and 26.5%, depending on their earnings.

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 a maximum contribution base.

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

Useful resources