Health insurance in Spain

Everyone living and working in Spain can register for free public healthcare. Although the country has (almost) universal medical coverage, many local and expat residents will supplement it with private health insurance (seguro de salud privado). This provides them with better and faster access to treatment, plus extra coverage for additional care, such as dentistry or mental healthcare.

Continue reading to learn which health insurance works best for your situation:

The healthcare system and health insurance

The Spanish healthcare system is one of the best in the world. In 2022, Spain’s National Health System (Sistema Nacional de Salud – SNS) ranked sixth out of 95 countries on the Health Care Index. And in Europe, it comes in third, behind only 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 effective and offers almost universal coverage for all residents, it is lacking on some fronts. For example, there is not enough access to mental healthcare, and children are only fully covered up to the age of 15.

It is common for expats and Spanish residents to supplement their coverage with private health insurance. The added insurance offers easier and better access to 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 residents. This is reportedly around 11% of the GDP.

Who needs health insurance in Spain?

If you’re living and working in Spain – either salaried or self-employed – you’ll be covered by public healthcare through your social security payments. Because of that, other people can also get free medical care, including:

• 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, including those who are separated or recently divorced

If you are staying in Spain for a short time or are not on the above list, you might need to take out private health insurance.

EU/EFTA nationals

Expats who contribute to state healthcare in another EU or EFTA country can access free healthcare in Spain with their European Health Insurance Card (EHIC).

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, you must register with the SNS and get a Spanish Health Card (Tarjeta Sanitaria Individual – TSI), or take out private medical insurance.

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

Non-EU/EFTA nationals

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

However, 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?

Those not covered by health insurance (e.g., undocumented migrants) can access the healthcare system but are likely to pay up to 100% of any costs of medical procedures. They must pay also at least 40% of the costs of any medication prescribed to them.

What is covered by Spanish health insurance?

	Covered?	Note:
Doctors and medical specialists	Yes
Emergency care, hospital stays, and at-home treatment	Yes
Prescription medication	Partially	The SNS covers 40–60% of the cost, depending on your earnings. Retirees only pay 10% of their medication fees.
Mental healthcare	Yes
Maternity care	Yes
Dentistry	No
Specialized vision care	Yes
Sexual and reproductive health	Partially	If you have a prescription from a family doctor, your costs are partially covered. Treatment without a prescription is not covered. Insurance for fertility treatments differs by region of Spain, so it’s good to check with your doctor first.
Vaccinations	Yes	Mandatory vaccines are covered, optional ones are not.
Alternative medicines and complementary therapies	No
Treatment abroad	Maybe	The SNS only covers emergency medical costs in EU member states.

Prescription medication

The SNS covers 40–60% of the cost of prescription drugs, depending on your earnings. The higher your income, the less the government will cover. Pensioners and retirees only have to pay 10% of their medication fees.

While undocumented migrants don’t pay for the public healthcare system, they can access basic medical care. If they’re also prescribed medication, they are required to pay at least 40% of the costs.

Mental healthcare

Public medical insurance covers referrals to a mental healthcare professional by a primary care physician. That said, unfortunately, the public mental health sector is extremely underresourced. Spain has altogether six clinical psychologists for every 100,000 residents (2022). This is much lower than the EU average of 38 per 100,000 inhabitants.

It’s important to note that mental healthcare is usually easier to access with private insurance. The waiting times are reduced, and you’ll likely get more freedom of choice.

Dentistry and dental care

The SNS does not cover basic dentistry, so the individual must pay for the costs of treatment. Thankfully, dentist (dentista) fees are relatively inexpensive and the general quality of care is of a high standard.

Private health insurance can halve the costs, with dental add-ons costing as low as €10–20 per month. If you need specialized dental care in a hospital (e.g., after an accident), public healthcare will cover it.

Sexual and reproductive health

While public healthcare includes some sexual health treatments, it does not cover everything. The basic rule of thumb is that if your treatment is prescribed, it’ll be covered and if it’s not prescribed, it’s not.

For example, hormonal contraception (anticonceptivos) like the pill (píldora anticonceptiva) and IUDs (DIU) require a prescription and are partially covered by public health insurance. Condoms and emergency Contraception like Plan B (la píladora del dia despues) are available without a prescription; these are not covered by the healthcare system.

With a referral from a family doctor, you can get free testing for STDs/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 public healthcare covers the cost in 70% of cases. 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 in the case of a serious and incurable disease. If you are 16 or 17, you don’t need parental consent to terminate a pregnancy.

As said above, coverage of fertility treatments differs by region of Spain, so it’s good to check with your family doctor about what specific types are available in your area.

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.

How to apply for public health insurance

You can access public healthcare with a European Health Insurance Card or a 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 get public health insurance as an expat

You must first download a certificate that states you are entitled to medical care. You can do that by:

• Visiting the Social Security e-Office
• On the top left of the page, select the option Citizen > Healthcare > Healthcare. Application for recognition of entitlement (as an insured person)
• Select your preferred identification method (this will open a new portal “Tu Seguridad Social”)
• Underneath the section ‘Healthcare’, you will find the option to download your certificate

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 Padrón
• Healthcare certificate

Your TSI 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 specialists, however, you must be referred by your family doctor.

Private health insurance in Spain

Should I get private health insurance?

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

The advantages of private health insurance in Spain

One of the advantages of private medical insurance is that you have easier and faster access to healthcare. You can skip waiting lines and don’t need a referral from a family doctor. In addition, some insurance companies cover additional procedures that are not covered by public healthcare. For example, the SNS does not cover home births.

Best of all, 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 doctors at your local embassy or consulate or through the non-profit English Speaking Healthcare Association Spain.

How to choose the best health insurance provider

When deciding on an insurance company, you should choose one that offers the coverage you need and is accredited. 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.

When choosing between medical professionals, it might be worth comparing your options on a portal such as SaludOnNet.

How much is private health insurance in Spain?

Generally, private insurance costs on average between €50–200 a month, depending on the coverage plan. If you need additional 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
• Sanitas

Health insurance contributions and reimbursements

The healthcare system in Spain is funded by social security payments (reportedly around 11% of the Spanish GDP). 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 the annual salary. Your employer will contribute the equivalent of 23.6% of your earnings, for a total of 28.3%.
• Freelancers and self-employed workers pay 18.75–26.5% 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

If you are unemployed or have a low income, you 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