Spain’s Healthcare System: What UK Expats Should Know

How the Spanish Healthcare System Works

Spain has a dual healthcare system — a public network funded through social security contributions, and a private sector for those who prefer additional flexibility, shorter wait times, or services outside the public offering.

Public healthcare (called Sanidad Pública) is free or low-cost at the point of use for those eligible, while private insurance gives faster access and a broader choice of English-speaking doctors and international hospitals.

Can UK Citizens Access Public Healthcare in Spain?

Yes — but only under specific conditions. Here's how you may qualify:

1. You're Employed or Self-Employed in Spain

If you’re working in Spain — either for an employer or as an autónomo (freelancer/self-employed) — and paying into the social security system, you’re automatically entitled to public healthcare coverage. You’ll need to register with the INSS (Instituto Nacional de la Seguridad Social) and get a Spanish social security number. After registration, you can apply for a health card (tarjeta sanitaria) from your regional health authority.

Example: An expat software developer on a digital nomad visa who registers as self-employed in Spain would be eligible for public healthcare once they start paying monthly social security contributions.

2. You're a UK Pensioner with an S1 Form

UK state pensioners can apply for an S1 certificate from the NHS Overseas Healthcare Services. This form proves the UK government will fund your healthcare while you live in Spain. Once you’ve got your S1, register it with the INSS in Spain and you’ll be able to use public healthcare services, including access to GPs, hospitals, and specialists.

Important: Your S1 form must be in place before applying for your tarjeta sanitaria. It typically covers your dependents as well.

Find out how to apply for an S1 form here.

3. You Meet Low-Income Regional Criteria

Some autonomous communities in Spain offer subsidised healthcare access for legal residents on low incomes — even if they don’t pay social security. Requirements vary between regions like Valencia, Andalusia, or Catalonia, and you may need to show a minimum length of residency or lack of other health cover.

Tip: Visit your local centro de salud (health centre) and ask about “acceso sanitario para personas sin recursos.”

4. You're a Dependent of Someone Eligible

If you’re a legal dependent (e.g. spouse or child) of someone covered under any of the categories above, you may also qualify for state healthcare under their entitlement. The primary insured person must include you on their INSS record.

What If You Don’t Qualify? You’ll Need Private Health Insurance

Not everyone qualifies for public healthcare — particularly during the visa application process. If you're coming to Spain under a non-lucrative visa or digital nomad visa, you’ll need full private health insurance that matches Spain’s requirements:

• Valid for at least 12 months
• No deductibles or co-payments — policies must be “sin copagos”
• Equal to or better than Spanish public healthcare
• Offered by an insurer operating in Spain

Many Spanish insurers offer specific expat-friendly plans tailored to these visa needs. Make sure the policy includes documentation in Spanish for submission with your visa paperwork.

See official requirements for the non-lucrative visa here.

The Convenio Especial: A Back-Up Option for Long-Term Residents

If you’ve been legally resident in Spain for over 12 months but don’t qualify for public healthcare or have a private plan, you may be able to sign up for the Convenio Especial.

This public scheme gives you access to the national healthcare system for a monthly fee, currently set at:

• €60/month for people under 65
• €157/month for people over 65

It doesn’t cover prescriptions or overseas treatment, but it provides general access to doctors, hospitals, and specialists within Spain.

Emergency Healthcare in Spain

Spain guarantees access to emergency healthcare regardless of your legal or insurance status. If you have an accident or require urgent treatment, you’ll receive care at an A&E (urgencias) department — though you may be billed later if you’re not covered.

Always carry your EHIC or GHIC card if visiting temporarily. These cards cover emergency treatment for UK tourists, but they’re not valid for residents.

Top Tips for UK Expats Navigating Spanish Healthcare in 2025

• Register for your tarjeta sanitaria as soon as you’re eligible — it’s required for all public services.
• Keep copies of all visa paperwork, residency certificates, and insurance policies in both English and Spanish.
• Use an English Sanitas representative to help compare private insurance options — and ensure your policy meets visa specs.
• Visit your local health centre (Centro de Salud) early — appointments can be slow to arrange.