Health insurance in Spain

Whether you’re using public or private medical care, learn how you can cover your bases with this article on health insurance in Spain.

All people living and working in Spain can register for free public healthcare. The Spanish healthcare system is among the best in the world, offering (almost) universal healthcare throughout the country.

However, in some circumstances, it might be better to take out private health insurance. For example, when you are a temporary resident or want to make use of specialized medical care.

Discover what works best for you with regard to health insurance in Spain by reading the following sections:

The healthcare system and health insurance

The Spanish healthcare system is one of the best in the world. In 2021, Spain’s National Health System (Sistema Nacional de Salud – SNS) ranked eighth out of 89 countries on the Health Care Index. In Europe, it comes in fourth place, behind only Austria, Denmark, and France.

The nonprofit think tank Foundation for Research on Equal Opportunity (FREOPP) gives Spain just a moderate score. Although the healthcare system is regarded as effective (it offers (almost) universal coverage for all residents), it is lacking on some fronts. For example, the mental healthcare sector is difficult to access and children’s healthcare is only fully paid for until the age of 15.

It is common for expats and Spanish residents to supplement their coverage with private health insurance (seguro de salud privado). The added medical insurance offers easier and better access to specialized medical care such as dentistry or mental healthcare.

Over 70% of the public healthcare system (asistencia sanitaria pública) is financed by social security contributions paid by all inhabitants in Spain. This is reportedly around 11% of the GDP.

Who needs health insurance in Spain?

In 2019, Spain was named the healthiest country in the world by the Bloomberg Healthiest Country Index. Insurance broker Money.co.uk disagrees (instead giving the honor to Japan), but does concede that Valencia and Madrid are the healthiest cities in the world. These incredible ratings also explain the overall life expectancy of 83.5 years old, which tops all other European Union (EU) member states.

Anyone living and working in Spain – either salaried or self-employed – contributes to state healthcare through social security payments. Because of that, the country is able to provide free healthcare to:

• Minor children under the age of 15
• Students under the age of 26
• Recipients of certain state benefits
• Retirees with a state pension

Spouses and partners of those registered for social security are also entitled to state healthcare. This includes people who are separated or recently got divorced.

EU/EFTA nationals

Internationals who contribute to state healthcare elsewhere (e.g., in Italy) get free medical care with their European Health Insurance Card (EHIC). This includes residents from the EFTA region (European Free Trade Association – Iceland, Lichtenstein, Norway, and Switzerland).

If you are staying in Spain for a short assignment (less than two years) or you are retiring in Spain while collecting a state pension elsewhere, you must fill out an S1 form. This will entitle you to healthcare during your residence in the country. This includes students on an exchange program, trainees, and researchers.

It’s important to note that some national health insurers will only cover the costs of your healthcare in another EU country for a limited period of time. If that is the case for you, you must register with the SNS or take out private medical insurance.

Non-EU/EFTA nationals

Expats from outside the EU/EFTA region can access Spanish healthcare through the travel insurance that they’ve taken out as part of their visa application.

If you’re planning to relocate to Spain for a longer period of time, you must register with the SNS or take out private health insurance.

What happens if I am not covered by health insurance?

Undocumented migrants can access the healthcare system but must pay at least 40% of the costs of any medication prescribed to them. They are also likely to pay up to 100% of any costs of medical procedures.

What does Spanish health insurance cover?

Doctors, hospitals, and emergency care

The TSI health card covers all primary care provided by doctors and hospitals. It also covers treatment at home, which can be particularly useful to the elderly and those living with a disability.

Ambulance rides in Spain are also covered by public healthcare.

Prescriptions and medication

The SNS covers between 40–60% of the cost of prescription drugs, depending on your earnings. Pensioners only pay 10% of their medicinal fees.

Although 60% of the remaining cost sounds steep, prescription drugs in Spain are relatively cheap.

Mental healthcare

Referrals to a mental healthcare professional by a family doctor are covered by public medical insurance. That said, unfortunately, mental health resources in the public sector are extremely lacking. Spain has only six clinical psychologists for every 100,000 residents. This is much lower than the EU average of 38 per 100,000 inhabitants.

With private health insurance, the waiting times are reduced and you’ll likely get better treatment.

Maternity care

Spanish healthcare covers a number of maternity services, including midwifery, health scans, and public hospital births. Home births are not very common and are not coved by public healthcare.

If you want to deliver at a private birthing facility, you must have private healthcare insurance or pay for it in full.

Dental care

Regular dentistry is not covered by the SNS and must be paid for in full by the individual. Dentist (dentista) 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.

If you need specialized dental care in a hospital (e.g., trauma help), it is covered by public healthcare.

Vision care and eye doctors

Vision or eye tests by an ophthalmologist (i.e., an eye doctor) will only be covered if you have a referral from a family doctor. They will give you a diagnosis and a treatment plan. If you need cataract surgery with mono-focal lenses, it is covered by the SNS. Other vision care does not get medical aid.

That means that if you visit an optician and order glasses, you will have to foot the bill yourself.

Sexual and reproductive health

While some sexual health treatments are covered by public healthcare, others are not.

Anticontraception (anticonceptivos) is widely available in all regions. Condoms are not covered but can be bought at any drug store, pharmacy, or supermarket. Emergency Contraception and Plan B (la píladora del dia despues) are also available without a prescription; you can buy them over the counter at a pharmacy. Hormonal contraception, including the pill (píldora anticonceptiva) and IUDs (DIU), do require a prescription. These are partially covered by public health insurance.

With a referral from a family doctor, you can get free testing for STDs (Enfermedades de Transmisión Sexual – ETS) and STIs (Infecciones de Transmisión Sexual – ITS) at a public health clinic. These are also available for sexual health information and advice.

Abortion is legal in Spain and is covered by public healthcare. You can terminate a pregnancy up to 14 weeks, or up to 22 weeks if it poses a serious health risk for you or the fetus. Abortion beyond those 22 weeks is only possible when the fetus is incompatible with life, or an extremely serious and incurable disease is detected. If you are aged 16 or 17, you don’t need parental consent to terminate a pregnancy.

Coverage of fertility treatments differs per regional Autonomous Community (Spain has 17 of them). It’s recommended to check with your family doctor before pursuing a treatment like IVF or the ROPA method.

Vaccinations

Obligatory vaccines are covered by the SNS. This includes the childhood jabs such as the Hepatitis B vaccine and the Diphtheria, tetanus, and acellular pertussis (DTaP) vaccine. The COVID-19 vaccine is also free of charge, however, the official government source is out of date.

Optional vaccinations (e.g., travel vaccinations) are not covered by public health insurance.

Alternative/complementary therapies

Spanish healthcare does not pay for alternative therapies, such as holistic medicines, homeopathy, acupuncture, reflexology, and chiropractic treatment. Some private insurance companies do offer coverage, but you’ll have to select this as an add-on and will likely pay a higher rate.

Treatment abroad

The TSI only covers emergency medical costs in EU member states. Be sure to ask your family doctor for more information before taking a vacation.

How to get public health insurance in Spain

You can access public healthcare with an EHIC card or a Spanish health card (tarjeta sanitaria individual – TSI). Both cards come free with medical insurance.

Before getting a TSI, you must register for a Spanish social security number. Your employer will likely have taken care of this for you. However, if you haven’t received one, you can sort this out through your local Social Security Office (Oficina del Instituto Nacional de Seguridad Social).

How to register for public healthcare

With your ID number, you can download a certificate that states you are entitled to medical care from the Social Security e-Office. Steps include:

• At the e-Office portal, you can select the option Citizen > Healthcare > Healthcare. Application for recognition of entitlement (as an insured person)
• Select your preferred identification method, and a new portal “Tu Seguridad Social” will open
• Underneath the section Healthcare, you will find the option to download your certificate

After getting the certificate, you can apply for a Spanish health card at your local primary healthcare center (centre d’atenció primària – CAP).

After that, you can apply for a Spanish health card at your local primary healthcare center (centre d’atenció primària – CAP). You will need to provide:

• A valid passport or ID
• Proof of registration in el Padron
• Healthcare certificate

Your TSI health card will be sent to your home within two or three weeks of filing. This card proves that you have medical insurance in Spain. Be sure to keep it on you at all times, so you are able to present it whenever you use a public health service or purchase a prescription from a pharmacy.

It allows you to register with an individual doctor or health center within your local healthcare district. To see any other specialist doctors, however, you must be referred by your family doctor.

Private medical insurance in Spain

Many residents choose to get additional private health insurance to get better and quicker access to treatment. There are fewer waiting lines for private medical facilities, and some insurers cover procedures that are not covered by public healthcare. For example, home births are not covered by the SNS.

Around 25% of the Spanish population has some form of private healthcare coverage. It is also widely popular among expats and temporary residents who don’t want – or can’t – sign up for public healthcare.

One of the advantages of private medical insurance is that you can easily choose a doctor with a strong grasp of English if you’re not fluent in Spanish. You can find a list of English-speaking doctors at your local embassy or consulate, or at the website of the non-profit English Speaking Healthcare Association Spain.

What is the best health insurance provider in Spain?

There are many private insurance companies that cater specifically to your circumstances.

As usual, it’s important to thoroughly research your medical insurance options and seek as much advice as possible before committing to a specific plan. International expats should check if their package provides the same protection in Spain as it does back home.

When choosing a medical insurance provider, you should make sure they are accredited by the Official Colleges of Physicians (Consejo General de Colegios Oficiales de Médicos – CGCOM) in Spain. This is the official body that regulates the Spanish medical profession.

How much is private health insurance in Spain?

Private insurance costs on average between €50-200 a month, depending on the coverage plan. If you need specialized care or regular treatment, your premium can go up. Some insurance providers do not work with monthly fees, but allow you to only pay for the treatment you need.

You can compare private health insurance companies and get free medical insurance quotes here.

Some of the best medical insurance providers in Spain include:

• Allianz Care
• Cigna Global

Health insurance contributions and reimbursements

As said before, the healthcare system in Spain is funded by social security payments made by all inhabitants in Spain. These contributions are automatically deducted from your wages. Employers also provide the system with an extra percentage for each of their workers.

How much you pay on average is based on minimum and maximum contribution rates set by the government each year. In general, the 2022 payment rates were fixed at 4.7% of your annual salary. Your employer will contribute the equivalent of 23.6% of your earnings (making a total contribution of 28.3%).

Freelancers and self-employed workers pay between 18.75% and 26.5% per year, depending on their income. Retirees have already contributed to the system during their working life, and are exempt from making payments.

Medical insurance for unemployed or low earners

Spanish residents who are unemployed or earn low wages can benefit from the pay-in scheme Convenio Especial (special agreement). It is essentially a low-cost insurance scheme that provides coverage 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.

Useful resources

• English Speaking Healthcare Association Spain – a non-profit organization listing English-speaking doctors and healthcare professionals in Spain
• Farmacias de Guardia – online directory of 24/7 pharmacies in Spain
• Ministry of Health – the official government website with information on Spanish healthcare
• Seguridad Social – the official website of the Spanish social security authorities
• Your Europe – the official EU website with information about the European Health Insurance Card