Understanding Healthcare in Spain as an Expat

Imagine you’re enjoying your new life in Spain — the sunshine, the food, the culture — but one day you need medical care. Where do you go? What does the public system cover? Do you need private insurance?

Many expats arrive without understanding how healthcare works in Spain and end up making medical decisions without clear information. In The Insurance Centre we’ll clear up all your doubts so you can feel prepared and at ease.

How does the healthcare system work in Spain?

Spain has one of the most highly rated healthcare systems in the world. It’s based on a universal healthcare model: all legal residents are entitled to public healthcare. But that doesn’t mean it’s free for everyone, or that it’s the only option.

Public healthcare: The basics you should know

Spain’s public healthcare is funded through taxes. This means that if you work legally in Spain or are registered as a resident and pay into Social Security, you can access it.

What’s included?

• Visits to general practitioners
• Emergency care
• Hospitalization
• Surgeries
• Diagnostic tests

What’s usually not included:

• Dental care
• Full ophthalmology services
• Extended physiotherapy
• Walk-in appointments without prior booking in many cases

Private healthcare: Is it necessary?

Many expats choose an expat health insurance in Spain to access private healthcare. Why?

• Shorter waiting times
• More options for specialists and clinics
• Service in other languages
• Flexible appointment times

Private insurance isn’t mandatory, but it’s highly recommended if you don’t have access to the public system or if you value faster, more personalized care.

Who can access the public system?

This is where many expats get confused. Let’s clarify:

Foreigners working in Spain
If you are employed, your employer pays into Social Security on your behalf. You automatically gain access to public healthcare.

EU Retirees
You can apply for the S1 form in your home country. With this, you register in Spain and access public healthcare just like any citizen.

Unemployed or self-employed expats
You’ll need to either:

• Pay into Social Security as a freelancer
• Get private insurance
• Or apply for the Convenio Especial, an agreement with the public system that allows you access by paying a monthly fee (around €60–€157 depending on age)

What does expat health insurance in Spain cover?

A good expat health insurance in Spain should offer:

• Access to private doctors and hospitals
• Care without long waits
• Possibility of assistance in English or other languages
• Coverage throughout the country or even in other European countries
• 24/7 emergency assistance
• Reimbursements for upfront medical expenses

Additionally, many policies include extra coverage like annual check-ups, gynecology, pediatrics, or dental treatments.

How to choose the best health insurance for expats

1. Are you eligible for public healthcare?
Before buying insurance, check whether you already qualify for public healthcare. This might help you save money and choose a complementary plan.

2. What are your real needs?

• Do you visit the doctor frequently?
• Do you have any pre-existing conditions?
• Do you prefer service in English or your native language?
• Do you have children or family with you?

Make a list and prioritize what you need.

3. Compare coverage, not just prices
It’s easy to be swayed by the cheapest premium, but what matters is what the policy actually covers. Look at:

• Medical directory (list of clinics and professionals included)
• Copayments (whether you pay a fee per visit)
• Waiting periods (time before certain services are available)

4. Consult with expat insurance experts
Someone who understands both the Spanish system and your needs as a foreigner can guide you best. At The Insurance Centre, we help expats like you find the perfect insurance for their lifestyle every day.

What if you already have insurance from your home country?

Many expats arrive with travel or international insurance. While it may work temporarily, it often doesn’t cover comprehensive care or pre-existing conditions. Also, if you plan to stay long-term, you’ll likely need a policy adapted to the local system.

Tips for Expats

• Register at your local health center if you’re eligible for public healthcare.
• If you get private insurance, always carry your private health card with you.
• Learn basic medical Spanish vocabulary (it can be very helpful!).
• Use apps like Salud Andalucía or La Meva Salut depending on your region to manage public appointments.
• Save emergency contact numbers (112 is the emergency number in Spain).

Living in Spain is an incredible experience, but to enjoy it to the fullest, you need peace of mind. Whether you use public healthcare, get expat health insurance in Spain, or combine both, the important thing is having clarity.

Don’t let a medical emergency catch you off guard. Now that you know how everything works, you’re one step closer to living worry-free.

Would you like help finding the perfect insurance for you? We’ll soon publish a comparison of the best insurance options for 2025. Don’t miss it!