All residents in Spain have access to the free public Spanish healthcare system, although private insurance may be necessary in certain situations.
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, and private health insurance does offer quicker medical treatment in private facilities. This guide provided by expat health insurer Bupa Global explains how health insurance in Spain works.
Who is covered by 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. All employees and self-employed workers in Spain are required to make social security contributions, which in turn entitles them to Spanish health cover. The spouse and children of workers are also entitled to healthcare in Spain, provided they also reside in Spain. You may also be able to register for Spanish healthcare if you are:
If you’re not eligible for health insurance in Spain, you can choose to 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.
BUPA Global is one of the world's largest international health insurers. They offer direct access to over 1.2 million medical providers worldwide, settling directly with them so you don't have to pay up front for your treatment. They provide access to leading specialists without the need to see your family doctor first and ensure that you have the same level of cover wherever you might be, home or away.
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 (previously known as E121) from their country of residence. This is a certificate of entitlement to healthcare in you live in another EU country. The S1 form from the UK is available here. Acquiring this form prior to departure is advisable and will help simplify the registration process in Spain. You can read more about EU citizens moving to Spain.
European Health Insurance Card
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.
Third country 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, do have an agreement in place with Spain so it’s important to enquire about your entitlements with the consulate or embassy in your home country prior to arrival.
EU nationals studying in Spain will also be covered by their EHIC throughout their period of study. Non-EU students, however, may be required to take out a private health insurance plan prior to arrival, although their university can provide more detail.
How is health insurance in Spain funded?
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 will make monthly contributions via payments which 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 2017. General employees contribute 4.7% of their annual salary to the social security system, while 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.
How to register for health insurance in Spain
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 Social) here.
If you are self-employed you are responsible for paying your own social security contributions, and you can apply for a social security number at your nearest Social Security Office. This involves completing a TA1 application form, as well as presenting your passport and a national identification card, such as the NIE (tax identification number) card. The NIE card is issued upon completion of a residency application. If you have an electronic DNI or other certificate, you can opt to apply online, otherwise your accountant can complete the registration process for you.
Once you have been formally registered with the social security system in Spain, you will receive a document entitling you to medical assistance. This form can then be used to apply for a health card, known as a Tarjata Sanitaria Individual (TSI). You can receive your health card by applying at your closest state health centre, where you must present your social security and national insurance certificates, as well as your passport.
Healthcare card in Spain
You TSI health card proves that you have health insurance 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.
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
Choosing a doctor
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.
Private health insurance in Spain
If you require additional health services, you can opt for private health insurance in Spain. Spanish private health insurance companies offer a range of packages which cater specifically to your age, health condition and other circumstances. As ever, it’s important to thoroughly research your options and seek as much advice as possible before committing to a specific health plan. Foreigners may like to check if their package provides the same protection in Spain as it does in their country of origin.
While the quality of Spain’s public healthcare is of a high standard, some residents do opt for private healthcare in Spain to 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, particularly if you have a medical history which suggests you will require regular treatment. If this is the case, then cutting down on waiting times may be a priority for you.
A private health insurance plan can also enable you to select a doctor with a strong grasp of English, which may 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.
Families may also want to explore various family insurance packages in order to get the best possible value for money, and some insurance firms also provide additional cover, such as 100 percent dental cover.
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.
Some of the largest private health insurance companies in Spain include:
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).
Special agreement with Spanish social security: Convenio Especial
Spanish authorities offer a pay-in scheme, known as the Convenio Especial (special agreement), 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 which provides cover in exchange for a monthly fee that is calculated on a number of factors. 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.