Insurance in Spain for Expats
All residents in Spain need to register to access healthcare.
Once registered for healthcare, basic state services are free, but there are some things that patients need to pay for. For example, you usually have to pay something towards prescriptions – either a reduced price or the full price.
UK nationals usually access the Spanish national health system in one of these ways:
- through entitlement to healthcare if they’re employed or self-employed in Spain
- paying directly into the public health insurance scheme (Convenio Especial)
- registering a UK-issued S1 form with the social security office
- using a European Health Insurance Card (EHIC) or Global Health Insurance Card (GHIC) for temporary stays
- through entitlement to healthcare as a permanent resident if they’ve lived in Spain for 5 years
Healthcare if you live and work in Spain
You must register as a resident if you want to stay in Spain for more than 3 months.
You must show proof of healthcare cover before you can register as a resident. This will usually be through social security contributions as an employee, private insurance or paying voluntary contributions (the ‘Convenio Especial’).
If you’re working or self-employed in Spain, you’re entitled to state healthcare on the same basis as a Spanish citizen. Your dependants are also entitled.
Register at your local health centre with your social security number. You can get a social security number from your local National Social Security Institute (TGSS) office in Spain.
Your dependants need to register separately.
You may be entitled to a Spanish EHIC for travel, including visits to the UK.
If you are not working
If you’ve been a resident in Spain for 5 years or more, you can apply for permanent residency. This will give you access to state healthcare on the same basis as a Spanish citizen.
Once you’re a permanent resident, you need to register for healthcare at your local INSS office.
You’ll need to show a ‘legislation letter’ (‘documento de no exportación’ in Spanish) stating that you are not covered by the UK for healthcare. You can request this by calling NHS Overseas Healthcare Services.
NHS Overseas Healthcare Services
Telephone: +44 (0)191 218 1999
Monday to Friday, 8am to 6pm
Saturday, 9am to 3pm
The INSS will give you a document which you need to take to your local health centre.
If the UK pays for your healthcare, for example through an S1 form, you cannot register for healthcare as a permanent resident.
If you are not a permanent resident and you are not working
You can apply to join the public health insurance scheme. This is called the Convenio Especial. You pay a monthly fee to join the scheme, which gives you access to the Spanish health system.
You can apply if you’ve been registered on the ‘padrón’ (at your local town hall) for at least one year.
Find out how to apply on your regional health authority’s website.
If you’ve lived in Spain for less than one year and cannot get healthcare cover, you’ll need to buy private health insurance.
If the UK pays for your healthcare, for example through an S1, you cannot join the Convenio Especial.
You may have the right to apply for a UK S1 if you start drawing a UK State Pension.
If you’re a dependant of someone living or working in Spain
Dependants and family members are classified differently in Spain than the UK.
Find out who’s considered a dependant under Spanish law.
If you classify as a dependant of someone entitled to state healthcare in Spain (because they’re either working in Spain, a permanent resident or receiving Spanish benefits) you’ll need to apply at your local INSS office.
How to access healthcare services
Once you’re registered for healthcare, you’ll get a health insurance card. Take it with you whenever you visit a doctor, hospital or pharmacy.
How much you’ll pay
Once registered for healthcare, basic state services are free.
There are some things that you may need to pay a percentage of the cost for, such as orthopaedic services.
Spain uses a co-payment system where residents usually pay between 10% and 60% of the cost of prescription medication. How much you pay depends on your circumstances.
If you’re paying into the Convenio Especial, you’ll pay the full cost for prescription medication. You’ll also pay for:
- non-urgent transportation
- orthopaedic supplies
- dietary supplies
Some basic dental treatment is available under the state system, but most people use private dentists. Many private insurance companies have specific dental policies.
Health Insurance in Spain
For UK pensioners the Spanish health service has been free of charge (local state doctors surgeries and hospitals with costs reclaimed from the UK) while the UK has been in the EU. Brexit has brought some uncertainty It is also free for those who are paying a monthly self-employed contributions which includes all family members of the household. For those that are not working or drawing a pension will have to pay for private medical care, however there are changes being planned so that all fiscal residents also have the benefit of free health care. (A fiscal resident is someone who completes their annual tax returns in Spain which means declaring all their income both from UK and Spain and including state and private pensions.)