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 — and paying into the social security system, you’re automatically entitled to public healthcare. You’ll need to register with the INSS to obtain a Spanish social security number. After registration, you can apply for a health card (tarjeta sanitaria) from your regional health authority.

Example: A digital nomad who registers as self-employed and begins paying monthly contributions becomes eligible for public healthcare.

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

UK state pensioners can apply for an S1 certificate from NHS Overseas Healthcare Services. This form confirms that the UK will fund your medical care while living in Spain.

Register the S1 with the INSS to gain full public healthcare access, including GPs, hospitals, and specialists.

Find out how to apply for an S1 form here.

3. You Meet Low-Income Regional Criteria

Some regions offer subsidised healthcare access for legal residents with limited income — even without social security payments. Requirements vary by region (Valencia, Andalusia, Catalonia, etc.).

Tip: At your local centro de salud, ask about “acceso sanitario para personas sin recursos.”

4. You're a Dependent of Someone Eligible

Legal dependents of an insured person may also access the public system under the main holder’s entitlement. The insured person must add dependents to their INSS file.

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

If you’re applying for a non-lucrative visa, digital nomad visa, or residency, you must provide full private health insurance that meets Spain’s visa rules:

• Valid for at least 12 months
• No deductibles or co-payments (the policy must be “sin copagos”)
• Equal to or better than public system coverage
• Issued by a recognised insurer in Spain

Most Spanish insurers offer visa-compliant expat plans with Spanish-language certificates for consulate use.

See official non-lucrative visa requirements here.

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

If you’ve lived legally in Spain for more than 12 months and don’t qualify for public healthcare or have no private plan, you may join the Convenio Especial.

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

This grants access to doctors, hospitals, and specialists within Spain. It does not cover prescriptions or treatment abroad.

Emergency Healthcare in Spain

Spain guarantees access to emergency care regardless of residency or insurance status. Treatment at urgencias will be provided, though those without coverage may be billed later.

Carry your EHIC or GHIC if you are visiting as a tourist — these cards cover temporary stays only. They are not valid for residents.

Top Tips for UK Expats Navigating Healthcare in 2025

• Register for your tarjeta sanitaria as soon as you become eligible.
• Keep all visa, residency, and insurance documents in both English and Spanish.
• Use an English-speaking Sanitas representative to compare visa-compliant insurance.
• Visit your local Centro de Salud early — appointments can be slow to arrange.