Convenio Especial in Spain: 2026 Guide for Expats and Long‑Term Residents

The Convenio Especial is Spain’s “pay in” scheme for public healthcare. It is designed for people who live in Spain long term but do not qualify for state cover through work, social security, an S1 form or other agreements. For many expats, early retirees and non‑working spouses, it can be the bridge from relying on private insurance to having full access to the public system.

What Is the Convenio Especial?

The Convenio Especial is a voluntary agreement that lets you affiliate to the Spanish National Health System in exchange for a fixed monthly fee. Once accepted, you receive a health card and can use the public system in your region in much the same way as any other insured person.

It is aimed at economically inactive residents who need health cover in order to live in Spain but have no automatic right to public healthcare. Typical users include non‑working partners, early retirees from outside the EU, and long‑term residents whose private insurance has become expensive or restrictive.

Who Can Apply in 2026?

Basic Eligibility Rules

The core requirements for the Convenio Especial are:

• You must be a legal resident in Spain with valid residency documentation.
• You must prove “effective residence” in Spain for a continuous period of at least 12 months immediately before you apply, normally via padrón registration.
• You cannot have any other entitlement to Spanish public healthcare (for example, through employment, self‑employment, an S1 certificate or another social security regime).

Time spent living in other EU/EEA countries, Switzerland or the UK can sometimes count towards the 12‑month requirement if you can prove continuity, but in practice most expats will need at least one full year registered at a Spanish address before applying.

Typical Expats Who Use the Convenio Especial

• Non‑lucrative visa holders who have completed their first year in Spain and want long‑term, predictable public cover.
• Digital nomads and remote workers who settle in Spain but are not paying into another national health system.
• Retirees from non‑EU countries who cannot use an S1 form but intend to live in Spain full‑time.
• Non‑working spouses and dependants who are not covered as beneficiaries under a partner’s social security.
• Long‑term students who remain in Spain after their studies and transition onto another residence permit.

How Much Does the Convenio Especial Cost?

The fee is set at national level and is not income‑based. In 2026 the standard monthly charges are:

• Under 65: 60 € per month.
• 65 and over: 157 € per month.

These payments give you access to the public system’s basic basket of services: prevention, diagnosis, treatment, rehabilitation and emergency transport, both in primary care and specialist care, as an outpatient or inpatient. There are no co‑payments on the services themselves and no waiting periods once you are admitted to the scheme.

What Does the Convenio Especial Cover (and Not Cover)?

Included Services

In broad terms, you can expect:

• Access to your regional public health network (GPs, health centres and public hospitals).
• Emergency care and urgent hospital treatment within Spain.
• Referrals to specialists and follow‑up care where medically indicated.
• Public maternity care and most routine screenings and vaccination programmes.

The agreement also gives you access to medically necessary care during temporary stays in other Spanish regions and, via the appropriate certificates, to urgent treatment during short trips within the EU/EEA, Switzerland and the UK.

Key Exclusions and Limitations

There are important gaps that many expats overlook:

• Prescription medicines: outpatient prescriptions are generally not included; you pay for most medications at the pharmacy.
• Dental care: routine dentistry is not covered, beyond the limited services provided in the public system (mainly for children and specific clinical cases).
• Some prosthetics and medical devices: certain aids and appliances may not be fully funded.
• No social security contributions: your payments do not count towards Spanish pension or unemployment rights.
• No automatic cover for dependants: each family member must apply and pay separately.
• No cover outside Spain: it is not an international health insurance; elective care abroad is not covered.

Pre‑Existing Conditions and Waiting Periods

One of the major advantages of the Convenio Especial compared with many private policies is that it does not exclude pre‑existing conditions. Once you are accepted, you are treated in the public system based on clinical need, regardless of existing diagnoses or ongoing treatments.

There are no clinical waiting periods for specific conditions. The main “wait” is administrative: you can only apply after proving 12 months of continuous effective residence, and in some regions the application itself can take several months to be processed.

How to Apply for the Convenio Especial

Step 1: Make Sure You Qualify

• Confirm that you have lived in Spain for at least 12 continuous months and are registered on the padrón at your current address.
• Check that you are not already entitled to public healthcare through employment, an S1 or other routes.

Step 2: Gather the Required Documents

Exact paperwork varies by region, but you will usually need:

• Passport and NIE or residence card (TIE).
• Recent padrón certificate showing at least 12 months of continuous registration.
• Proof of previous residence in other EU/EEA countries or the UK if you plan to count that time.
• A declaration from your home country’s authority confirming you are not entitled to its exported public healthcare in Spain.
• Bank details for direct debit of the monthly fee.

Step 3: Submit Your Application to the Regional Health Service

You sign the special agreement with the health service of the autonomous community where you are registered, or with INGESA if you live in Ceuta or Melilla. Applications are usually made in person or by appointment at a designated office, although some regions also allow online or electronic submissions.

Once the application is approved and your first payment is taken, you receive a health card and can begin using the public system under the terms of the Convenio Especial.

Regional Variations and Processing Times

Each autonomous community manages its own applications, so processing times and small rules can differ. Some regions are stricter about evidence of residence; others may have slightly more flexible interpretations for EU citizens. In practice, it is common for the process to take several weeks or even a few months from submission to activation, especially in larger cities.

Because you cannot start the application until you have completed your first 12 months of residence, many expats effectively need private health insurance for their entire first year and often for part of the second year while the Convenio Especial is being processed.

Convenio Especial vs Private Health Insurance

When the Convenio Especial Makes Sense

• You plan to live in Spain long term and want stable access to the public system.
• You have pre‑existing conditions or are older, and private premiums are high or restrictive.
• You are comfortable using public hospitals and do not mind less flexibility over where and when you are treated.

When Private Insurance Still Wins

• You want shorter waiting times and more choice of specialists and hospitals.
• You need better dental cover, wider prescription support or extra services such as physiotherapy and check‑ups.
• You travel frequently outside Spain and want international cover.
• You have not yet completed your first year of residence and need immediate, comprehensive cover.

For many expats, the most robust setup is a hybrid approach over time: start with private insurance to meet visa requirements and cover the “gap year”, then decide whether to keep a private policy, switch to the Convenio Especial, or run both in parallel once you qualify.

Key Takeaways for Expats and Long‑Term Residents

The Convenio Especial is not a replacement for all forms of health insurance, but it is an important part of the toolkit for people who are committed to living in Spain long term. It offers a predictable way to access public healthcare regardless of age or medical history, in exchange for a fixed monthly fee.

If you are planning a move to Spain, or are already here on a non‑working or retirement visa, it is worth planning your first two years with the Convenio Especial in mind: make sure you are covered from day one with private insurance, keep your padrón registration continuous, and time your application so that you can move smoothly onto the public system once you are eligible.