The Spanish Health Service
Spain's healthcare is ranked among the world's best, but access isn't automatic. Every newcomer should plan carefully to secure health cover for themselves and their families. Spain operates both a robust public system (Sanidad Pública) and a thriving private sector—each with its own registration requirements, insurance options, and eligibility criteria.
Public healthcare in Spain is generally free or low-cost at the point of use for those who qualify. You become eligible if you work and pay Spanish social security, receive a UK state pension and register an S1 form, or have lived as a legal resident for five years. Minor children, legal dependents, and students also qualify under certain conditions.
Many expats start out with private insurance, especially for faster access, dental and ambulance cover, and to meet visa requirements. If you’re not in work and can’t use the S1, a Convenio Especial paid-in scheme is available in most regions at a set monthly fee. Ask about this option at your local health centre.
EHIC/GHIC (European/Global Health Insurance Card):
- The EHIC has been replaced by the new GHIC for UK residents. EHIC is still valid until expiry.
- Both allow access to emergency and medically necessary care during temporary stays—holidays, short-term visits, posted work, etc. They don’t cover ongoing residency, planned treatment, or pre-existing conditions.
- Apply for your GHIC card at NHS: Apply for GHIC (each family member needs their own).
- If you need more guidance, check NHS: Healthcare on holiday and abroad.
S1 Certificate (UK State Pensioners):
- If you’re retired and receive a UK state pension, you can apply for an S1 certificate. This entitles you to Spanish public healthcare, fully funded by the UK government.
- Register your S1 at your nearest INSS office, then get a Spanish health card (tarjeta sanitaria).
- Dependents can also be covered by your S1.
- Delays in S1 processing are common; some expats use private insurance for immediate cover.
- Apply for your S1 certificate via the International Pension Centre.
Working and Self-Employed Expats:
- If you are employed in Spain or operate as self-employed (autónomo), your employer or you will register and pay into Spanish social security. This automatically entitles you to public healthcare for you and registered dependents.
- Register with the Spanish Social Security (INSS) and apply for your health card at your local health centre.
Convenio Especial & Regional Schemes (Legal Residents):
- Legal residents who don’t work or have an S1 may be able to join the Convenio Especial, paying a monthly fee (from €60/month) for public health cover. This does not include prescriptions or certain treatments.
- Each region sets its own criteria; ask your centro de salud or visit this guide to Convenio Especial.
- Most newly arrived expats are recommended to maintain private insurance while waiting for eligibility confirmation.
Registering for Care—What You’ll Need:
- NIE Number: Your foreigner ID number. Required for all official processes.
- Empadronamiento: Register your address at the town hall. This links you to your nearest health centre and allows you to obtain your health card.
- All applications require proof of residency, passport/ID, and social security registration or confirmation of eligibility.
Private Health Insurance:
- Required for non-EU arrivals, visa applicants, and early retirees (not eligible for S1).
- Benefits include quick access, dental care, English-speaking doctors, and coverage tailored to expat needs.
- Compare providers carefully. For visa-compliant options, see HealthPlanSpain.com.
Extra Practical Advice:
- Digital and remote healthcare (“telemedicina”) is widespread; check with your insurer or health centre for online consultations and e-prescriptions.
- Public system prescriptions are subsidised. Private insurance may not cover medication—always check your policy details.
- For emergencies, dial 112 from any phone in Spain.
- Most clinics in popular expat areas offer English-speaking staff—request language support when booking or choosing your policy.
Key Points to Remember:
- GHIC/EHIC cards only cover temporary visits—not full residency or long-term medical needs.
- Public healthcare is for residents who work, contribute, have an S1, or qualify for regional schemes.
- Private health insurance is vital for non-working arrivals, early retirees, or those waiting on registration.
- NHS care is only for permanent UK residents—S1 holders must return to the UK to restore entitlement.
- Prepare all documents for your family before you travel—each member needs their own card and registration.
