What Is a Copayment in Health Insurance? How Sanitas Copagos Work in Spain

A copayment, copago in Spanish, is a small fixed amount you pay each time you use a covered service, on top of your monthly premium. On Sanitas plans it runs from €0 to €15 for a consultation, up to €8 for an emergency visit and up to €12 for a diagnostic test.

Who arranges it: HealthPlan Spain is an authorised Sanitas agent (agent code 22395) in Marbella that arranges Sanitas policies in English, at the same price as buying direct from Sanitas.

In exchange the premium is much lower: at age 30 to 39, Sanitas Accede with copayments costs €29.00 to €32.71 a month and Sanitas Mas Salud with none costs €89.53 to €116.82. Copayments are billed by direct debit with your premium the month after you use the service, never at the clinic.

This guide gives the copayment schedule for every Sanitas plan sold for cover in Spain that has one, and which plans have none. It then covers how billing works, how to decide between the two, and why a visa application needs the no-copayment kind.

• Range: €0 to €15 per consultation, up to €8 per emergency visit and up to €12 per diagnostic test, depending on the plan and how often you use it.
• Annual caps: €290 per insured person on Sanitas Accede, €350 on Sanitas Avanza, €360 on Mas Salud Plus and Professional Plus.
• No cap: Mas Salud Optima, Sanitas Unico and Mas 90 Plus.
• Billing: collected by direct debit with the premium, normally the month after you use the service, never at the clinic.
• No copayments at all: Sanitas Mas Salud, Mas Salud Family, Top Quantum, Residents Visa, Sanitas International Students, Sanitas Professional, Mas 90 and Premium 500.

How much are Sanitas copayments? The consultation ladder by plan

Most Sanitas copayment plans use a ladder: the more services you use in a policy year, the more each one costs. A "service" is a consultation; on Optima also a simple test or simple treatment; on Plus and Professional Plus any consultation, test, treatment or emergency visit. On those Mas Salud and Professional plans, dental visits and high-frequency courses never count towards the ladder; on Accede and Avanza a basic dental consultation counts like any other consultation.

Emergencies, tests, dental and the annual cap

Figures are the 2026 plan terms as published by Sanitas. A high-frequency course is a run of physiotherapy or respiratory therapy charged once, except on Mas 90 Plus, where high-frequency means GP, paediatric, nursing, physiotherapy and rehabilitation visits at €3.50 each. The cap is per insured person per policy year; once reached, you pay nothing more until renewal. Sanitas Unico is sold only from age 60 and has its own page. See the plans with copayments side by side.

The pattern is simple. On Accede you pay from the first visit. On Avanza, Plus, Unico and Professional Plus the first six services of the year cost nothing, so a year of six or fewer consultations with no tests or emergency visits carries no copayments at all. On Optima the ladder starts at €4 and climbs with use.

Which Sanitas plans have no copayments?

Sanitas Mas Salud, Mas Salud Family, Top Quantum, Residents Visa, Sanitas International Students and Sanitas Professional include every covered service in the premium. So do the worldwide plans Mas 90 and Premium 500. The dental cover included with Mas 90 carries a €3 copayment per procedure. You pay nothing when you use them. Sanitas Professional is sold only to registered autonomos, the self-employed, so you will find it on our self-employed pages; the other plans are compared side by side on the plans without copayments page. In Spanish these are the seguros sin copago, also written sin copagos.

How copayments are billed

You never pay at the clinic or hospital. Sanitas adds up the services you used in a month and collects the copayments by direct debit from the bank account on the policy, normally the following month, alongside the premium. Some dental covers with copayments group the charges and collect every three months instead. Every charge is itemised in the app, and a paper statement is posted unless you switch to digital only. Our FAQs on when copayments are debited and copayment statements have the detail.

With or without copayments: which saves money?

Run the numbers for your own age band before deciding, because the premium gap is large and the copayments are small. At 30 to 39 in mainland Spain, Sanitas Mas Salud Optima costs roughly a third less than Sanitas Mas Salud for the same cover. You can compare the plans on our calculator for your own age and province, and the plans hub sets Mas Salud, Optima and Plus side by side with each copayment scale. Ten consultations and two complex tests on Optima cost €4 × 3 + €7 × 7 + €12 × 2, which is €85. A light or average user is several hundred euros a year better off with copayments.

The no-copayment plan wins when you expect heavy use, when you want a fixed monthly cost with nothing to track, or when the policy is for a visa or residency application. The price-by-age table in our guide to how much health insurance costs in Spain lets you do this sum for any age.

Copayments and Spanish visas

Spanish consulates require full cover with no copayments for a non-lucrative, digital nomad or student visa, and the EU residency registration and the non-lucrative renewal ask for the same. That rules out Accede, Avanza, Optima, Plus, Unico and Mas 90 Plus for that purpose, however good they are for a resident who already has status. Sanitas Mas Salud, Mas Salud Family, Top Quantum, Residents Visa, Mas 90 and Premium 500 qualify, and the Students plan covers student visas. Sanitas Professional is only for registered autonomos, the self-employed, so it suits a residency application in Spain rather than a visa application at a consulate. The visa health insurance page sets out the requirement in full.

Copayment, coinsurance or excess?

People arriving from the UK or the United States often look for an excess, a deductible or coinsurance. Sanitas network cover does not work that way: a copayment is a fixed euro amount per service, known in advance, with nothing to pay before cover starts and no percentage of the bill. The percentages you will meet are the reimbursement module on Top Quantum and the worldwide plans, and the optional pharmacy and optical add-ons, which pay back half. Under the reimbursement module Sanitas refunds 70 to 90 per cent of a bill from a doctor outside its network, depending on the plan, and you carry the rest. Waiting periods are a separate rule, set plan by plan rather than by copayment status. Most plans wait six months for an MRI, Accede does not cover MRI at all, and Residents Visa has no waiting periods.

Frequently asked questions

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