Spain’s New Healthcare Rules for Expats, Nomads and Long‑Stay Visitors in 2026

Spain is updating how public healthcare works for people who spend a lot of time in the country without always fitting the classic “resident” box. This article explains the new rules around “effective residence”, what they mean for expats, digital nomads and long‑stay visitors, and when private health insurance is still essential.

The Big Change: “Effective Residence” and the New Decree

The Spanish government has drafted a royal decree to widen public healthcare access for non‑resident foreigners who clearly live in Spain for extended periods each year. Instead of demanding a full residence permit, the new model uses the idea of “effective residence”.

In practice, that means proving you genuinely live in a Spanish municipality with things like padrón registration, school enrolment for children, a rental contract or recent utility bills. The decree is still going through the approval process and each autonomous community will be responsible for applying the rules on the ground, so details can vary by region.

Residents: How Healthcare Works If You Live in Spain Full‑Time

When You Count as a Resident for Healthcare

For most people, if you live in Spain full‑time, are registered on the padrón and have your residence paperwork in order, you will be treated as a resident for healthcare purposes. Tax residency and health entitlement are not exactly the same thing, but they usually overlap once you are settled and registered locally.

The usual first steps are registering on the padrón at your town hall, getting your health card (tarjeta sanitaria) from the regional health service and being assigned a local GP and health centre.

Main Ways Residents Access Public Healthcare

Residents can normally access the public system in one of three ways:

• Working or self‑employed and paying into Spanish social security, which gives you and your dependants access to the system.
• Using an S1 form if you are an eligible pensioner or benefit holder from another EU country or the UK, so Spain provides the care and your home country pays.
• Joining the Convenio Especial public scheme, where long‑term residents who have been on the padrón for at least 12 months can pay a monthly fee for state healthcare.

Each route has its own paperwork and conditions, but once you are accepted you use the public system like any other insured person in your region.

When Residents Still Need Private Health Insurance

Even residents often keep private health insurance. Some residence visas specifically require comprehensive private cover with no co‑payments for at least the first year. Many people also choose private policies to avoid waiting lists, access English‑speaking doctors, or use private hospitals and clinics for faster diagnostics and elective treatment.

Non‑Residents and Long‑Stay Visitors: What Changes in 2026?

The Old Situation: Patchy and Confusing Access

Until now, non‑residents who spent several months a year in Spain were in a grey area. They might rely on travel insurance, an EHIC or GHIC card (if eligible), or simply pay out of pocket for private care. Regular access to a GP in the public system was often off the table unless they formalised residency.

The New “Effective Residence” Route

The new decree is designed to open a clearer door for people who are not officially resident on paper but are effectively living in Spain for long stretches each year. By proving effective residence with local documentation, they may be able to register at a health centre and access primary care and other services while they are in the country.

This is particularly relevant for long‑stay visitors, seasonal workers and families who spend most of the year in Spain but have not gone through the full residency process. Exactly how generous or strict this access will be depends on the final wording of the decree and how each region implements it.

Why Many Non‑Residents Still Need Private Cover

Even with the new rules, non‑residents should not treat public healthcare as a replacement for proper insurance. There will still be waiting lists, regional differences and gaps while the decree is rolled out. Private health insurance remains the safest way to protect yourself against unexpected hospital bills and to ensure you can choose where and how you are treated.

Digital Nomads: Healthcare Options If You Work Remotely From Spain

Visa and Insurance Requirements

The digital nomad visa and other remote‑work setups usually require private health insurance that is valid in Spain and offers broad coverage. This is checked as part of the visa or residence permit process, and public healthcare entitlement does not appear automatically just because you have a visa.

Combining Private Insurance and Public Access

Digital nomads who end up spending most of the year in Spain may eventually qualify as residents or show effective residence under the new decree. In that case, they could have both public access and a private policy running in parallel. Public care can handle routine and emergency treatment, while private insurance gives flexibility, speed and extra options.

Retirees: Healthcare for People Who Settle in Spain Long‑Term

EU and UK Retirees With S1 Forms

Many retirees from EU countries and the UK access Spanish public healthcare through the S1 system. Spain provides the medical care and your home country reimburses the costs, while you use your local health centre and hospital like any other insured resident.

Non‑EU Retirees and the Convenio Especial

Retirees from outside the EU who settle in Spain often start with private insurance to meet visa requirements. After at least a year on the padrón, some can apply for the Convenio Especial to buy into the public system for a monthly fee. Many keep a private policy on top for faster access and extra comfort.

Private Health Insurance vs Public Healthcare: What Still Makes Sense in 2026?

When Public Healthcare Is Usually Enough

For fully integrated residents with stable entitlement, the public system provides solid emergency care, GP access and hospital treatment. For some people, especially those on tighter budgets and living near good public hospitals, that is enough.

When Private Cover Still Adds Real Value

Private health insurance continues to matter for visa approvals, for people who do not yet qualify for public access, and for anyone who wants faster appointments, more choice of specialists or English‑speaking support. For expats, nomads and long‑stay visitors in Spain, the most robust setup in 2026 is often a mix: use public healthcare where you are entitled to it, but keep a good private policy to cover the gaps and give you more control over your care.